Can azithromycin shorten shock resolution in ICU patients?

Empiric azithromycin appears to have no substantial impact on shock duration, mechanical ventilation duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, or in-hospital mortality in septic shock patients admitted to the ICU, according to a study.

The authors conducted a retrospective study to determine if empiric antimicrobial regimens containing azithromycin could shorten time to shock resolution in adults with septic shock admitted to ICUs of three university-affiliated, urban teaching hospitals between June 2012 and June 2016.

Eligible patients with septic shock received norepinephrine treatment as the first-line vasopressor for at least 4 hours and treated with antibiotics for a minimum of 48 hours from the time of shock onset. The authors used propensity scores to match patients who received azithromycin to those who did not.

Some 3,116 patients met the eligibility criteria. After propensity score matching, 258 were included, with 124 in the azithromycin group and 134 in the control group.

Patients treated with or without azithromycin had comparable median shock duration (45.6 vs 59.7 hours; p=0.44) and in-hospital mortality (37.9 percent vs 38.1 percent; p=0.979). No significant differences were observed in mechanical ventilation duration, ICU LOS, or hospital LOS.

“Although there is evidence describing the immunomodulatory effects of macrolide antibiotics, there is little literature exploring the clinical effects these properties may have and their impact on measurable outcomes,” the authors noted.