Long-term oral antibiotic treatment : why, what, when and to whom?

Antibiotics are typically prescribed as short courses for acute infections, in order to reduce bacterial load, shift the balance in favour of host defences and thus help to overcome infection. Over the past decade, however, interest in the long-term anti-inflammatory and immunomodulatory effects of selected antibiotics has been on the increase. Since the clinical effectiveness of erythromycin was reported in diffuse panbronchiolitis in the 1980s, the use of macrolides has been adopted into many other chronic inflammatory airway diseases characterised by frequent exacerbations, including cystic fibrosis (CF), non-CF bronchiectasis, COPD, severe noneosinophilic asthma, bronchiolitis obliterans after lung transplantation and organising pneumonia. In this chapter, we discuss the indications and limitations of long-term macrolide treatment in these chronic respiratory conditions