Mechanisms, Efficacy, Safety, and Pharmacoeconomics of Low-Dose, Long-Term Macrolide Antibiotics in the Treatment of Chronic Obstructive Pulmonary Disease: A Review

Abstract: Chronic Obstructive Pulmonary Disease (COPD) is usually associated with abnormal airways and/or alveoli caused by exposure to toxic particles or gases. In addition to their traditional anti-infective effects, macrolide antibiotics, when administered for long courses, may improve respiratory function, clinical outcomes, and quality of life in COPD patients, as well as reduce the frequency of acute exacerbations of COPD. For example, continuous azithromycin treatment for 1 year can reduce the annual frequency of acute exacerbations from 1.83 to 1.48 episodes, making it of great value in the treatment of COPD. However, macrolide antibiotics have potential adverse drug reactions, such as cardiotoxicity, diarrhea, and hearing impairment. Long-term use can also induce antibiotic resistance, which limits their widespread application. This article reviews the research progress on the mechanism of action, clinical efficacy, safety, and pharmacoeconomics of macrolide antibiotics in the treatment of COPD, aiming to provide a theoretical basis for optimizing individualized treatment strategies for COPD. For patients with frequent acute exacerbations or severe COPD, long-term treatment with azithromycin (500 mg, three times a week) is recommended; for patients with comorbid cardiovascular disease risks, electrocardiographic monitoring and risk assessment before treatment are suggested. Elderly patients or those on long-term medication need regular hearing tests. Keywords: chronic obstructive pulmonary disease, macrolides, antimicrobial agents