L’asthme, le cardiologue, les médicaments : questions soulevées par les macrolides

Abstract

Erythromycin was discovered in the early 1950s, the development in the 1980s of new generation macrolides with an improvement in their pharmacokinetic properties and their tolerance led to a renewed interest in this family of antibiotics. They are indicated in respiratory tract infections, sexually transmitted diseases and gastrointestinal infections. In addition to their antibacterial property, macrolides would have antiviral and also immunomodulatory properties, which would have motivated the search for new therapeutic indications. After the discovery of the activity of erythromycin on diffuse panbronchiolitis with reduced symptoms and improved life expectancy, studies have shown that macrolides reduce exacerbations in patients with COPD, asthma, bronchiectasis and cystic fibrosis. Macrolides have also been proposed in the treatment of coronary heart disease. In severe asthma, azithromycin has been proposed in certain endotypes as prolonged treatment for several months, the efficacy would be related to an immunomodulatory effect. Prolonged prescription of macrolides, in addition to the risk of resistance development, increases adverse effects. Apart the frequent digestive side effects, macrolides can lead to a prolongation of the QT interval. There is then a risk of torsades de pointes, ventricular tachycardia and ventricular fibrillation. The highest risk is observed with erythromycin, the lowest with azithromycin. Patients with cardiac disorders, as well as those taking anti-arrhythmics or drugs known to cause interactions, should be carefully monitored.