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As well as these beneficial effects, however, it is important to realize that side effects such as gastrointestinal upset, raised transaminase levels, cardiac arrhythmias (particularly prolonged QT interval related), auditory impairment, urogenital candidiasis and, lastly, and possibly most importantly, the risk of microbial macrolide resistance, particularly non-tuberculous mycobacteria (NMT), may occur.30,43 Therefore, macrolides cannot be recommended as routine therapy for non-CF BE before further research is carried out, although their use, particularly azithromycin, can be considered in selected patients.4,44 In patients with frequent respiratory exacerbations or continuous symptoms for more than 6 months, particularly if chronically infected with Pseudomonas aeruginosa, a trial of 36 months of 3 times per week 250500mg azithromycin can be done after ruling out NTM infection.4,44 Transaminase monitoring should be performed in the first few weeks of treatment and then, as well as NTM screening, every 6 months if there is evidence of benefit to the patient in terms of quality of life and frequency of exacerbations and the therapy is not discontinued.4 There are no studies to support either the effectiveness or safety of treatments of more than 12 months duration

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