Adam C Gaunt, Rishi Sharma and Sally Erskine
Unified Airways Disease (UAD) encompasses distinct clinical entities including chronic rhinosinusitis and asthma and gives credence to the hypothesis that these are different facets of the same disease process. Macrolide antibiotics are derived from the prototypic macrolide erythromycin. This was discovered in the early 1950’s as an isolate from the soil bacteria Saccharopolyspora erythraea and it is known to be a primarily bacteriostatic agent. Macrolides are a commonly used class of antibiotic that are known to have actions beyond their primary bactericidal functions and have been shown to be of benefit in conditions affecting all constituents of the airway, including chronic rhinosinusitis, asthma, diffuse panbronchiolitis and cystic fibrosis. These properties include potent anti-inflammatory and immunomodulatory effects. Promising results that have been shown with the use of macrolide therapies in airways diseases gives hope that there may be a wider application for them in Unified Airways Disease (UAD). A key property that macrolides (and newer generation ketolides) possess is the ability to interfere with protein translation at the 50s subunit of the bacterial ribosome. It is feasible that this action allows macrolides to disrupt the cellular processes related to bacterial proliferation and influence the inflammatory response, decreasing the production of inflammatory proteins and cytokines and disrupting biofilm formation. Macrolides are well established drugs with a known side-effect profile and relatively low cost and therefore could provide a cost-effective alternative to other costly therapies or surgeries.
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