Long-term macrolide maintenance therapy in non-CF bronchiectasis: Evidence and questions

作者：Haworth Charles S^*; Bilton Diana; Elborn J Stuart

来源：Respiratory Medicine, 2014, 108(10): 1397-1408.

DOI：10.1016/j.rmed.2014.09.005

• Azithromycin
• Erythromycin
• Macro tides
• Non-cystic fibrosis bronchiectasis
• Pulmonary exacerbation

Macrolide antibiotics have anti-inflammatory and immunomodulatory properties in addition to antibacterial activity. Until recently, only a small number of studies evaluating macrolides in patients with non-cystic fibrosis (CF) bronchiectasis had been published. These were open-label, uncontrolled, short-duration studies that included small numbers of patients. However, these studies suggested that macrolides can reduce exacerbation frequency, reduce sputum volume, and improve lung function in patients with non-CF bronchiectasis. %26lt;br%26gt;Three recently published randomised, double-blind, placebo-controlled studies showed that macrolides (azithromycin or erythromycin) taken for between 6 and 12 months led to significant reductions in exacerbation rate and reduced the decline in lung function. In all studies, macrolides were generally well tolerated. %26lt;br%26gt;The advantages of macrolide maintenance therapy need to be balanced against the risks, which include emergence of bacterial resistance, cardiotoxicity and ototoxicity. In addition, a key need is the consistent definition of endpoints for studies in non-CF bronchiectasis, particularly the definition of exacerbation, to allow systematic data analysis. Existing studies on the use of low-dose macrolides in non-CF bronchiectasis are encouraging, but further studies are needed to define the optimal agent, dose, duration for treatment, and the patients likely to benefit and long-term safety.

• 出版日期2014-10