[CIS PIDD] [cis-pidd] Long term Azithromycin for IgA deficiency & recurrent bronchitis

[CIS-PIDD]

Dear Colleagues,

I've followed a 16 year-old adolescent since 2014 with mild IgA deficiency 0.36 (0.6-3.0) & low IgG4 (0.01). She had severe bronchitis aged 9 years and thereafter she has had recurrent annual viral infections with bronchitis. She has allergic rhinitis treated with nasal steroids and recently has been on a steroid MDI for asthma under the care of a pulmonologist. Prior to steroid therapy for the asthma she was on prophylactic Azithromycin from January to November 2015. In February 2016 she developed bronchitis requiring 2 antibiotic courses,  and went back on Azithromycin 3 times a week thereafter. In May 2016 she had normal lymphocyte subsets and total memory B-cells, but class-switched B-cells were low at 6.4%. Serum MBL, classical & alternate complement pathways, and lymphocyte proliferation were all normal, and there was a strong response to vaccination with tetanus & pneumovax 23 with protective specific IgG levels. I have not seen her since May 2016 but I understand she has now been diagnosed clinically with bacterial tonsillitis by her family physician (but no lab evidence), and is still on Azithromycin AB 3 times a week.

My concern is for how long can one continue AB prophylaxis in this scenario? I usually prescribe it only for 6 months over winter in young scholars with IgA deficiency and recurrent infections, to help them cope with school.  Also, what sort of routine precautions are advisable (annual hearing tests? 6 monthly ECG for QT interval prolongation?)

I’d appreciate any advice and hearing what others do & about routine monitoring protocols.

Thanks,

Stan

Stanley Ress
Emeritus Associate Professor of Medicine, UCT
Specialist physician & Clinical Immunologist,
UCT Private Academic hospital, Anzio Road, Observatory,
Cape Town, 7925 South Africa
TEL:INTERN<file://localhost/tel/INTERN>. + 2721-4421966 or 4421816 FAX:   "    + 2721-(0)865173095
Cell: 0833115482
email: stan.ress at uct.ac.za<mailto:stan.ress at uct.ac.za>






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