Impact of Long-Term Erythromycin Therapy on the Oropharyngeal Microbiome and Resistance Gene Reservoir in Non-Cystic Fibrosis Bronchiectasis

• DOI: 10.1128/msphere.00103-18
• Publication Date: 2018-04-17T09:54:03Z
• Authors: Jocelyn M. Choo; Guy C. J. Abell; Rachel Thomson; Lucy Morgan; Grant Waterer; David L. Gordon; Steven L. Taylor; Lex E. X. Leong; Steve L. Wesselingh; Lucy D. Burr; Geraint B. Rogers
• Keywords: Adult; Male; 0301 basic medicine; antibiotic resistance; Cystic Fibrosis; Antibiotic resistance; bronchiectasis; 610; Oropharynx; Real-Time Polymerase Chain Reaction; Microbiology; 03 medical and health sciences; RNA, Ribosomal, 16S; Drug Resistance, Bacterial; Macrolide therapy; 1312 Molecular Biology; Actinomyces; Humans; Haemophilus parainfluenzae; Lung; Aged; oropharyngeal microbiome; Erythromycin Ethylsuccinate; Microbiota; 2404 Microbiology; Streptococcus; Sequence Analysis, DNA; Middle Aged; QR1-502; Anti-Bacterial Agents; Bronchiectasis; 3. Good health; Oropharyngeal microbiome; macrolide therapy; Female; Research Article

Recent demonstrations that long-term macrolide therapy can prevent exacerbations in chronic airways diseases have led to a dramatic increase in their use. However, little is known about the wider, potentially adverse impacts of these treatments. Substantial disruption of the upper airway commensal microbiota might reduce its contribution to host defense and local immune regulation, while increases in macrolide resistance carriage would represent a serious public health concern. Using samples from a randomized controlled trial, we show that low-dose erythromycin given over 48 weeks influences the composition of the oropharyngeal commensal microbiota. We report that macrolide therapy is associated with significant changes in the relative abundances of members of the Actinomyces genus and with significant increases in the carriage of transmissible macrolide resistance. Determining the clinical significance of these changes, relative to treatment benefit, now represents a research priority.