• cystic fibrosis
• macrolide antibiotics
• azithromycin

There is growing interest in the potential use of macrolide antibiotics as anti-inflammatory agents in cystic fibrosis. This stems from the dramatic success of long term erythromycin in the treatment of diffuse panbronchiolitis (DPB), a condition with a high prevalence in Japan but rare elsewhere.^1–3 Clinically, DPB exhibits some similarities to cystic fibrosis including chronic productive cough, exertional dyspnoea, chronic sinusitis, mucoid Pseudomonas aeruginosa colonisation, and bronchiectasis. The introduction of erythromycin as a treatment for DPB has had a dramatic impact on mortality, increasing 10 year survival from 12.4–21.9% to over 90% in those colonised with P aeruginosa.^3,4 Similar success has been reported with clarithromycin, roxithromycin, and azithromycin.^1,3 While the aetiology of both conditions may be very different, it is the similarities which beg the question “do the macrolides have a role in the treatment of cystic fibrosis?”

The macrolide antibiotics are an intriguing group of drugs with both anti-inflammatory and antibacterial …