title: Boost of mucosal secretory immunoglobulin A response by clarithromycin in paediatric influenza.
abstract: OBJECTIVE
  The antiviral neuraminidase inhibitor oseltamivir (OSV) is used to treat influenza. The macrolide clarithromycin (CAM) is used to treat bacterial infections and has anti-inflammatory and immunomodulatory activities. This retrospective study investigated the immunomodulatory effects of CAM in children presenting with influenza A.
  
  
  METHODS
  The study recruited 40 children with acute influenza, and grouped them according to the treatment received: 5-day treatment with OSV (n = 14), CAM (n = 8), OSV + CAM (n = 12) and untreated (n = 6). The before and after treatment comparisons were made of the level of secretory IgA (sIgA) against influenza A virus (H3N2) and (H1N1), total sIgA, viral RNA copy numbers in nasopharyngeal aspirates and disease symptoms.
  
  
  RESULTS
  Infection induced anti-viral mucosal sIgA in the nasopharyngeal aspirates of most patients of all treatment groups. Particularly prominent increases in the levels were found in the CAM and OSV + CAM groups. Low induction of anti-viral sIgA was observed in the OSV group, but the addition of CAM to OSV augmented sIgA production and restored local mucosal sIgA levels. The frequency of residual cough in the OSV + CAM group was significantly lower than in the other groups including the group treated with OSV.
  
  
  CONCLUSIONS
  CAM boosted the nasopharyngeal mucosal immune response in children presenting with influenza A, even in those treated with OSV who had low production of mucosal anti-viral sIgA, and alleviated the symptoms of influenza.
authors.affiliation: Division of Enzyme Chemistry, Institute for Enzyme Research, Tokushima University, Tokushima 770-8503, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Sawabuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Iwase
authors.forename: Chika
authors.initials: C
authors.lastname: Ito
authors.forename: Dai
authors.initials: D
authors.lastname: Mizuno
authors.forename: Hajime
authors.initials: H
authors.lastname: Togari
authors.forename: Isamu
authors.initials: I
authors.lastname: Watanabe
authors.forename: Sadiqur R
authors.initials: SR
authors.lastname: Talukder
authors.forename: Junji
authors.initials: J
authors.lastname: Chida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kido
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000627:therapeutic use*; D003371:Cough / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D004359:Drug Therapy, Combination; D006801:Humans; D007070:Immunoglobulin A / Q000378:metabolism*; D007223:Infant; D009980:Influenza A virus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity; D007251:Influenza, Human / Q000150:complications / Q000188:drug therapy* / Q000276:immunology*; D009297:Nasal Mucosa / Q000276:immunology*; D053139:Oseltamivir / Q000627:therapeutic use; D015995:Prevalence; D012367:RNA, Viral / Q000378:metabolism; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D007070:Immunoglobulin A; D012367:RNA, Viral; D053139:Oseltamivir; D017291:Clarithromycin