Do Macrolides Help With COPD?

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Do Macrolides Help With COPD? 

By John Bottrell, RRT · July , 2019

I’ve been reading a lot lately about macrolides. Studies seem to show that they may help with COPD. This makes sense considering COPD lungs are prone to developing respiratory infections. And these infections may cause flare-ups. Here’s all you need to know about macrolides for COPD.

What are macrolides?

They are a type of antibiotic. They are made from saccharopolyspora erythraea. This is a type of bacteria that grows in soil.1-2

They bind with bacteria inside your body. This inhibits bacteria from reproducing. Macrolides have historically been prescribed for ending bacterial infections. However, new evidence seems to suggest that they may also prevent them as well.1-2

Commonly prescribed macrolides include Biaxin (Clarithromycin), Zithromax (Azithromycin), and Dificid (Fidaxomicin). Another one is erythromycin.1-2

Why use macrolides for COPD?

I have read many articles about macrolides for COPD. Apparently, the concept is not new. By the 1970s it was well known that bacterial infections were a significant contributor to COPD flare-ups. So, the idea of giving COPD patients a small dose of antibiotics every day to prevent flare-ups was a noble idea.3

But, these studies were limited. Plus, the antibiotics used back then would not prove helpful today. So, these older studies did not prove that macrolides were helpful for COPD. Another fear back then was antibiotic resistance. And this kind of proved true in that many of the antibiotics used back then are no longer effective today, and resistance is one of the reasons.3

The idea of using antibiotics has been rejuvenated by the medical community in recent years. A family of antibiotics that may prove useful here are macrolides. They are effective for many of the bacteria that affect COPD lungs, including Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae and Pseudomonas aeruginosa.3

Other modern evidence shows that these bacteria are responsible for upwards to 50% of COPD flare-ups. It’s also known that bacteria are responsible for initiating an immune response. This response causes the release of certain chemicals. These chemicals cause worsening airway inflammation. This may contribute to the risk of flare-ups.3-4

How do macrolides help to reduce COPD flare-ups?

There are three ways in which macrolides may reduce COPD flare-ups.

Preventing infections. The most obvious reason is that they reduce bacterial colonization in the lungs. This in and of itself should reduce airway inflammation and reduce flare-ups.3-4

Reducing GERD. Another possible. contributing factor to flare-ups is gastrointestinal reflux (GERD). Macrolides are now known to “improve gastric emptying, thereby reducing GERD, thereby reducing flare-ups.

Anti-inflammatory properties. Unknown in the 1970s was that macrolides may also have anti-inflammatory properties. So, they may help reduce the underlying airway inflammation present in COPD airways.3

Past studies on the use of macrolides for COPD showed mixed results. Some showed promise. Still, the fear of antimicrobial resistance remained. Likewise, macrolides may also cause heart complications in some patients. So, these fears, plus lack of definitive study results, have made macrolide therapy for COPD something only tried in those with severe COPD when all other options have been exhausted.

Do newer studies show otherwise?

Yes. A recent review of all past studies on macrolides for COPD shows promising results. This review of studies showed that daily use of macrolides reduced COPD flare-ups by 23%. This is compared with COPD patients not taking daily macrolides.4

Also interesting is that those taking macrolides had a longer period of time before their first COPD exacerbation after starting macrolides. This is compared to those who were not taking macrolides.4

So, the conclusion was that macrolides “significantly” reduced COPD exacerbations.4

As usual, the authors note that more studies are indicated in this area. However, this review of studies shows definite promise using macrolides. Still, the fears of resistance and the fears of other side effects stimy some of the excitement.

When are macrolides recommended?

The criteria for using macrolides for COPD are as follows:3

They should only be used in patients with moderate to severe COPD. This includes stages two through four.
They should only be used when all other potential COPD medicines and therapies fail to result in improved symptoms.
They should only be used in patients who are compliant with their COPD treatment regimen. Examples here include taking medicine every day and using inhalers properly.
The patient must have had two COPD flare-ups in the past year. Both these flare-ups had to either have been treated with antibiotics or corticosteroids. Or, one flare-up resulting in hospital admission within the past year.

Macrolides do show promise for the treatment of COPD

Macrolides are still in the experimental stage. However, they do show promise for the treatment of COPD. So when all other options exhausted, macrolide therapy may be right for you. At the very least it may lead to an interesting discussion with your COPD doctor.

copd.net/clinical/macrolides/