Macrolides and diseases associated with loss of epithelial barrier integrity

In addition to the antiinflammatory/immunoregulatory actions of macrolide antibiotics, more recent investigations indicate the potential barrier-protective effects of these drugs on the epithelium. This chapter builds on and expands the chapters on the cytoprotective effects of macrolides, on airway epithelial cells, and on mucoregulatory effects of this drug class on the respiratory mucosa, which were published in 2005 in a previous PIR volume on Antibiotics as antiinflammatory and immunoregulatory agents. Birkhäuser Basel, Basel, 2005 (75); Takeyama K, in: Antibiotics as antiinflammatory and immunomodulatory agents [Internet]. Birkhäuser Basel, Basel, 2005; 96). We consider here the accumulated clinical literature on the subject, including more recent publications since the last PIR review, which particularly concern azithromycin and its efficacy in the treatment of patients with asthma and chronic obstructive pulmonary disease (COPD). We also mention possible effects of barrier-protective macrolides on the dermal and gut epithelium, suggesting their potential for efficacy in the treatment of skin and gut diseases associated with epithelial barrier injury.