Examining the safety and efficacy of Azithromycin in Cystic fibrosis: A systematic review and Meta-analysis

Cystic fibrosis (CF) patients experience chronic lung inflammation and decline. Azithromycin (AZM), a macrolide antibiotic, offers potential anti-inflammatory and antimicrobial benefits. We aim to evaluate the safety and efficacy of AZM therapy in patients with CF. A comprehensive search was conducted across PubMed, Scopus, Web of Science, and Cochrane on 22 December 2023. We included all relevant randomized controlled trials (RCTs) and cohort studies. Meta-analysis was conducted using R Studio software (version: 2023.12.1). Continuous outcomes were expressed as weighted mean differences with standard deviation (SD), and dichotomous variables were reported as relative risks with a 95 % confidence interval (CI). A total of 18 studies comprising 2877 patients were included, with 11 studies meeting the criteria for inclusion in the meta-analysis. AZM significantly reduced the need for new oral antibiotics (RR = 0.77; 95 % CI: [0.66, 0.89]). No significant increase in adverse events was observed. However, lung function (FEV1, FVC, FEF), inflammatory markers, and pulmonary exacerbations remained unchanged. Azithromycin holds promise for managing CF, but further research is needed to fully understand its long-term impact on lung health and resistance patterns.