Which antibiotic has anti-inflammatory effects?

From the Guidelines

Macrolide antibiotics, such as azithromycin and erythromycin, have been shown to have significant anti-inflammatory effects, making them a potential therapeutic option for patients with chronic inflammatory conditions. The use of macrolides for their anti-inflammatory properties is supported by several studies, including a randomized controlled trial by Albert et al 1, which found that azithromycin reduced the frequency of acute exacerbations of chronic obstructive pulmonary disease (COPD) in patients with a history of exacerbations. Another study by Seemungal et al 1 found that erythromycin also reduced the frequency of acute exacerbations of COPD. Some key points to consider when using macrolides for their anti-inflammatory effects include:

• The potential for increased risk of bacterial resistance and hearing loss, as noted in the study by Albert et al 1
• The need for careful patient selection and monitoring, particularly in patients with a history of cardiovascular disease or QT prolongation
• The potential for macrolides to be used in combination with other therapies, such as inhaled corticosteroids or phosphodiesterase-4 inhibitors, to enhance their anti-inflammatory effects. According to the 2017 Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease report 1, long-term azithromycin and erythromycin therapy can reduce exacerbations in patients with COPD, although the use of azithromycin is associated with an increased incidence of bacterial resistance and hearing test impairment. Overall, the use of macrolides for their anti-inflammatory effects is a promising therapeutic strategy, particularly in patients with chronic inflammatory conditions such as COPD. However, careful patient selection and monitoring are necessary to minimize the risk of adverse effects.

From the Research

Antibiotics with Anti-Inflammatory Effects

• Macrolide antibiotics, such as erythromycin, clarithromycin, and azithromycin, possess anti-inflammatory properties 2, 3, 4, 5, 6
• These properties are considered fundamental to the efficacy of these macrolides in the treatment of chronic inflammatory diseases like diffuse panbronchiolitis and cystic fibrosis 2, 3
• Roxithromycin, a macrolide with better plasma concentrations and higher tissue concentrations than erythromycin, has been shown to have anti-inflammatory effects in vivo 4
• Azithromycin has been found to exhibit significant anti-inflammatory properties, including the attenuation of lipopolysaccharide-induced increase in plasma TNF-alpha concentration and improvement of inflammatory markers in bronchoalveolar lavage fluid 5, 6

Specific Anti-Inflammatory Effects

• Macrolides have been shown to suppress the "cytokine storm" of inflammation and confer an additional clinical benefit through their immunomodulatory properties 3
• Azithromycin has been found to modulate host responses, facilitating its long-term therapeutic benefit in cystic fibrosis, non-cystic fibrosis bronchiectasis, exacerbations of chronic obstructive pulmonary disease (COPD), and non-eosinophilic asthma 5
• Roxithromycin, azithromycin, and clarithromycin have been shown to affect various processes involved in inflammation, including the migration of neutrophils, the oxidative burst in phagocytes, and the production of various cytokines 4