You call your COPD patient’s pulmonologist to chit chat about his current exacerbation and like a reflex, she recommends azithromycin. You’re like but what about antibiotic resistance? Does he really need antibiotics? What’s the deal?
[spacer height=”20px”]Here’s the deal:
[spacer height=”20px”]Macrolides are more than bacteria-killers, they also have been shown in countless studies to have immunomodulatory effects, and animal studies show they may even reduce bronchoconstriction. Further, the anti-inflammatory applications could be rather broad.
[spacer height=”20px”]In terms of immunomodulation, initial reports of this effect surfaced in the 1980s when patients with diffuse panbronchiolitis were found to have improved prognoses when treated with macrolides. Ultimately, studies were done which demonstrated reduced neutrophil activation and infiltration as well as decreased levels proinflammatory cytokines. Further, azithromycin was found to drive the generation of anti-inflammatory macrophages. Grossly, this means reduced inflammation. Clinically, this means sputum volumes rapidly decreased and lung functions improved. Studies have also shown improved overall outcomes in patients with sepsis due to PNA.
[spacer height=”20px”]Some studies have demonstrated the potential for broncho-relaxation as well. Unfortunately, this is currently limited to animal models but azithromycin has been shown to have concentration dependent relaxant effects on pre-contracted tracheal strips.
[spacer height=”20px”]As such, while antibiotic resistance does remain a concern, and in fact, increasing pneumococcal resistance is a reality, we have a low threshold to give azithromycin in worthy COPD exacerbations, as well as in other chronic illnesses like CF, bronchiectasis. Further, its use is by no means limited to pulmonary chronic disease but may be helpful in chronic prostatitis, glomerulonephritis, rosacea and who knows what else!
[spacer height=”20px”][spacer height=”20px”]Sources:
Image taken from: http://vey-kun.deviantart.com/art/Fist-Punch-yo-275545298
 Parnham, Michael J., et al. “Azithromycin: mechanisms of action and their relevance for clinical applications.” Pharmacology & therapeutics 143.2 (2014): 225-245.
Daenas, Christos, et al. “Azithromycin has a direct relaxant effect on precontracted airway smooth muscle.” European journal of pharmacology553.1 (2006): 280-287.
 Stamatiou, Rodopi, et al. “Azithromycin has an antiproliferative and autophagic effect on airway.”