Effects of claritromycin on inflammatory parameters and clinical conditions in children with bronchiectasis.
BACKGROUND
The effects of the macrolides cannot be ascribed to their antibacterial action alone. Their immunoregulatory and anti-inflammatory functions are significant too. They are frequently used in the treatment of diffuse panbronchiolitis and cystic fibrosis (CF).


OBJECTIVE
To evaluate the effects of a macrolide antibiotic [clarithromycin (CAM)] on the process of inflammation [by measuring IL-8, TNF-alpha, IL-10 levels and cell profiles in bronchoalveolar lavage (BAL) fluid], pulmonary function and sputum production in children with steady-state bronchiectasis, secondary to causes other than CF or primary immunodeficiencies.


METHODS
Seventeen patients randomized to the treatment group received CAM and supportive therapies for 3 months and 17 patients in the control group were given supportive therapies only.


RESULTS
Compared with the control group, the treatment group showed a significant decrease in IL-8 levels, total cell count, neutrophil ratios in BAL fluid and daily sputum production at the end of the third month. There was also a significant increase in the treatment group's BAL fluid macrophage ratios. The differences in pulmonary function test parameters were not significant.


CONCLUSIONS
Use of CAM in children with steady-state bronchiectasis results in laboratory improvement by reducing the inflammatory processes in the lungs. No corresponding clinical improvement could be shown but although this is possible with long-term use, trial validation is necessary.
Chest Diseases Unit, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100-Ankara, Turkey. ebruy@hacettepe.edu.tr
E
E
Yalçin
N
N
Kiper
U
U
Ozçelik
D
D
Doğru
P
P
Firat
A
A
Sahin
M
M
Ariyürek
G
G
Mocan
N
N
Gürcan
A
A
Göçmen
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000188:drug therapy; D001987:Bronchiectasis / Q000188:drug therapy* / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology / Q000382:microbiology; D002648:Child; D017291:Clarithromycin / Q000627:therapeutic use*; D015169:Colony Count, Microbial; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D007958:Leukocyte Count; D008297:Male; D012129:Respiratory Function Tests; D013183:Sputum; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D000900:Anti-Bacterial Agents; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D017291:Clarithromycin