Long-term macrolide treatment for chronic respiratory disease.
Eur Respir J. 2012 Nov 22;
Authors: Spagnolo P, Fabbri LM, Bush A
Abstract
Long-term macrolide treatment was first shown to alter the natural history of diffuse panbronchiolitis (DPB) in the late '80s. Since then, macrolides have been demonstrated to exert anti-inflammatory and immunomodulatory activity in addition to being antimicrobial. Indeed, their spectrum of action extends to regulation of leukocyte function and production of inflammatory mediators, control of mucus hypersecretion, resolution of inflammation, and modulation of host defence mechanisms. As such, the potential benefit of macrolide antibiotics has been evaluated in a variety of chronic respiratory diseases. The best studied condition is cystic fibrosis (CF), in which there have been six randomized controlled trials showing evidence of benefit. However, most of the studies were limited by the small number of patients and the short follow-up. More recently, landmark studies have demonstrated the efficacy of azithromycin in reducing the risk of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD), but optimal duration and dosing of macrolide treatment remain uncertain.With the exception of patients with DPB and CF, until clear evidence of efficacy is available, the long-term use of macrolide should be limited to highly selected patients after careful evaluation of benefit and harm, or in the context of randomized controlled clinical trials.
PMID: 23180583 [PubMed - as supplied by publisher]
