title: Long-term macrolide treatment for chronic respiratory disease.
abstract: Long-term macrolide treatment was first shown to alter the natural history of diffuse panbronchiolitis (DPB) in the late 1980s. 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 the 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, of which there have been six randomised controlled trials showing evidence of benefit. However, most of the studies were limited by small numbers of patients and 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, but the optimal duration and dosing of macrolide treatment remain uncertain. With the exception of patients with DPB and cystic fibrosis, until clear evidence of efficacy is available, the long-term use of macrolides should be limited to highly selected patients after careful evaluation of benefit and harm, or in the context of randomised controlled clinical trials.
authors.affiliation: Section of Respiratory Diseases, Dept of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy. paolo.spagnolo@unimore.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Spagnolo
authors.forename: Leonardo M
authors.initials: LM
authors.lastname: Fabbri
authors.forename: Andrew
authors.initials: A
authors.lastname: Bush
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy; D001987:Bronchiectasis / Q000188:drug therapy; D001988:Bronchiolitis / Q000188:drug therapy; D001989:Bronchiolitis Obliterans / Q000188:drug therapy; D002908:Chronic Disease; D002986:Clinical Trials as Topic; D003550:Cystic Fibrosis / Q000188:drug therapy; D006192:Haemophilus Infections / Q000188:drug therapy; D006801:Humans; D018942:Macrolides / Q000008:administration & dosage* / Q000627:therapeutic use*; D011014:Pneumonia / Q000188:drug therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012141:Respiratory Tract Infections / Q000188:drug therapy*; D012852:Sinusitis / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D018942:Macrolides