Immunomodulatory Effects of Macrolide Antibiotics – Part 2: Advantages and Disadvantages of Long-Term, Low-Dose Macrolide Therapy

• Published in: Respiration Vol. 81; no. 1; pp. 75 - 87
• Main Authors: Altenburg, J., de Graaff, C.S., van der Werf, T.S., Boersma, W.G.
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland Karger 01.01.2011; S. Karger AG
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Antibacterial agents; Antibiotics; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antimicrobial agents; Arrhythmia; Arrhythmias, Cardiac - chemically induced; Asthma; Bacterial Infections; Biological and medical sciences; Bronchiectasis; Chronic Disease; Chronic obstructive pulmonary disease; Chronic obstructive pulmonary disease, asthma; Clinical outcomes; Clinical trials; Cystic fibrosis; Data processing; Drug Administration Schedule; Drug Dosage Calculations; Drug Resistance, Bacterial; Drug therapy; Errors of metabolism; Fibrosis; Gastrointestinal Diseases - chemically induced; Heart; Humans; Immune system; Immunomodulation; Inflammation; Inflammatory diseases; Long-Term Care; Lung diseases; Macrolide antibiotics; Macrolides - administration & dosage; Macrolides - adverse effects; Medical sciences; Metabolic diseases; Miscellaneous hereditary metabolic disorders; Pathogens; Patient Selection; Pharmacology. Drug treatments; Pneumology; Randomized Controlled Trials as Topic; Respiration; Respiratory Tract Diseases - drug therapy; Respiratory Tract Diseases - microbiology; Respiratory Tract Diseases - physiopathology; Review; Side effects; Sinusitis; Time; Diffuse panbronchiolitis; Macrolides; Cystic fibrosis; Diffuse; Respiratory disease; Low dose; Metabolic diseases; Long term; Macrolide; Genetic disease; Bronchiolitis; Antibiotic; Treatment; Advantage; Disadvantage; Diffuse pan bronchiolitis; Digestive diseases; Bronchus disease; Antibacterial agent; Pancreatic disease; Pneumology
• ISSN: 0025-7931; 1423-0356; 1423-0356
• DOI: 10.1159/000320320

The available evidence for long-term, low-dose treatment with 14- and 15-membered ring macrolides in non-cystic fibrosis (CF) bronchiectasis, COPD, chronic sinusitis, and asthma is reviewed with special attention to possible adverse effects and the emergence of resistance during long-term macrolide treatment. Macrolide maintenance therapy has been proven to be of benefit in diffuse panbronchiolitis and CF, presumably due to an anti-inflammatory mechanism of action in addition to its direct antimicrobial effect. Solid evidence to justify this treatment regimen for non-CF bronchiectasis, asthma, or sinusitis is still lacking, although a beneficial effect of long-term macrolide therapy has been found in small clinical trials on these subjects. Data from randomized trials of long-term macrolide treatment in COPD are conflicting. A sufficiently long duration of treatment and the careful selection of patients appears to be crucial. Aside from its beneficial effects, possible side effects of macrolide treatment should be taken into account, the most important of these being gastrointestinal upset and cardiac arrhythmias. Development of macrolide resistance among respiratory pathogens is very common during long-term macrolide treatment. Whether this finding is clinically significant is a matter of debate.