Can you use antibiotics long term for chronic respiratory disease?

Antibiotics (like azithromycin) can sometimes be prescribed long-term to patients with chronic respiratory diseases. This is to try to reduce the number of flare-ups of conditions such as asthma or bronchiectasis. In this case the antibiotic is not used to treat an active infection, but rather to keep bacterial colonization under control. This is when bacteria are lining the airways and can sometimes induce an immune response but not actively multiply as quickly as in an acute infection.

Therefore, the long-term antibiotic carries more of an immune modulatory effect which helps reduce the number of exacerbations (flare-ups). Normally, the most commonly prescribed antibiotic in this case is azithromycin, usually one tablet three times per week, for a few months in winter or even longer.

The benefits need to be balanced against the potential risks, as long term antibiotics can lead to bacterial resistance and also there may be some other complications (such as cardiac changes – the antibiotic affecting the heart, potentially increasing the risk of heart rhythm disturbances). Therefore, it is very important to discuss such a treatment with your doctor, to understand and manage the risks versus benefits in your case.

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