Use of macrolides in lung diseases: recent literature controversies.
OBJECTIVE
To review the mechanisms of action of macrolides in pediatric respiratory diseases and their clinical indications.


METHODS
Review in the PubMed database, comprising the following terms in English: "macrolide and asthma"; "macrolide and cystic fibrosis"; "macrolide bronchiolitis and viral acute"; "macrolide and bronchiolitis obliterans" and "macrolide and non-CF bronchiectasis".


RESULTS
The spectrum of action of macrolides includes production of inflammatory mediators, control of mucus hypersecretion, and modulation of host-defense mechanisms. The potential benefit of macrolide antibiotics has been studied in a variety of lung diseases, such as cystic fibrosis (CF), bronchiectasis, asthma, acute bronchiolitis, and non-CF bronchiectasis. Several studies have evaluated the benefits of macrolides in asthma refractory to therapy, but the results are controversial and indications should be limited to specific phenotypes. In viral bronchiolitis, there is no consistent benefit in acute conditions, although recent data have shown an effect in recurrent wheezing prevention. In patients with CF results are also contradictory, but the consensus states there is a small clinical benefit, especially for patients infected with P. aeruginosa. There was also no positive action of macrolides in patients with post-infectious bronchiolitis obliterans. Children with non-CF bronchiectasis seem to have clear benefits regarding the use of macrolides, which showed clinical advantages in parenchyma protection and lung function.


CONCLUSIONS
The long-term use of macrolides should be limited to highly selected situations, especially in patients with bronchiectasis. Careful evaluation of the benefits and potential damage are tools for their indication in specific groups.
Pneumology Unit, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Luiz Vicente Ribeiro Ferreira da
LV
Silva Filho
Pediatric Pneumology Unit, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Postgraduate Program in Pediatrics/Child Health, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
Leonardo Araujo
LA
Pinto
Pediatric Pneumology Unit, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil; Postgraduate Program in Pediatrics/Child Health, Faculdade de Medicina, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil. Electronic address: rstein@pucrs.br.
Renato Tetelbom
RT
Stein
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy; D001987:Bronchiectasis / Q000188:drug therapy; D001988:Bronchiolitis / Q000188:drug therapy; D002648:Child; D003550:Cystic Fibrosis / Q000188:drug therapy; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D006801:Humans; D008171:Lung Diseases / Q000188:drug therapy*; D018942:Macrolides / Q000494:pharmacology*
D000900:Anti-Bacterial Agents; D018942:Macrolides
Adolescentes; Adolescents; Children; Crianças; Doenças pulmonares; Inflamação; Inflammation; Macrolides; Macrolídeos; Pulmonary diseases