Macrolides: known knowns, and known unknowns

Recent randomised controlled trials of macrolide therapy have increased our knowledge about how to treat our patients with bronchiectasis. However, many aspects of macrolide therapy remain unclear. Macrolide antibiotics possess anti-inflammatory and immunomodulatory properties in addition to their antibacterial properties. Multiple mechanisms of action have been described. Four major randomised, placebo-controlled trials have recently shown that prolonged treatment with azithromycin (EMBRACE, BAT, and BIS studies) or erythromycin (BLESS study) significantly decreased the frequency of pulmonary exacerbations in p…