Macrocycle molecules for the management of systemic infections: the clarithromycin paradigm.

Macrolides currently play a major role in the management of severe infections. Evidence derives from several retrospective studies have shown a significant reduction of mortality from community-acquired pneumonia upon treatment with a macrolide. Apart from other explanations, their effect is probably mediated through modulation of the immune function of the host. Supporting this inference are results from various studies which have shown that macrolides, such as clarithromycin, prolonged survival and modulate monocytes functions in both animal models and clinical presentation of pyelonephritis and sepsis of Gram-negative pathogens. The present review focuses on how the concept of macrolide function within the human immune system has evolved in recent years. Particular emphasis is on the role of macrolides in the treatment of sepsis syndrome. Many of the findings herein discussed have created a novel perspective for the management of sepsis syndrome with 14-membered macrolide, specifically clarithromycin.