Non-antimicrobial effects of macrolides: literature review

The aim of this work is to review current publications on the non-antibacterial effects of macrolides. Macrolides are among the most widely prescribed broad-spectrum antibacterial drugs, especially in patients with respiratory infections. It is now recognized that drugs of this group, in particular azithromycin, also have an immunomodulatory effect, which leads to their therapeutic effect not only in infectious but in other chronic inflammatory diseases also. However, the frequent and prolonged use of macrolides in the treatment of respiratory tract diseases, and recently azithromycin in the treatment of COVID-19, has led to an increase in bacterial resistance to antibiotics of this group. Results: it was shown that one of the key aspects of the development of chronic inflammation of the respiratory tract (for instance, chronic obstructive pulmonary disease) is the loss of the protective epithelial barrier due to the effects of pathogens and pollutants. Azithromycin has been shown to enhance the barrier properties of airway epithelial cells over time, which makes an important contribution to its therapeutic effectiveness. The main non-antibacterial effects of macrolides are considered, which in the future can be applied in treatment of inflammatory diseases associated with airway epithelium damage.