Immunomodulatory effects of macrolides in the lung: lessons from in-vitro and in-vivo models

Macrolide antibiotics appear to play a role in the management of diseases of chronic airway inflammation, distinctly separate from their antibactericidal activity. In the last fifteen years, their success in human clinical trials has prompted both in-vitro and in-vivo investigations to determine the mechanisms by which this family of antibiotics modulate the immune response. A large body of evidence suggests that macrolides directly target multiple components of the inflammatory cascade that occur independent of bactericidal/bacteriostatic effects. We will review the existing data in support of immunomodulatory effects of macrolides on activated leukocytes at the site of lung inflammation, on pulmonary host cells, and in animal models of lung disease.