British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease
This guideline, commissioned by the BTS, is to support best practice in this developing arena. It makes recommendations on use in asthma, bronchiectasis, COPD, bronchiolitis obliterans, and other respiratory conditions, and discusses safety issues and antimicrobial resistance.
Source:
Thorax
SPS commentary:
A related article highlights key points from the guidance. The best evidence for long-term macrolides was in bronchiectasis (3 RCTs), and the guideline group was able to make a strong recommendation for offering their use to reduce exacerbations in those with ≥3 exacerbations per year. Conditional recommendations are made for asthma, COPD and bronchiolitis obliterans syndrome, and there was insufficient evidence to allow any recommendation for use in chronic cough or organising pneumonia to be made.
None of the macrolides has a product licence in the UK for use as a long-term immunomodulatory agent and therefore their use in this way would be off-label.