Long-term macrolide therapy in chronic inflammatory airway diseases

Abstract

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.

Protective Effects of Clarithromycin, a Lipophilic 14-membered Macrolide, on Hemolysis Induced by Lysophosphatidylcholine in Human Erythrocytes

“…The anti-hemolytic mechanism of this macrolide might depend on the lipophilic structure of its 14-membered ring lactone counteracting the formation of LPC micelles. Furthermore, the anti-hemolytic effect of clarithromycin is consistent with the results demonstrating that the clinical ef cacy of clarithromycin against respiratory in ammatory disease is relatively higher than that of other macrolides, 2,3,31) and it is thus expected that clarithromycin is superior to erythromycin and azithromycin, which show the same anti-inflammatory properties. We believe that a direct cytoprotective action of clarithromycin may be contribute to its beneficial effects on airway inammatory disorders.…”

Pulmonary vascular changes in asthma and COPD

“…The potential of antimicrobial macrolides in treating chronic airways diseases was first discovered in a case report of a corticosteroid-dependent asthma patient [135]. This class of drugs was recently shown to be effective in (i) preventing COPD exacerbations and, (ii) in the treatment of neutrophilic asthma [136,137], and especially (iii) in preventing neutrophilic reversible allograft dysfunction. The latter disease is a subtype of bronchiolitis obliterans syndrome, the most devastating complication after lung transplantation [138].…”

Long-term macrolide treatment for chronic respiratory disease

“…Collectively, these observations provided the rationale for a number of studies performed over the last decade to assess the efficacy of macrolides in chronic respiratory diseases other than DPB, such as cystic fibrosis (CF), asthma, chronic obstructive pulmonary disease (COPD), non-CF bronchiectasis, and bronchiolitis obliterans syndrome (BOS) [10]. The purpose of this review is to summarise and discuss the potential for macrolide therapy in chronic respiratory diseases in the light of the data provided by recently concluded large clinical trials.…”