Effect of clarithromycin on experimental rhinovirus-16 colds: a randomized, double-blind, controlled trial.
OBJECTIVE
Macrolide antibiotics are frequently prescribed to patients with symptoms of a common cold. Despite their lack of proven antiviral activity, macrolide antibiotics may have anti-inflammatory actions, such as inhibition of mucus secretion and production of interleukins 6 and 8 by epithelial cells. Because the symptoms of rhinovirus colds are attributed to the inflammatory response to infection, we studied the effects of treatment with clarithromycin on the symptomatic and inflammatory response to nasal inoculation with rhinovirus.


METHODS
We performed a prospective, double-blind, controlled trial in 24 healthy subjects who were seronegative for antibodies to rhinovirus-16. Subjects were randomly assigned to receive either clarithromycin (500 mg) or trimethoprim-sulfamethoxazole (800/160 mg, as a control antibiotic) twice a day for 8 days, beginning 24 hours before inoculation with rhinovirus-16.


RESULTS
All 12 subjects in each group were infected and developed symptomatic colds. The groups did not differ in the intensity of cold symptoms (median [25th to 75th percentile] score in the clarithromycin group of 25 [5 to 33] versus 21 [11 to 26] in the trimethoprim-sulfamethoxazole group, P = 0.86), weight of nasal secretions (25 g [8 to 56 g] versus 12 g [5 to 28 g], P = 0.27), or decline in nasal peak flow during the 8 days following viral inoculation. In both groups, similar and significant increases from baseline were observed in the numbers of total cells and neutrophils, and in the concentrations of interleukins 6 and 8, in nasal lavage fluid during the cold. The changes that we observed did not differ from those in an untreated historical control group.


CONCLUSIONS
We conclude that clarithromycin treatment has little or no effect on the severity of cold symptoms or the intensity of neutrophilic nasal inflammation in experimental rhinovirus-16 colds.
Abisheganaden
J A
JA
Division of Allergy and Immunology, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA.
Avila
P C
PC
Kishiyama
J L
JL
Liu
J
J
Yagi
S
S
Schnurr
D
D
Boushey
H A
HA
D000328:Adult; D000900:Anti-Bacterial Agents / Q000276:immunology / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use; D017291:Clarithromycin / Q000276:immunology / Q000627:therapeutic use*; D003139:Common Cold / Q000097:blood / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007249:Inflammation; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D007958:Leukocyte Count / Q000187:drug effects; D008297:Male; D017817:Nasal Lavage Fluid / Q000737:chemistry / Q000276:immunology / Q000821:virology; D009504:Neutrophils / Q000187:drug effects; D011446:Prospective Studies; D012229:Rhinovirus / Q000145:classification; D012720:Severity of Illness Index; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D015850:Interleukin-6; D016209:Interleukin-8; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D017291:Clarithromycin