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已发表论文
低剂量长期大环内酯类抗生素治疗慢性阻塞性肺疾病的机制、疗效、安全性和药物经济学：综述
Authors Wu J, Wu D, Wang H, Liu J, Chen Y
Received 18 August 2025
Accepted for publication 15 January 2026
Published 29 January 2026 Volume 2026:21 561395
DOI https://doi.org/10.2147/COPD.S561395
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Vanesa Bellou
Jirong Wu,1 De’an Wu,2 Hejing Wang,3 Jing Liu,4 Yanfei Chen5
1Dong Fureng Economic & Social Development School, Wuhan University, Wuhan, Hubei, People’s Republic of China; 2Department of Respiratory Medicine, The Third People’s Hospital of Gansu Province, Lanzhou, Gansu, People’s Republic of China; 3Research and Education Section, The Third People’s Hospital of Gansu Province, Lanzhou, Gansu, People’s Republic of China; 4Department of Medical Imaging, Hexi University, Zhangye, Gansu, People’s Republic of China; 5Department of Rheumatology and Immunology, The First Hospital of Lanzhou University, Lanzhou, Gansu, People’s Republic of China
Correspondence: De’an Wu, Email 3042146269@qq.com
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
1Dong Fureng Economic & Social Development School, Wuhan University, Wuhan, Hubei, People’s Republic of China; 2Department of Respiratory Medicine, The Third People’s Hospital of Gansu Province, Lanzhou, Gansu, People’s Republic of China; 3Research and Education Section, The Third People’s Hospital of Gansu Province, Lanzhou, Gansu, People’s Republic of China; 4Department of Medical Imaging, Hexi University, Zhangye, Gansu, People’s Republic of China; 5Department of Rheumatology and Immunology, The First Hospital of Lanzhou University, Lanzhou, Gansu, People’s Republic of China
Correspondence: De’an Wu, Email 3042146269@qq.com
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