[Azithromycin to prevent asthma exacerbations: only for patients with non-eosinophilic asthma]

Macrolides are antibiotics with anti-inflammatory properties that may be beneficial in the treatment of asthma. In a systematic review, Hiles et al. analysed the effect of azithromycin in the prevention of asthma exacerbations in patients with severe asthma. In their study they conclude that prolonged treatment with azithromycin (at least 3 months) reduces the number of asthma exacerbations; however, the conclusions of this review should be interpreted carefully as the included studies vary in study design, dosing schedule and severity of the asthma. Additionally, maintenance treatment with macrolides may have safety risks, side-effects and lead to antibiotic resistance. Prolonged macrolide therapy should, therefore, be reserved for patients with non-eosinophilic asthma who have no alternative treatment options.