British Thoracic Society guideline for the use of long-term macrolides in adults with respiratory disease

If oral macrolide therapy is considered, justification for ongoing treatment should be guided by clinical response based on specific outcome measures including exacerbation frequency, symptoms and quality of life assessed at baseline. (Strong) Macrolides can be considered with the aim of improving quality of life but may require a long period of therapy (eg, 1 year) for significant effects. Chronic obstructive pulmonary disease Recommendations Long-term macrolide therapy could be considered for patients with COPD with more than three acute exacerbations requiring steroid therapy and at least one exacerbation requiring hospital admission per year to reduce exacerbation rate. Subsequent follow-up at 6 and 12 months should determine whether benefit is being derived from therapy by using objective measures such as the exacerbation rate, CAT score or Quality of Life as measured by a validated assessment tool such as SGRQ.