The immunomodulatory effects of macrolide antibiotics in respiratory disease

Macrolide antibiotics are well known for their antibacterial properties, but extensive research in the context of inflammatory lung disease has revealed that they also have powerful immunomodulatory properties. It has been demonstrated that these drugs are therapeutically beneficial in various lung diseases, with evidence they significantly reduce exacerbations in patients with COPD, asthma, bronchiectasis and cystic fibrosis. The efficacy demonstrated in patients infected with macrolide tolerant organisms such as Pseudomonas aeruginosa supports the concept that their efficacy is at least partly related to immunomodulatory rather than antibacterial effects. Inconsistent data and an incomplete understanding of their mechanisms of action hampers the use of macrolide antibiotics as immunomodulatory therapies. Macrolides recently demonstrated no clinically relevant immuno-modulatory effects in the context of COVID-19 infection. This review provides an overview of macrolide anti-biotics and discusses their immunomodulatory effects and mechanisms of action in the context of inflammatory lung disease.

Automated summary

Macrolide antibiotics, known for their antibacterial properties, also exhibit powerful immunomodulatory effects in the context of inflammatory lung disease. They have shown therapeutic benefits in various lung diseases but inconsistent data and incomplete understanding of their mechanisms of action hinder their use as immunomodulatory therapies. In the context of COVID-19 infection, macrolides have not demonstrated clinically relevant immunomodulatory effects.