Which patients with respiratory disease need long-term azithromycin?

Macrolide antibiotics like azithromycin inhibit bacterial growth and replication by interrupting protein synthesis. But azithromycin also has immunomodulatory properties.1 In the acute phase of infl ammation, azithromycin exerts an initial neutrophil degranulation effect and enhances the oxidative response that is primed by particulate stimulus, which could facilitate its antibacterial effects. In the late phase, it down-regulates the oxidative burst and increases apoptosis of neutrophils to promote healing without compromising immunity. Azithromycin also attenuates airway mucus hypersecretion, improves ciliary function, and promotes pulmonary epithelial cell healing.2,3 Collectively, these effects make the drug effective in many chronic infl ammatory lung conditions (Table 1).