Long-term macrolide treatment of chronic inflammatory airway diseases: risks, benefits and future developments
Article first published online: 28 AUG 2012
© 2012 Blackwell Publishing Ltd
Clinical & Experimental Allergy
Volume 42, Issue 9, pages 1302–1312, September 2012
How to Cite
E. J. Cameron, C. McSharry, R. Chaudhuri, S. Farrow and N. C. Thomson, Clinical & Experimental Allergy, 2012 (42) 1302–1312.
- Issue published online: 28 AUG 2012
- Article first published online: 28 AUG 2012
- Accepted manuscript online: 9 FEB 2012 01:07PM EST
- Manuscript Accepted: 30 JAN 2012
- Manuscript Revised: 23 DEC 2011
- Manuscript Received: 24 JUL 2011
- microbial resistance;
- non-bacterial macrolides
Macrolide antibiotics were discovered over 50 years ago and following their use as antimicrobials it became apparent that this group of antibiotics also possessed anti-inflammatory properties. Subsequent clinical trials showed benefits of macrolides as long-term adjuncts in the treatment of a spectrum of chronic inflammatory respiratory diseases, particularly diffuse panbronchiolitis, cystic fibrosis, post-transplant bronchiolitis obliterans and more recently chronic obstructive pulmonary disease (COPD). The evidence for efficacy of macrolides in the long-term treatment of chronic asthma and bronchiectasis is less well established. The mechanism(s) of action of macrolides in the treatment of these diseases remains unexplained, but may be due to their antibacterial and/or anti-inflammatory actions, which include reductions in interleukin-8 production, neutrophil migration and/or function. Macrolides have additional potentially beneficial properties including anti-viral actions and an ability to restore corticosteroid sensitivity. The increased prescribing of macrolides for long-term treatment could result in the development of microbial resistance and adverse drug effects. New macrolides have been developed which do not possess any antimicrobial activity and hence lack the ability to produce microbial resistance, but which still retain immunomodulatory effects. Potentially novel macrolides may overcome a significant barrier to the use of this type of drug for the long-term treatment of chronic inflammatory airway diseases.