Effect of clarithromycin on cytokines and chemokines in children with an acute exacerbation of recurrent wheezing: a double-blind, randomized, placebo-controlled trial.
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.
Fonseca-Aten
Monica
M
Departments of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.
Okada
Pamela J
PJ
Bowlware
Karen L
KL
Chavez-Bueno
Susana
S
Mejias
Asuncion
A
Rios
Ana Maria
AM
Katz
Kathy
K
Olsen
Kurt
K
Ng
Simon
S
Jafri
Hasan S
HS
McCracken
George H
GH
Ramilo
Octavio
O
Hardy
R Doug
RD
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
D018925:Chemokines; D016207:Cytokines; D010919:Placebos; D017291:Clarithromycin