OBJECTIVES : Azithromycin (AZM) is a macrolide antibiotic well known for its antibacterial action. It has anti-inflammatory effects apart from the bacteriostatic property. We aimed to assess the anti-inflammatory effects of AZM in lower respiratory diseases through a pooled analysis.

METHODS : A Comprehensive search was performed in PubMed/MEDLINE, Scopus, Cochrane, and Google Scholar, to find relevant articles up to January 2021 without any restrictions. The randomized controlled trials which assessed the anti-inflammatory effects of AZM in patients with lower respiratory disease were included in this study. The outcome of interest was change in immunological markers such as C-reactive protein (CRP), Interleukin 6 & 8 (IL-6 and IL-8) and Interferon-g (IFN-g). The quality of the included studies was assessed using the Cochrane Risk of Bias Assessment Tool.

RESULTS : Fifteen studies out of 2779 studies with 1205 participants were included in this meta-analysis. The mean treatment duration of the intervention was 18 weeks with mean dose of AZM 250mg/day. Though there was a reduction in CRP (WMD: -5.87 mg/l; 95% CI: -12.79 to 1.06; I²=76%; n=4), IL-6 (WMD: -0.03 pg/ml; 95% CI: -1.74 to 1.68; I²= 0%; n=2), IL-8 (WMD: -8.11 pg/ml; 95% CI: -18.66; to 2.44; I²= 76%; n=3), IFN-g (WMD: -19.38 pg/ml; 95% CI: -77.92 to 39.17; I²= 89%; n=2) in the AZM group compared to control, it was not significant.

CONCLUSIONS : Evidence suggests that AZM reduces inflammatory markers in lower respiratory diseases; however, the effect is not significant. Hence, AZM can be used as adjunctive therapy in respiratory disease to enhance the anti-inflammatory effects.