Chest
Volume 123, Issue 1, January 2003, Pages 261-265
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Opinions/Hypotheses
Tissue Reparative Effects of Macrolide Antibiotics in Chronic Inflammatory Sinopulmonary Diseases

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It is well established that macrolide antibiotics are efficacious in treating sinopulmonary infections in humans. However, a growing body of experimental and clinical evidence indicates that they also express distinct salutary effects that promote and sustain the reparative process in the chronically inflamed upper and lower respiratory tract. Unlike the anti-infective properties, these distinct effects are manifested at lower doses, usually after a relatively prolonged period (weeks) of treatment, and in the absence of an identifiable, viable pathogen. Long-term, low-dose administration of macrolide antibiotics has been used most commonly for sinusitis, diffuse panbronchiolitis, asthma, bronchiectasis, and cystic fibrosis. It is associated with down-regulation of nonspecific host inflammatory response to injury and promotion of tissue repair. Although large-scale trials are lacking, the prolonged use of these drugs has not been associated with emergence of clinically significant bacterial resistance or immunosuppression. Long-term, low-dose administration of 14- and 15-membered ring macrolide antibiotics may represent an important adjunct in the treatment of chronic inflammatory sinopulmonary diseases in humans.

Section snippets

Chronic Rhinosinusitis and Nasal Polyps

Chronic sinusitis, a common disease of the paranasal sinuses, is characterized by purulent sinus effusion and nasal discharge.16 Neutrophils play an important role in regulating the inflammatory process by secreting various pro-inflammatory cytokines, such as interleukin (IL)-8.17 Fourteen-membered ring macrolide antibiotics, such as erythromycin and clarithromycin, are efficacious in chronic sinusitis.8181920 Patients administered low-dose clarithromycin8 or roxithromycin (not available in the

Conclusion

Long-term, low-dose administration of 14- and 15-membered ring macrolide antibiotics is associated with salutary tissue reparative effects in patients with chronic inflammatory sinopulmonary diseases such as chronic sinusitis, asthma, bronchiectasis, cystic fibrosis, and diffuse panbronchiolitis that are distinct from their anti-infective properties. Overall, these responses are associated with down-regulation of the nonspecific host inflammatory response to injury in these tissues.

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  • Cited by (0)

    Dr. Garey is on the Speakers' Bureau for Abbott Laboratories and Aventis Pharmaceuticals. Dr. Danziger is on the Speakers' Bureau and has received research grants from Abbott Laboratories, Ortho-McNeil Pharmaceuticals, AstraZeneca Pharmaceuticals, and Merck & Co.

    Dr. Rubinstein is on the Speakers' Bureau and has received research grants from Abbott Laboratories, Aventis Pharmaceuticals, GlaxoSmithKline, and Chiron. Financial support for this review was provided by the University of Illinois at Chicago and Abbott Laboratories.

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