A systematic review and meta-analysis have found that macrolide antibiotics — commonly used to treat bacterial infections — may offer meaningful clinical benefits for people with asthma, including better symptom control and fewer severe exacerbations. The research findings were outlined in the paper, “Macrolides for Asthma: A Systematic Review and Meta-Analysis of Randomized Trials,” published in the Journal of Allergy and Clinical Immunology.
The analysis was conducted as part of the upcoming American Academy of Allergy, Asthma and Immunology (AAAAI)/American College of Allergy, Asthma and Immunology (ACAAI) Joint Task Force on Practice Parameters (JTFPP) guidelines. Researchers evaluated data from 19 randomized controlled trials encompassing 1,825 participants. They reviewed studies sourced from MEDLINE, EMBASE and the Cochrane CENTRAL database through April 2025. Reviewers independently screened and extracted data before analyzing results using random‑effects models.
Key findings from the study concluded that macrolides:
- Improve overall asthma control, with participants seeing a statistically significant reduction on the Asthma Control Questionnaire (ACQ-6) scoring system
- Likely reduce severe asthma exacerbations, with a notable decrease in event frequency
- Modestly improve quality of life, based on the Asthma Quality of Life Questionnaire (AQLQ)
Importantly, nearly 41% of patients taking macrolides experienced clinically meaningful improvement in asthma control — almost double the rate of those on placebo. The review also reported little to no difference in serious adverse events or mortality between macrolide therapy and placebo, suggesting that the treatment may be relatively safe for appropriately selected patients.
According to researchers, the positive effects were consistent among both T2‑high and T2‑low asthma phenotypes. This suggests macrolides may provide therapeutic value across diverse inflammatory profiles, a finding they said may influence future treatment pathways.
Given the consistent benefits reported and the high-to-moderate certainty of evidence, these results may influence forthcoming U.S. asthma guidelines, the authors wrote — particularly for patients with severe or difficult‑to‑control asthma who have limited treatment options.
