Shteinberg Michal, Schneer Sonia, Lavon Ophir, Adir Yochai
Pulmonary Institute, Carmel Medical Center.
B. Rappaport Faculty of Medicine, Technion- Israel Institute of Technology.
Harefuah. 2016 Sep;155(9):567-571.
Macrolide agents have both antibacterial properties as well as various effects on the inflammatory system. In recent years there is growing evidence regarding the favourable effects of macrolides in a range of chronic respiratory conditions. Historically, erythromycin and clarithromycin were found to stabilize pulmonary deterioration in diffuse panbronchiolitis. In cystic fibrosis patients colonized with pseudomonas aeruginosa, long term treatment with azithromycin reduces exacerbations and presents improved lung function. A similar effect on prevention of exacerbations has been demonstrated in noncystic fibrosis bronchiectasis. In patients undergoing lung transplantation, long term azithromycin prevents bronchiolitis obliterans syndrome. In patients with chronic obstructive pulmonary disease (COPD), azithromycin prevents acute exacerbations. Chronic treatment with macrolides is associated with adverse effects including gastrointestinal symptoms, interactions with other drugs and cardiovascular complications. Of the macrolides, azithromycin is associated with the lowest interactions and adverse effects and is also the most investigated.
大环内酯类药物既有抗菌特性，又对炎症系统有多种作用。近年来，越来越多的证据表明大环内酯类药物在一系列慢性呼吸道疾病中具有有益作用。从历史上看，发现红霉素和克拉霉素可稳定弥漫性泛细支气管炎患者的肺部病情恶化。在感染铜绿假单胞菌的囊性纤维化患者中，长期使用阿奇霉素可减少病情加重，并改善肺功能。在非囊性纤维化支气管扩张症中也证明了阿奇霉素对预防病情加重有类似效果。在接受肺移植的患者中，长期使用阿奇霉素可预防闭塞性细支气管炎综合征。在慢性阻塞性肺疾病（COPD）患者中，阿奇霉素可预防急性加重。长期使用大环内酯类药物会产生不良反应，包括胃肠道症状、与其他药物的相互作用以及心血管并发症。在大环内酯类药物中，阿奇霉素的相互作用和不良反应最少，也是研究最多的。
