Long-term azithromycin reduces exacerbations in selected patients with bronchiectasis and COPD. Before starting, exclude active non-tuberculous mycobacterial infection, because macrolide monotherapy can select macrolide-resistant NTM. Check the QTc on an ECG and review interacting drugs, and ask about hearing loss and tinnitus.
Repeat these checks if symptoms change during treatment.
- Send sputum for mycobacterial culture before the first dose.
- Record a baseline ECG and avoid if QTc is prolonged.
- Review co-prescribed QT-prolonging drugs.
- Ask about hearing and tinnitus at baseline and follow-up.
Why it matters
Macrolide monotherapy in undiagnosed NTM can create a resistant infection that is very hard to treat.
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