[Lower tract infections as potential indication for therapy with macrolides]

Community acquired pneumonia (CAP) is the sixth leading cause of death. Atypical pneumonia caused by Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila accounts for up to 40% of all cases of CAP. Atypical pneumonia due to Mycoplasma and Chlamydophila usually cause milder forms of pneumonia and are characterized by a more drawn out course of symptoms unlike other forms of pneumonia which can come on more quickly with more severe early symptoms. Mycoplasma pneumonia often affects younger people and may be associated with symptoms outside of the lungs (such as anemia and rashes), and neurological syndromes (such as meningitis, myelitis, and encephalitis). Severe forms of Mycoplasma pneumonia have been described in all age groups. Chlamydophila pneumonia occurs year round and accounts for 5-15% of all pneumonias. It is usually mild with a low mortality rate. In contrast, atypical pneumonia due to Legionella accounts for 2-6% of pneumonias and has a higher mortality rate. Elderly individuals, smokers, and people with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Contact with contaminated aerosol systems (like infected air conditioning systems) has also been associated with pneumonia due to Legionella. All of known macrolides, including azythromycin and clarythromycin, have excellent activity against the atypical respiratory pathogens. The are primarily bacteriostatic, by binding to the 50S subunit of the ribosome, they inhibit bacterial protein. The potential indications for treatment lower respiratory tract infections with macrolides were presented in this study.