Bacterial infections bronchiolitis

Against the bacterial modulation concept are a range of arguments that involve both mechanistic studies on inflammatory processes reported here and more circumstantial evidence derived from clinical studies. For example, in lung transplant, one phenomenon of chronic rejection of the graft is known as bronchiolitis obliterans. Around 40% of patients with this condition respond to treatment with azithromycin and detailed studies suggest that these are the sub-set of patients in which neutrophilia in the airway contributes to the apparent disease. Administration of azithromycin leads to fewer neutrophils in the airway and recovery of airway function. Other forms of bronchiolitis obliterans appear not to respond to azithromycin. Responses are obtained in the absence of clear infection and so in this example it is reasoned that the macrolide effect is an immunomodulatory one. ° ... 

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