Macrolide antibiotics have been known to have both antimicrobial and immunomodulatory activities. Low dose, long term macrolide has been shown to inhibit lymphocyte proliferation, decrease neutrophils accumulation, mucus secretion and bronchial tissue contraction. It also suppresses pathogens like Chlamydia and Mycoplasma pneumoniae which have been associated with persistent airway inflammation.
Aim This review was to determine if the immunomodulatory effect of azithromycin has a positive impact on asthma control in children with difficult asthma.
Method A retrospective chart review was carried out on 10 children where azithromycin was used as part of their antiasthma treatment. We looked at their frequency of exacerbation, need for oral steroids, symptom control, number of hospital admissions and the ability to stepdown in treatment regime 1 year before and after commencing azithromycin.
Results Eight of 10 80 patients showed a good improvement in their overall symptom control. There was a decrease in the frequency of exacerbations in six patients 60. We discontinued regular daily prednisolone in 3 patients 38 and decreased prednisolone dose in 4 patients. 2 patients had their nebulised treatment discontinued and was recommenced back to regular inhaled therapy only. There was a decrease in the frequency of hospital admissions in 6 patients 75.
Conclusion Low dose, long term macrolide antibiotics are a promising addition to antiasthma regimen in difficult asthma patients. The salutary effect is probably due to their distinct immunomodulatory properties and the eradication of persistent airway infections with Chlamydia and Mycoplasma pneumoniae. More studies are needed to address these issues.