title: Effect of clarithromycin on cytokines and chemokines in children with an acute exacerbation of recurrent wheezing: a double-blind, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Clarithromycin is postulated to possess immunomodulatory properties in addition to its antimicrobial activity.
  
  
  OBJECTIVE
  To evaluate the effect of clarithromycin on serum and nasopharyngeal cytokine and chemokine concentrations in children with an acute exacerbation of recurrent wheezing.
  
  
  METHODS
  Children with a history of recurrent wheezing or asthma and who presented with an acute exacerbation of wheezing were enrolled in a double-blind, randomized trial of clarithromycin vs placebo. Concentrations of tumor necrosis factor alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-1beta (IL-1beta), IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, RANTES, eotaxin, macrophage inflammatory protein 1alpha, macrophage inflammatory protein 1beta, and monocyte chemoattractant protein 1 were measured in serum and/or nasopharyngeal aspirates before, during, and after therapy. Mycoplasma pneumoniae and Chlamydophila pneumoniae infection were evaluated for by polymerase chain reaction and serologic testing.
  
  
  RESULTS
  Nasopharyngeal concentrations of TNF-alpha, IL-1beta, and IL-10 were significantly and persistently lower in children treated with clarithromycin compared with placebo. There tended to be a greater effect of clarithromycin on nasopharyngeal cytokine concentrations in patients with evidence of M. pneumoniae or C. pneumoniae infection. No significant differences were detected in serum cytokines for children treated with clarithromycin compared with placebo.
  
  
  CONCLUSIONS
  Clarithromycin therapy reduces mucosal TNF-alpha, IL-1beta, and IL-10 concentrations in children with an acute exacerbation of recurrent wheezing.
authors.affiliation: Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Fonseca-Aten
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Okada
authors.forename: Karen L
authors.initials: KL
authors.lastname: Bowlware
authors.forename: Susana
authors.initials: S
authors.lastname: Chavez-Bueno
authors.forename: Asuncion
authors.initials: A
authors.lastname: Mejias
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Rios
authors.forename: Kathy
authors.initials: K
authors.lastname: Katz
authors.forename: Kurt
authors.initials: K
authors.lastname: Olsen
authors.forename: Simon
authors.initials: S
authors.lastname: Ng
authors.forename: Hasan S
authors.initials: HS
authors.lastname: Jafri
authors.forename: George H
authors.initials: GH
authors.lastname: McCracken
authors.forename: Octavio
authors.initials: O
authors.lastname: Ramilo
authors.forename: R Doug
authors.initials: RD
authors.lastname: Hardy
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D001992:Bronchoalveolar Lavage Fluid / Q000276:immunology; D018925:Chemokines / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use*; D016207:Cytokines / Q000097:blood*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D012008:Recurrence; D012135:Respiratory Sounds / Q000187:drug effects* / Q000276:immunology
chemical_list: D018925:Chemokines; D016207:Cytokines; D010919:Placebos; D017291:Clarithromycin