Clinical efficacy and safety of long-term anti-inflammatory therapy with azithromycin in children with primary ciliary dyskinesia

Introduction. Long-term anti-inflammatory therapy with azithromycin in children with primary ciliary dyskinesia (PCD) reduces the frequency of exacerbations and improves the course of the disease, but it may be associated with the development of adverse effects.

Aim. To evaluate the clinical efficacy and safety of long-term anti-inflammatory therapy with azithromycin in children with PCD.

Materials and methods. The study included 99 children with PCD aged 2 to 18 years. The children were divided into groups: Group 1 (n = 32) included children who received azithromycin therapy for 1 year, Group 2 (n = 19) included children who received therapy for more than 2 years, and Group 3 (n = 48) included children who did not receive azithromycin therapy. The frequency of exacerbations, markers of inflammation (CRP, leukocytes, neutrophils), renal-hepatic profile (cholesterol, urea, creatinine, AST, ALT, alkaline phosphatase, total bilirubin, direct and indirect bilirubin), QT interval on ECG, and bacteriological cultures from the nose and throat with determination of sensitivity to azithromycin were evaluated.

Results. Anti-inflammatory therapy with azithromycin significantly reduced the frequency of exacerbations: by 2.2 times in the first year (from 6.2 to 2.8 episodes/year) and by 1.6 times in treatment for more than 2 years (from 3.4 to 2.1 episodes/year) and the CRP level (p < 0.05). No deviations were observed in biochemical parameters and the QT interval (p > 0.05). However, an increase in antibiotic resistance was detected: the sensitivity of S. aureus decreased, and S. pneumoniae was completely resistant after more than 2 years of therapy.

Conclusions. Long-term therapy with azithromycin is effective in children with PCD, significantly reducing the frequency of exacerbations and the activity of inflammation, with a favorable safety profile. However, it is associated with the progressive development of resistance to key respiratory pathogens, which requires a strictly individualized approach, dynamic microbiological monitoring, and a balance between benefits and risks for each child.

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