Department of Pulmonary Diseases, Medical Centre Alkmaar, Alkmaar, The Netherlands.
Respiration. 2011;81(1):75-87. doi: 10.1159/000320320. Epub 2010 Aug 21.
The available evidence for long-term, low-dose treatment with 14- and 15-membered ring macrolides in non-cystic fibrosis (CF) bronchiectasis, COPD, chronic sinusitis, and asthma is reviewed with special attention to possible adverse effects and the emergence of resistance during long-term macrolide treatment. Macrolide maintenance therapy has been proven to be of benefit in diffuse panbronchiolitis and CF, presumably due to an anti-inflammatory mechanism of action in addition to its direct antimicrobial effect. Solid evidence to justify this treatment regimen for non-CF bronchiectasis, asthma, or sinusitis is still lacking, although a beneficial effect of long-term macrolide therapy has been found in small clinical trials on these subjects. Data from randomized trials of long-term macrolide treatment in COPD are conflicting. A sufficiently long duration of treatment and the careful selection of patients appears to be crucial. Aside from its beneficial effects, possible side effects of macrolide treatment should be taken into account, the most important of these being gastrointestinal upset and cardiac arrhythmias. Development of macrolide resistance among respiratory pathogens is very common during long-term macrolide treatment. Whether this finding is clinically significant is a matter of debate.
本文回顾了 14- 和 15-元大环内酯类药物在非囊性纤维化 (CF) 支气管扩张症、COPD、慢性鼻窦炎和哮喘中的长期低剂量治疗的现有证据，特别关注长期大环内酯类药物治疗期间可能出现的不良反应和耐药性的出现。大环内酯类药物维持治疗已被证明对弥漫性泛细支气管炎和 CF 有益，这可能是由于除了直接的抗菌作用外，它还具有抗炎作用。尽管在这些疾病的小型临床试验中发现了长期大环内酯类药物治疗的有益效果，但仍缺乏 justifies 这一治疗方案用于非 CF 支气管扩张症、哮喘或鼻窦炎的可靠证据。COPD 长期大环内酯类药物治疗的随机试验数据相互矛盾。足够长的治疗时间和仔细选择患者似乎至关重要。除了其有益的效果外，还应考虑大环内酯类药物治疗的可能副作用，其中最重要的是胃肠道不适和心律失常。在长期大环内酯类药物治疗期间，呼吸道病原体非常容易产生耐药性。这一发现是否具有临床意义仍存在争议。
