There is inconclusive evidence that macrolide antibiotics may have an effect on asthma exacerbations through their antibacterial and/or anti-inflammatory properties. Some of the previous studies have been disappointing, for example, adding clarithromycin to inhaled steroid in uncontrolled asthma was ineffectiveThis open-label, randomized, prospective study from Greece included 40 school-aged children with intermittent or mild persistent asthma, presenting with an acute exacerbation. Clarithromycin was given as an add-on therapy, at a dose of 15 mg/kg for 3 weeks.
Children in the clarithromycin group had more symptom-free days (78 vs. 69 days) and less periods with loss of control (9 vs. 19) compared to controls. They had a reduced duration of the index episode (5.0 vs. 7.5 days). However, lung function did not differ between groups.
The authors concluded that when added to regular treatment, a 3-week course of clarithromycin was associated with an increase in the number of symptom-free days, reductions in the number and severity of days with loss of control following index episode, and a decrease in the duration of the initial asthma exacerbation.
It would be interesting to see if these findings can be replicated in a larger population and in children with higher severity of asthma.
References:
Koutsoubari I, Papaevangelou V, Konstantinou GN, Makrinioti H, Xepapadaki P, Kafetzis D, Papadopoulos NG. Effect of clarithromycin οn acute asthma exacerbations in children: an open pilot randomized study. Pediatric Allergy Immunology 2011: 00.
Adding clarithromycin to inhaled steroid in uncontrolled asthma was ineffective
Image source: Clarithromycin structure, Wikipedia, public domain.
Comments from Twitter:
KevFrost @kevfrost: 20 kids who were told they were getting antibiotics did better on subjective scores than 20 that were told they werent?
AnneMarie Cunningham @amcunningham: yes- not such a surprising result... Interested in anti-inflam suggestion of action