Macrolides: Indications and Contraindications

Recently, there has been a growing interest in the use of chronic macrolides for the prophylaxis of recurrent exacerbations in severe chronic obstructive pulmonary disease (COPD) patients. Macrolides are antibiotics that add important immunomodulatory properties to their antimicrobial effect, making them especially useful for controlling pulmonary and systemic inflammation associated with recurrent exacerbations. The macrolide with the widest evidence is azithromycin; when used as prophylactic treatment, its long half-life allows intermittent dosing of 250-500 mg/day 3 times a week. Long-term azithromycin has been shown to be highly effective in reducing moderate-severe exacerbations of COPD and has been included in recent updates of clinical guidelines. It should be noted that its use is not without potential adverse effects; the increased risk of development of microbial resistance is a matter of particular concern and should be reserved for units specialized in the management of severe COPD where clinical and microbiological monitoring of treatment is ensured