ObjectiveTo systematically review the clinical efficacy of low-dose erythromycin in patients with stable chronic obstructive pulmonary disease (COPD). MethodsRandomized controlled trials (RCTs) about low-dose erythromycin plus routine treatment versus routine treatment/placebo plus routine treatment in treating stable COPD was electronically searched in PubMed, EMbase, CBM, The Cochrane Library (Issue 4, 2013), CNKI, VIP and WanFang Data from the their establishment dates to May 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. The results of meta-analysis was performed using RevMan 5.2 software. ResultsA total of eight RCTs involving 526 patients were finally included. The results of metaanalysis showed that:a) compared with the control group, low-dose erythromycin significantly improved six-minute walk distance (SMD=0.30, 95%CI 0.05 to 0.55, P=0.02), reduced the frequency of acute exacerbation (RR=0.44, 95%CI 0.25 to 0.78, P=0.005), and decreased the concentrations of IL-8 (SMD=-1.63, 95%CI-2.17 to-1.09, P < 0.000 01), TNF-α (SMD=-1.49, 95%CI-2.36 to-0.62, P=0.000 8), and neutrophil elastase (NE) (SMD=-0.94, 95%CI-1.36 to-0.51, P < 0.000 1) in sputum. b) the erythromycin therapy could improve forced expiratory volume in one second (FEV1) (SMD=0.19, 95%CI-0.19 to 0.58, P=0.32) but without significant differences compared with the control group. ConclusionLow-dose erythromycin could improve exercise tolerance, reduce the frequency of acute exacerbation, and help relieve airway inflammation, but in the improvement of FEV1, low-dose erythromycin is not better than routine treatment. Due to limited quantity and quality of the included studies, larger scale, multicenter, high quality RCTs are needed to verify the aforementioned conclusion.