Long-term azithromycin reduces exacerbations in bronchiectasis with frequent flares. Before starting, send sputum for non-tuberculous mycobacteria, because macrolide monotherapy can select for resistant Mycobacterium avium complex. Check an ECG for a prolonged QT interval and ask about hearing, both of which can worsen with prolonged macrolide use.
- Send sputum for mycobacterial culture before long-term azithromycin.
- Check the QT interval on an ECG before starting.
- Ask about hearing loss and tinnitus at follow-up.
- Repeat mycobacterial cultures periodically while on treatment.
Why it matters
Macrolide monotherapy in undiagnosed NTM disease breeds resistance that is very hard to treat.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for pulmonology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free