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AMBULATORY CARE

Use of Macrolides and Tetracyclines for Chronic Inflammatory Diseases

at time of writing, Pharmacy Practice Resident, Veterans Affairs Medical Center, Lexington, KY; now, Critical Care Resident, Virginia Commonwealth University, Richmond, VA

Martin E Evans, MD

Chief, Infectious Diseases Section, Veterans Affairs Medical Center; Professor, Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Kentucky, Lexington

Matthew T Lane, PharmD

Clinical Coordinator, Pharmacy Services, Veterans Affairs Medical Center, Lexington

Robert H Schosser, MD

Chief, Division of Dermatology; Professor, Department of Internal Medicine, School of Medicine, University of Kentucky

Robert P Rapp, PharmD

Professor of Pharmacy and Surgery, Division of Pharmaceutical Sciences and Practice, College of Pharmacy, University of Kentucky

Reprints: Dr. Evans, Division of Infectious Diseases, MN672, University of Kentucky School of Medicine, 800 Rose St., Lexington, KY 40536-0298, fax 859/323-8926, Martin.Evans{at}uky.edu

OBJECTIVE: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions.

DATA SOURCES: Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis.

STUDY SELECTION AND DATA EXTRACTION: Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based.

DATA SYNTHESIS: Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea.

CONCLUSIONS: The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.

Key Words: acne, blepharitis, cardiovascular disease, cystic fibrosis, macrolides, periodontitis, rheumatoid arthritis, rosacea, tetracyclines

Published Online, November 23, 2004. www.theannals.com, DOI 10.1345/aph.1E282

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-05-003-H01

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