Macrolide antibiotics and the airway: antibiotic or non-antibiotic effects?

IMPORTANCE OF THE FIELD: The macrolides are a class of antibiotics widely prescribed in infectious disease. More recently, there has been considerable interest in potential indications for these agents, in addition to their simple antibacterial indications, in a number of lung pathophysiologies. AREAS COVERED IN THIS REVIEW: Demonstrated clinical efficacy of macrolides in diseases such as diffuse panbronchiolitis was difficult to ascribe to a direct antimicrobial action. More recently, positive experiences in dealing with post-transplant bronchiolitis obliterans syndrome suggests that other chronic lung diseases may benefit from macrolide therapy. This is important, as the treatment options for such diseases are often very limited. In this review, potential antibiotic and non-antibiotic beneficial actions of macrolide therapy are discussed and conclusions drawn from a limited but growing literature. WHAT THE READER WILL GAIN: The reader will gain an overview of lung diseases that may benefit from macrolides, and a consideration of the possible mechanisms underlying such benefit. TAKE HOME MESSAGE: The key message from our review is that this class of agents may prove to be a useful therapeutic option for a range of respiratory diseases, but that further trials and mechanistic studies are required to clarify their role.