Use of macrolides in lung diseases: recent literature controversies
Luiz Vicente Ribeiro Ferreira da Silva Filho1, Leonardo Araujo Pinto2, Renato Tetelbom Stein2
1Pneumology Unit, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Objective:
To review the mechanisms of action of macrolides in pediatric respiratory diseases and their clinical indications.
Sources:
Review in the PubMed database, comprising the following terms in English: "macrolide and asthma"; "macrolide and cystic fibrosis"; "macrolide bronchiolitis and viral acute"; "macrolide and bronchiolitis obliterans" and "macrolide and non-CF bronchiectasis".
Summary Of The Findings:
The spectrum of action of macrolides includes production of inflammatory mediators, control of mucus hypersecretion, and modulation of host-defense mechanisms. The potential benefit of macrolide antibiotics has been studied in a variety of lung diseases, such as cystic fibrosis (CF), bronchiectasis, asthma, acute bronchiolitis, and non-CF bronchiectasis. Several studies have evaluated the benefits of macrolides in asthma refractory to therapy, but the results are controversial and indications should be limited to specific phenotypes. In viral bronchiolitis, there is no consistent benefit in acute conditions, although recent data have shown an effect in recurrent wheezing prevention. In patients with CF results are also contradictory, but the consensus states there is a small clinical benefit, especially for patients infected with P. aeruginosa. There was also no positive action of macrolides in patients with post-infectious bronchiolitis obliterans. Children with non-CF bronchiectasis seem to have clear benefits regarding the use of macrolides, which showed clinical advantages in parenchyma protection and lung function.
Conclusions:
The long-term use of macrolides should be limited to highly selected situations, especially in patients with bronchiectasis. Careful evaluation of the benefits and potential damage are tools for their indication in specific groups.
Insights
Macrolide antibiotics offer benefits in pediatric lung diseases, particularly non-CF bronchiectasis. Long-term use requires careful consideration for specific patient groups, balancing benefits against potential harm.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Infectious Diseases
Background:
- Macrolides possess anti-inflammatory and immunomodulatory properties.
- Their use in pediatric respiratory diseases is explored for various conditions.
- Understanding macrolide mechanisms is crucial for targeted therapy.
Purpose of the Study:
- To review macrolide mechanisms of action in pediatric respiratory diseases.
- To evaluate clinical indications for macrolide use in these conditions.
Main Methods:
- PubMed database review.
- Search terms included macrolides combined with asthma, cystic fibrosis, viral acute bronchiolitis, bronchiolitis obliterans, and non-CF bronchiectasis.
- Analysis of existing studies on macrolide efficacy.
Main Results:
- Macrolides modulate inflammatory mediators, mucus, and host defenses.
- Benefits in asthma and cystic fibrosis (CF) are controversial or limited.
- No consistent benefit in acute viral bronchiolitis, but potential in recurrent wheezing prevention.
- Clear advantages observed in non-CF bronchiectasis for lung function and parenchyma protection.
Conclusions:
- Long-term macrolide use should be reserved for highly selected cases, especially non-CF bronchiectasis.
- Careful assessment of risks and benefits is essential for indication.
- Further research may refine macrolide use in specific pediatric respiratory conditions.
Related Concept Videos
01:19Antiasthma Drugs: Leukotriene Modifiers
Leukotriene modifiers work through two distinct mechanisms:
01:17Drugs Used in Lower Respiratory Disorders: Overview
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
01:26COPD: Management Using Bronchodilators and Corticosteroids
01:29Microbiota of the Respiratory Tract
01:23Inhaled Medications
01:17Other Pulmonary Disorders