Antibiotics as immunomodulant agents in COPD

It is widely accepted that some antibiotics have activities beyond their direct antibacterial effects. Macrolide is the antibiotic class with more convincing studies and evidence on its immunomodulatory and anti-inflammatory activities. Different clinical studies have shown that macrolide prophylaxis in patients with moderate-severe chronic obstructive pulmonary disease (COPD) can have a significant impact on the exacerbation rate reducing morbidity and, potentially, mortality of the disease. Other antibiotics, such as fluoroquinolones, demonstrate a variety of immunomodulatory effects but only few clinical data are available in COPD. New macrolide derivatives devoid of antibacterial activity have been synthetized. This review analyses the relevance of immunomodulatory and anti-inflammatory effects of antibiotics in the management of COPD.

► Immunomodulatory effects of antibiotics related to their proper antibacterial activity. ► Activity of macrolides on innate and adaptive immunities important in COPD. ► Antibiotic prophylaxis in COPD patients with severe disease and chronic bronchitis phenotype. ► Side effects and antibiotic resistance critical in antibiotic prophylaxis. ► New opportunities from new antibiotic-derived drugs devoid of anti-bacterial activity.