Role of long term antibiotics in chronic respiratory diseases

Abstract

Antibiotics are commonly used in the management of respiratory disorders such as cystic fibrosis (CF), non-CF bronchiectasis, asthma and COPD. In those conditions long-term antibiotics can be delivered as nebulised aerosols or administered orally. In CF, nebulised colomycin or tobramycin improve lung function, reduce number of exacerbations and improve quality of life (QoL). Oral antibiotics, such as macrolides, have acquired wide use not only as anti-microbial agents but also due to their anti-inflammatory and pro-kinetic properties. In CF, macrolides such as azithromycin have been shown to improve the lung function and reduce frequency of infective exacerbations. Similarly macrolides have been shown to have some benefits in COPD including reduction in a number of exacerbations. In asthma, macrolides have been reported to improve some subjective parameters, bronchial hyperresponsiveness and airway inflammation; however have no benefits on lung function or overall asthma control. Macrolides have also been used with beneficial effects in less common disorders such as diffuse panbronchiolitis or post-transplant bronchiolitis obliterans syndrome. In this review we describe our current knowledge the use of long-term antibiotics in conditions such as CF, non-CF bronchiectasis, asthma and COPD together with up-to-date clinical and scientific evidence to support our understanding of the use of antibiotics in those conditions.

Short-Term Variation of Lung Function and Airway Inflammation in Children and Adolescents with Bronchiolitis Obliterans

“…Anti-inflammatory therapies such as corticosteroids have been tried in small trials with minimal success [15]. Other studies suggest a potential role for long-term macrolide therapy in the treatment of BO in which the anti-inflammatory properties and ability of macrolide therapy to reduce the inflammatory mediators of interleukins IL-1, IL-6 and IL-8, and demonstrate a role for the therapy [16].…”

Effects of Low-dose Clarithromycin Added to Fluticasone on Inflammatory Markers and Pulmonary Function among Children with Asthma: A Randomized Clinical Trial

“…14,15 In the study by Marc et al , 16 the abnormal carbon monoxide diffusion capacity values indicate that some children with Mpl have reduced pulmonary gas diffusion after recovery from Mpl community-acquired pneumonia. The reduction is related to delayed and short-term macrolide therapy.…”

Drug development of Lung Diseases by way of Drug Repurposing; What a Pulmonary Physician can do in the Laboratory

“…Local factors of the airways such as the macrophages, transporters or local gene expression play a role in the absorption of the drug and these are parameters that can be modified. The patient target group should be considered as some devices need synchronization upon device activation and patient inspiration [4,[10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Breathing patterns also modify the deposition of aerosol within the airways, and therefore correct usage of inhalable devices is necessary.…”