Long-term macrolides in diffuse interstitial lung diseases

Abstract

In the present review we provide currently available evidence for the use of macrolides in the treatment of diffuse interstitial lung diseases (ILDs). Up to now, research on macrolides has mainly focused on three areas. First, macrolides have shown some promising results in cellular models and case reports as antifibrotic agents, by promoting autophagy and clearance of intracellular protein aggregates and acting as regulators of surfactant homeostasis. Secondly, macrolides have an immunomodulatory effect, which has been applied in some organising pneumonia cases. In particular, macrolides have been tested in association with systemic corticosteroids as steroid-sparing agents and alone as either first-line agents in mild cases or second-line agents where steroids were poorly tolerated or had failed. Thirdly, a recent area of research concerns the possible role of macrolides as modulators of lung microbiota and the host-microbiota interaction. This function has been particularly studied in idiopathic pulmonary fibrosis patients, in whom changes in microbiota have been proved to be associated with disease progression. However, the lack of high-quality studies makes the application of macrolide therapy in ILDs a field in which research should be conducted on a large scale.

The Impact of Omega-3 Fatty Acids on the Evolution of Acinetobacter baumannii Drug Resistance

“…Microbial exposure to macrolides can occur as a direct result of their use as antimicrobials but also as a secondary effect of their use as immune modulators or regulators of pulmonary surfactant homeostasis ( 26 , 27 ). The latter two uses are related to host lipid metabolism, i.e., preventing AA release for subsequent cyclooxygenase activation ( 28 ) or changing the lipid composition of pulmonary surfactant by as yet unknown mechanisms, respectively.…”

Desquamative interstitial pneumonia with clinical, radiological and histologic correlation

“…The role of alternative immunosuppressant medications in RB-ILD and DIP that are utilized in other ILDs has been less well defined. However, macrolide antibiotics have been reported to be an alternative effective steroid-sparing treatment in DIP [22]. Lung transplantation may be a necessity for patients with severe and progressive disease.…”

Effect of Early Initiation of Combination Therapy of Anti-Inflammatory and Anti-Fibrotic Drugs on Post COVID-19 Interstitial Lung Disease: A Case Report

“…Macrolide antibiotics have been addressed with special recognition in the literature regarding their underlying anti-inflammatory and immunomodulatory effect in addition to an antimicrobial and potentially antifibrotic role. 16 The effectiveness of macrolide in organizing pneumonia as a first-line agent for mild diseases, as adjuvant therapy with a systemic corticosteroid and as a steroid-sparing agent have been reported. 17,18,19 Our knowledge about the longterm behaviour of post COVID-19 related ILD is premature at this time of the pandemic, and in particular, the rate of complete responsiveness to corticosteroid and the relapse rate of ILD during the taper of corticosteroid or upon its discontinuation.…”