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 ineffective
This 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.
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