Potential role of antibiotics in the treatment of asthma.
Although the role of antibiotic treatment in asthma is still disputed, clinical use of antimicrobials in this setting is more widespread than warranted on the basis of indications in the literature. Viral upper respiratory tract infections are known to be involved in asthma exacerbations. More recently, evidence of Mycoplasma pneumoniae and Chlamydia pneumoniae involvement in asthma attacks has been reported both in adult and paediatric populations. These pathogens are also involved in chronic asthma, and both in vitro and animal model studies indicate that atypical agents may play a role in the pathogenesis of the disease. Recent studies on asthma patients with evidence of atypical infection suggest that specific antimicrobial treatment (basically macrolides or fluoroquinolones) may confer additional advantages compared to standard therapy alone. Furthermore, a considerable amount of data has been gathered describing additional effects associated with macrolide treatment (reduced bronchial hyper-responsiveness, altered cytokine production, etc.). These non-antimicrobial effects have been defined as "anti-inflammatory activity". Should this information be confirmed, the use of macrolides in patients with asthma may be twofold: eradication of occult atypical infection; and reduction in the airway inflammation burden. Future lines of research in this field should attempt to determine whether specific antibiotic treatment may alter the natural history of asthma.
Blasi
Francesco
F
Institute of Respiratory Diseases, University of Milan, IRCCS Ospedale Maggiore Milano, Italy. francesco.blasi@unimi.it
Cosentini
Roberto
R
Tarsia
Paolo
P
Allegra
Luigi
L
D000328:Adult; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000209:etiology; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D006801:Humans; D018942:Macrolides / Q000627:therapeutic use; D012137:Respiratory System / Q000187:drug effects / Q000378:metabolism / Q000473:pathology
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D018942:Macrolides