Immunomodulatory Effects of Macrolide Antibiotics - Part 2: Advantages and Disadvantages of Long-Term, Low-Dose Macrolide Therapy.
Summary of "Immunomodulatory Effects of Macrolide Antibiotics - Part 2: Advantages and Disadvantages of Long-Term, Low-Dose Macrolide Therapy."
The available evidence for long-term, low-dose treatment with 14- and 15-membered ring macrolides in non-cystic fibrosis (CF) bronchiectasis, COPD, chronic sinusitis, and asthma is reviewed with special attention to possible adverse effects and the emergence of resistance during long-term macrolide treatment. Macrolide maintenance therapy has been proven to be of benefit in diffuse panbronchiolitis and CF, presumably due to an anti-inflammatory mechanism of action in addition to its direct antimicrobial effect. Solid evidence to justify this treatment regimen for non-CF bronchiectasis, asthma, or sinusitis is still lacking, although a beneficial effect of long-term macrolide therapy has been found in small clinical trials on these subjects. Data from randomized trials of long-term macrolide treatment in COPD are conflicting. A sufficiently long duration of treatment and the careful selection of patients appears to be crucial. Aside from its beneficial effects, possible side effects of macrolide treatment should be taken into account, the most important of these being gastrointestinal upset and cardiac arrhythmias. Development of macrolide resistance among respiratory pathogens is very common during long-term macrolide treatment. Whether this finding is clinically significant is a matter of debate.
Affiliation
Department of Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, The Netherlands.
Journal Details
This article was published in the following journal.
Name: Respiration; international review of thoracic diseases
ISSN: 1423-0356
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20733282
- DOI: http://dx.doi.org/10.1159/000320320
Medical and Biotech [MESH] Definitions
Feasibility Studies
Studies to determine the advantages or disadvantages, practicability, or capability of accomplishing a projected plan, study, or project.
Beta-lactam Resistance
Nonsusceptibility of bacteria to the action of the beta-lactam antibiotics. Mechanisms responsible for beta-lactam resistance may be degradation of antibiotics by BETA-LACTAMASES, failure of antibiotics to penetrate, or low-affinity binding of antibiotics to targets.
Vecuronium Bromide
Monoquaternary homolog of PANCURONIUM. A non-depolarizing neuromuscular blocking agent with shorter duration of action than pancuronium. Its lack of significant cardiovascular effects and lack of dependence on good kidney function for elimination as well as its short duration of action and easy reversibility provide advantages over, or alternatives to, other established neuromuscular blocking agents.
Anesthetics, Inhalation
Gases or volatile liquids that vary in the rate at which they induce anesthesia; potency; the degree of circulation, respiratory, or neuromuscular depression they produce; and analgesic effects. Inhalation anesthetics have advantages over intravenous agents in that the depth of anesthesia can be changed rapidly by altering the inhaled concentration. Because of their rapid elimination, any postoperative respiratory depression is of relatively short duration. (From AMA Drug Evaluations Annual, 1994, p173)
Monobactams
Monocyclic, bacterially produced or semisynthetic beta-lactam antibiotics. They lack the double ring construction of the traditional beta-lactam antibiotics and can be easily synthesized.
PubMed Articles
Recent Advances in the Field of 16-Membered Macrolide Antibiotics.
The continuing emergence of bacterial resistance has provided an incentive for recent intensified research on macrolide antibiotics. Belonging to the macrolide family, 16-membered macrolides also expe...
Immunomodulatory Effects of Macrolide Antibiotics - Part 1: Biological Mechanisms.
Macrolide antibiotics are well known for their antibacterial and anti-inflammatory properties. This article provides an overview of the biological mechanisms through which macrolides exert this 'doubl...
Risk of hypotension with concomitant use of calcium-channel blockers and macrolide antibiotics.
Purpose The literature describing the risk of hypotension in patients receiving concomitant therapy with a calcium-channel blocker (CCB) and a macrolide antibiotic is reviewed. Summary A literature se...
Macrolide antibiotics, like erythromycin, clarithromycin, and azithromycin, possess anti-inflammatory properties. These properties are considered fundamental to the efficacy of these three macrolides...
Thickening of the cell wall in macrolide-resistant Staphylococcus aureus.
Macrolides are widely used at low dosage for long-term therapy of chronic sinusitis. Twenty clinical macrolide-resistant Staphylococcus aureus strains were morphologically compared with 10 clinical ma...
Clinical Trials
Outcomes of Patients Not Responding to Antibiotics in the Community
A study to report the outcomes of patients who fail to respond to beta-lactam and macrolide antibiotics in the community
Macrolide Maintenance Therapy in Chronic Obstructive Pulmonary Disease (COPD)
To assess whether maintenance treatment with macrolide antibiotics in COPD patients with three or more exacerbations in the preceding year of inclusion can decrease the exacerbation rate i...
PER 03/10/94 AMENDMENT: PART B. To determine whether there is an effect on plasma drug levels of azithromycin and rifabutin as measured by changes in the plasma concentration-time curve (A...
Bronchiolitis obliterans syndrome (BOS), an obstructive airway disease as a result of chronic rejection, is one of the major causes of morbidity and mortality in long-term survivors of all...
Cognitive Effects of Immunomodulatory Drugs in MS
The purpose of this study is to examine and compare changes in the specific thinking skills of patients with RRMS who are receiving treatment with one of three immunomodulatory medications...
