[Maintenance treatment with macrolide antibiotics in COPD: not for everyone].

Several studies and meta-analyses have recently shown a positive effect of maintenance treatment with macrolide antibiotics in patients with chronic obstructive pulmonary disease (COPD). The next step is not to implement this therapy on a large scale, but to restrict the use of antibiotics as much as possible. In a recent meta-analysis, maintenance therapy with macrolides reduced exacerbation frequency and improved quality of life (Wang et al., 2018). Comparable effects have been observed in patients with rare inflammatory pulmonary diseases. However, it is arguable to restrict maintenance therapy in clinical practice, since the effects on exacerbation rate and quality of life are limited. Furthermore, long-term antibiotics have various side effects and induce microbial resistance. A practical approach is to restrict maintenance therapy to patients with three or more exacerbations per year despite optimal treatment. We propose that macrolide treatment should only be continued long-term after a successful initial six-month trial with clearly defined end-points.