Use of macrolides and tetracyclines for chronic inflammatory diseases.
OBJECTIVE
To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions.


METHODS
Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis.


METHODS
Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based.


RESULTS
Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea.


CONCLUSIONS
The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.
Voils
Stacy A
SA
Veterans Affairs Medical Center, Lexington, KY, USA.
Evans
Martin E
ME
Lane
Matthew T
MT
Schosser
Robert H
RH
Rapp
Robert P
RP
D000152:Acne Vulgaris / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001762:Blepharitis / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000188:drug therapy; D002908:Chronic Disease; D003550:Cystic Fibrosis / Q000188:drug therapy; D006801:Humans; D007249:Inflammation / Q000188:drug therapy*; D018942:Macrolides / Q000627:therapeutic use*; D010518:Periodontitis / Q000188:drug therapy; D012393:Rosacea / Q000188:drug therapy; D013754:Tetracyclines / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D018942:Macrolides; D013754:Tetracyclines