Macrolide antibiotics in the treatment of asthma. An update

It seems clear that certain macrolide antibiotics exert anti-inflammatory and immune modulating effects beyond their purely antibacterial action, as has been demonstrated in a number of bronchial inflammatory disorders such as diffuse panbronchiolitis. Randomised, controlled clinical trials involving larger patient samples are needed to confirm whether these actions are of clinical relevance in application to asthma. On the other hand, the macrolide antibiotics have a long half-life, with a prolonged elimination interval, which appears to favour the development of resistances that persist over the long term, as in the case of azithromycin. Would the risk/benefit ratio of sustained low-dose macrolide use be justified, considering the risk of selecting resistant strains? A number of questions must be answered before these drugs can be recommended in application to asthmatic patients: In which patients should they be used? Which drug or drugs would be most appropriate? What would the recommended dose be, and for how long should treatment be administered? What adverse effects can be expected?