European Journal of Clinical Pharmacology

, Volume 68, Issue 5, pp 479–503 | Cite as

Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practice in respiratory diseases

  • P. ZarogoulidisEmail author
  • N. Papanas
  • I. Kioumis
  • E. Chatzaki
  • E. Maltezos
  • K. Zarogoulidis
Review Article



Macrolides have long been recognised to exert immunomodulary and anti-inflammatory actions. They are able to suppress the “cytokine storm” of inflammation and to confer an additional clinical benefit through their immunomodulatory properties.


A search of electronic journal articles was performed using combinations of the following keywords: macrolides, COPD, asthma, bronchitis, bronchiolitis obliterans, cystic fibrosis, immunomodulation, anti-inflammatory effect, diabetes, side effects and systemic diseases.


Macrolide effects are time- and dose-dependent, and the mechanisms underlying these effects remain incompletely understood. Both in vitro and in vivo studies have provided ample evidence of their immunomodulary and anti-inflammatory actions. Importantly, this class of antibiotics is efficacious with respect to controlling exacerbations of underlying respiratory problems, such as cystic fibrosis, asthma, bronchiectasis, panbrochiolitis and cryptogenic organising pneumonia. Macrolides have also been reported to reduce airway hyper-responsiveness and improve pulmonary function.


This review provides an overview on the properties of macrolides (erythromycin, clarithromycin, roxithromycin, azithromycin), their efficacy in various respiratory diseases and their adverse effects.


Antibiotics Inflammation Immunomodulation Macrolides 


Conflicts of interest

Nothing to declare.

Author contributions

P.Z. and N.P. conceived and wrote the manuscript. E.C. assisted in the explanation and presentation of the multiple anti-inflammatory/immunomodularlatory properties. I.K., E.M. and K.Z. provided useful insights.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • P. Zarogoulidis
    • 1
    Email author
  • N. Papanas
    • 3
  • I. Kioumis
    • 1
  • E. Chatzaki
    • 4
  • E. Maltezos
    • 2
  • K. Zarogoulidis
    • 1
  1. 1.Pulmonary Department, “G. Papanikolaou” HospitalAristotle University of ThessalonikiThessalonikiGreece
  2. 2.Unit of Infectious DiseasesUniversity Hospital of AlexandroupolisAlexandroupolisGreece
  3. 3.Second Department of Internal MedicineDemocritus University of ThraceAlexandroupolisGreece
  4. 4.Laboratory of Pharmacology, Medical SchoolDemocritus University of ThraceAlexandroupolisGreece

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