[The role of intracellular bacteria in etiology of lower airways infection--therapeutic implications].

Intracellular, non capsulated atypical bacteria (Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila) colonise lower airways very often. Atypical bacteria cause acute infection and exacerbation of chronic inflammation of bronchial tree, mainly chronic obstructive pulmonary disease (COPD). They may trigger bronchial asthma and induce asthma exacerbation. These pathogens are often isolated in sputum of patients suffering from asthma and COPD in stable clinical stage, but opinion about eradication of bacteria in this situation is controversial. Lately, much attention has been paid to immunogenic possibilities of atypical bacteria, especially Chlamydia penumoniae in pathomechanisms of asthma and COPD. Macrolides from near a half century have been a therapeutic option against intracellular pathogens. These highly lipophylic compounds very easily penetrate cellular membrane, act on subunit 50S of ribosome decreasing reproduction of bacteria in infected epithelial cells. Universal anti-inflammatory action of macrolides is due to their influence on pro-inflammatory cells (neutrophils, eosinophils, lymphocytes CD8) and in consequence decrease of releasing inflammatory mediators (myeloperoxidase, elastase, leukotrien B4, interleukin 8).