CHEST Guidelines-Macrolides-for-Clinically-Significant-Bronchiectas

Macrolides-for-Clinically-Significant-Bronchiectas

Pdf Summary

Long-term macrolide therapy is an evidence-based treatment that reduces frequent exacerbations in stable adult patients with bronchiectasis, although there is limited evidence for attenuation of lung function decline and improvement in quality of life. While systematic reviews and meta-analyses of randomized controlled trials confirm the benefits in reducing exacerbations, the mechanisms—whether anti-inflammatory or anti-infective—are unclear. Notably, macrolides may carry risks such as auditory and cardiovascular side effects, gastrointestinal issues, and ecological concerns like antimicrobial resistance and impact on the lung microbiome, which need careful consideration before initiation.<br /><br />The efficacy of macrolides in reducing exacerbations is clear, with significant decreases in the number of exacerbations and increases in exacerbation-free patients. However, their effects on pulmonary function and quality of life show limited clinical significance. Concerns regarding resistance and the impact on nontuberculous mycobacteria (NTM) suggest the importance of confirming NTM infection absence before therapy.<br /><br />Patient selection for macrolide treatment should focus on those undergoing severe exacerbations despite optimized airway clearance. While azithromycin and erythromycin are commonly used, questions remain regarding optimal drug choice, dose, and regimen. There is also the crucial consideration of drug interactions, particularly with cardiovascular medications like statins.<br /><br />Given these complexities, long-term macrolide use necessitates a careful benefit-to-risk analysis, consideration of baseline pathogens, and monitoring for potential adverse events. Further research is needed to enhance understanding of these factors, especially concerning sustainability, optimal treatment structures, and integration with inhaled antibiotics.<br /><br />In summary, while macrolides offer important benefits for exacerbation reduction in bronchiectasis, clinicians must weigh these against potential risks and consider individual patient factors to optimize outcomes.

Keywords

macrolide therapy

bronchiectasis

exacerbations

lung function

antimicrobial resistance

NTM infection

azithromycin

erythromycin

drug interactions

risk analysis