Macrolides are a group of antibiotics whose activity is ascribable to the presence of the macrolide ring, to which one or more deoxy sugars may be attached. Two properties are inherent in this group of antibiotics, the immunomodulatory and the anti-inflammatory actions, ensuring great efficacy in a wide spectrum of infections. Macrolides demonstrate several immunomodulatory activities both in vitro and in vivo. They can down-regulate prolonged inflammation, increase mucus clearance, prevent the formation of bacterial biofilm and either enhance or reduce activation of the immune system. According to given properties and exceptional effects on bacterial phatogens, the macrolide antimicrobial agents have been found to serve a unique role in the management of chronic airway disorders, including diffuse panbronchiolitis, cystic fibrosis and chronic obstructive pulmonary disease. Use of macrolides can result in clinical improvement in patients with severe, chronic inflammatory airway diseases, improving their spirometry indicators, gas exchange and overall quality of life.
1. Altenburg J. et al.: Immunomodulatory effects of macrolide antibiotic- part 1: biological mechanisms. Respiration, 81, 67, 2011.
2. Cazalias J., Tanabe S., Gagnon G.: Tetracyclines and chemically modified tetracycline-3 (CMT-3) modulate cytokine secretion by lipopolysaccharide-stimulated whole blood. Inflammation, 32, 130, 2009.
3. Culic O., Erakovic V., Parnham M.J.: Anti-inflammatory effects of macrolide antibiotics. Eur. J. Pharmacol., 429, 209, 2001.
4. Friedlander A.L., Albert R.K.: Chronic macrolide therapy in inflammatory airway diseases. Chest, 138, 1202, 2010.
5. Hodge S., Hodge G., Jersmann H.: Azithromycin improves macrophage phagocytic function and expression of mannose receptor in chronic obstructive pulmonary disease. Am. J. Respir. Crit. Care Med., 178, 139, 2008.
6. Itkin I.H., Menzel M.L.: The use of macrolide antibiotic substances in the treatment of astma. J. Allergy, 45, 146, 1970.
7. Kudoh S., Azuma A., Yamamoto M.: Improvement of survival in patients with diffuse panbrochiolitis treated with low-dose erythromycin.Am. J. Respir. Crit. Care Med., 157, 1829, 1998.
8. Martinez F., Curtis J., Albert R.: Role of macrolide therapy in chronic obstructive pulmonary disease. Interantional Journal of COPD, 3, 331, 2008.
9. Rubin B.K., Henke M.O.: Immunomodulatory activity and effectiveness of macrolides in chronic airway disease. Chest, 125, 70, 2004.
10. Targowski T., Jahnz-Różyk K.: Immunomodulatory properties of macrolides. Pol. Merk. Lek., 149, 408, 2008.
11. Ungureanu V.: Macrolides, lincosamides, streptogramines (MLS): mechanisms of action and resistance. Bacteriol Virusol Parazitol Epidemiol., 55, 131, 2010.
12. Zarogoulidis P. et al.: Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practise in respiratory diseases. Eur. J. Clin. Pharmacol., 68, 479, 2012.