Antibiotics as immunomodulant agents in COPD.
It is widely accepted that some antibiotics have activities beyond their direct antibacterial effects. Macrolide is the antibiotic class with more convincing studies and evidence on its immunomodulatory and anti-inflammatory activities. Different clinical studies have shown that macrolide prophylaxis in patients with moderate-severe chronic obstructive pulmonary disease (COPD) can have a significant impact on the exacerbation rate reducing morbidity and, potentially, mortality of the disease. Other antibiotics, such as fluoroquinolones, demonstrate a variety of immunomodulatory effects but only few clinical data are available in COPD. New macrolide derivatives devoid of antibacterial activity have been synthetized. This review analyses the relevance of immunomodulatory and anti-inflammatory effects of antibiotics in the management of COPD.
Respiratory Medicine Section, Dipartimento Toraco-Polmonare e Cardiocircolatorio, University of Milan, IRCCS Fondazione Cà Granda Ospedale Maggiore, Milan, Italy. francesco.blasi@unimi.it
Francesco
F
Blasi
Marco
M
Mantero
Stefano
S
Aliberti
D000818:Animals; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D006801:Humans; D007107:Immune System / Q000187:drug effects*; D056747:Immunomodulation / Q000187:drug effects; D018942:Macrolides / Q000009:adverse effects / Q000737:chemistry / Q000627:therapeutic use*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000276:immunology*; D020545:Respiratory Mucosa / Q000187:drug effects / Q000276:immunology / Q000378:metabolism
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018942:Macrolides