The immunomodulatory effects of macrolide antibiotics in respiratory disease

Jennifer Pollock, James D. Chalmers (Lead / Corresponding author)

Research output: Contribution to journalReview articlepeer-review

36 Citations (Scopus)


Macrolide antibiotics are well known for their antibacterial properties, but extensive research in the context of inflammatory lung disease has revealed that they also have powerful immunomodulatory properties. It has been demonstrated that these drugs are therapeutically beneficial in various lung diseases, with evidence they significantly reduce exacerbations in patients with COPD, asthma, bronchiectasis and cystic fibrosis. The efficacy demonstrated in patients infected with macrolide tolerant organisms such as Pseudomonas aeruginosa supports the concept that their efficacy is at least partly related to immunomodulatory rather than antibacterial effects. Inconsistent data and an incomplete understanding of their mechanisms of action hampers the use of macrolide antibiotics as immunomodulatory therapies. Macrolides recently demonstrated no clinically relevant immunomodulatory effects in the context of COVID-19 infection. This review provides an overview of macrolide antibiotics and discusses their immunomodulatory effects and mechanisms of action in the context of inflammatory lung disease.

Original languageEnglish
Article number102095
Number of pages12
JournalPulmonary Pharmacology and Therapeutics
Early online date3 Nov 2021
Publication statusPublished - Dec 2021


  • Azithromycin
  • Bronchiectasis
  • COPD
  • Cystic fibrosis
  • Neutrophils

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Biochemistry, medical
  • Pharmacology (medical)


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