The Efficacy, Safety, and Economic Outcomes of Using Azithromycin in Both Upper & Lower Respiratory Tract Infection: A Health Technology Assessment

Abstract

Background: Azithromycin is widely used for the treatment of respiratory tract infections (RTIs) due to its broad-spectrum antibacterial activity and preferred safety profile. This study aimed to evaluate efficacy, safety, cost-effectiveness and societal benefits of azithromycin therapy in RTIs.

Methods: An extensive literature search was conducted following PRISMA guidelines. PubMed, Google scholar and Cochrane libraries database was searched for relevant studies published from 1990 to present. The population, intervention, comparator, outcomes, and study design (PICO) framework guided study selection criteria. Eligible studies included randomized controlled trials (RCTs), observational studies, and economic evaluations assessing safety, efficacy, and cost outcomes of azithromycin therapy in RTIs, specifically upper respiratory tract infections. Data extraction and screening were performed by two independent researchers, with discrepancies resolved by a third researcher.

Results: Efficacy evaluation included systematic reviews and meta-analysis comparing azithromycin with other antibiotics. Azithromycin demonstrated superior clinical and comparable efficacy to alternative treatments. Safety analysis indicated that azithromycin had fewer adverse effects, although results varied across studies. Cost-effectiveness analysis revealed that azithromycin was consistently most cost-effective option, with lower direct and indirect costs compared to alternative treatments. Azithromycin's shorter treatment duration also led to reduced healthcare resource utilization, reduced sickness absenteeism, improvement in work and daily activities thereby mitigating overall societal costs

Conclusion: Azithromycin exhibits a favorable risk-benefit profile in management of Upper RTIs, supported by its superior clinical efficacy, safety, and cost-effectiveness compared to alternative antimicrobials. Its shorter treatment duration contributes to reduced hospitalization periods and societal costs, making it a valuable therapeutic option for URTIs.