Macrolides – more than antibiotics

Sa？etak Macrolide antibiotics play an important role in the treatment of infectious diseases because of their relatively broad antimicrobial spectrum and good safety profile. A wide usage of macrolides has lead to certain clinical observations which cannot be explained by direct antibiotic action. There are numerous reports on macrolide effect in chronic inflammatory diseases, such as diffuse panbronchiolitis, cystic fibrosis, bronchiolitis obliterans syndrome, etc. Intensive preclinical and clinical research have shown that macrolides exhibit immunomodulatory activity and that macrolide-induced inhibition of Pseudomonas aeruginosa virulence factor production and biofilm formation is responsible for some of the effects. Beneficial results of the immunomodulation, increased survival rate and decreased hospital stay, have been reported for community acquired pneumonia and sepsis. It is up to clinicians to recognise further opportunities to exploit macrolide immunomodulation, whereas drug-discovery research efforts, based on reverse pharmacology approach, should be directed towards discovery of new immunomodulatory macrolides lacking antimicrobial activity