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Long-term macrolide therapy in chronic inflammatory airway diseases

Dept of Respiratory Medicine, Manchester Royal Infirmary, Manchester, UK.

CORRESPONDENCE: M. A. Woodhead, Dept of Respiratory Medicine, Manchester Royal Infirmary, Manchester, M13 9WL, UK. Fax: 44 1612764989. E-mail: mark.woodhead{at}cmmc.nhs.uk

Keywords: Airway, anti-inflammatory, ketolide, macrolide

Received: March 19, 2008
Accepted August 21, 2008

In addition to direct antibacterial actions, 14- and 15-member-ring macrolides have immune modulating effects that appear to be the reason for clinical benefit in diffuse panbronchiolitis.

A literature search was conducted for studies of the clinical effectiveness of macrolides in other chronic lung conditions.

A number of studies were identified that showed short-term beneficial outcomes or the potential for such outcomes in cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, asthma and post-transplant obliterative bronchiolitis. The studies were limited by small patient numbers, different outcome measures and short-term follow-up, and were not designed to assess potentially harmful effects.

Further large prospective and long-term studies are required in order to identify potential benefit and harm before these agents can be recommended routinely for these conditions.

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