Macrolides in Community-Acquired Pneumonia: The Importance of the Non-Antimicrobial Effect

Community acquired pneumonia (CAP) is among the leading causes of death worldwide. Despite intense research in the field and the development of new therapies, mortality remains largely unaltered for the past three decades. Antimicrobial agents are the cornerstone of therapy against CAP, but sometimes despite early diagnosis and the initiation of antibiotics, mortality remains high. A possible explanation may be due to several other host-related factors that keep the septic reaction intense. Part of this intensity may be attributed to the host-pathogen interaction and the deterioration of the host that is evoked by an immunologic overreaction. There is substantial evidence that macrolides have an inmunomodulatory effect on the host immune response, with multiple observational and prospective studies supporting a significant increased survival rate in patients with CAP treated with macrolides. We will review the significance of this non-antimicrobial effect of macrolides for the management of CAP.