Use of long-term macrolide therapy in chronic obstructive pulmonary disease

Curr Opin Pulm Med. 2014 Mar;20(2):153-8. doi: 10.1097/MCP.0000000000000028.


Purpose of review: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with adverse outcomes and thus prevention of exacerbations is crucial. New data attest that long-term macrolide therapy decreases the risk of COPD exacerbations. We review the key studies that analyzed the effect of long-term use of macrolide antibiotics on the prevention of exacerbations, focusing on the higher quality evidence. Health-related quality of life, sputum bacteriology and development of resistance, inflammatory markers, lung function, cost-benefit analysis, and lung function in relation to long-term macrolide therapy are also discussed.

Recent findings: Two well designed, randomized, placebo-controlled trials report that select patients treated for 1 year with erythromycin or azithromycin, in addition to usual care, have prolonged time to and lower frequency of COPD exacerbations. There are more hearing decrements and higher prevalence of macrolide-resistant bacteria among the patients treated with macrolide therapy.

Summary: Prevention of COPD exacerbations is paramount given the adverse consequences on quality of life, lung function, and survival. Macrolide therapy for 1 year, in addition to usual therapy, decreases the risk of COPD exacerbations but carries the risk of hearing decrements and development of macrolide-resistant bacteria.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Azithromycin / therapeutic use*
  • Cost-Benefit Analysis
  • Disease Progression*
  • Drug Administration Schedule
  • Drug Resistance, Bacterial
  • Erythromycin / therapeutic use*
  • Humans
  • Prospective Studies
  • Pulmonary Disease, Chronic Obstructive / complications*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Randomized Controlled Trials as Topic
  • Respiratory Tract Infections / drug therapy*
  • Respiratory Tract Infections / microbiology
  • Respiratory Tract Infections / physiopathology
  • Sputum / microbiology*
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Erythromycin
  • Azithromycin