title: Effect of clarithromycin on acute asthma exacerbations in children: an open randomized study.
abstract: BACKGROUND
  Asthma exacerbations are major contributors to asthma morbidity and rather difficult to treat. There is inconclusive evidence that macrolide antibiotics may have an effect on asthma exacerbations through their antibacterial and/or anti-inflammatory properties. The aim of the study was to evaluate the efficacy of clarithromycin on medium-term asthma activity when given as an add-on therapy in children with acute asthma.
  
  
  METHODS
  This pilot, open-labeled, randomized, prospective study included 40 school-aged children, with intermittent or mild persistent asthma, presenting with an acute exacerbation. Children were randomized to receive 15 mg/kg of clarithromycin for 3 wk, in addition to their regular (GINA-guided) exacerbation treatment. The microbial trigger of exacerbations was assessed by serology and PCR. Children were followed up with diary cards for 12 wk; lung function was assessed at entry, 3, and 12 wk after the exacerbation.
  
  
  RESULTS
  Children in the clarithromycin group had significantly more symptom-free days (78 ± 2 vs. 69 ± 6 days, p < 0.00001) and less total number of periods with loss of control (9 vs. 19, respectively, p = 0.013) during the follow-up period, compared to controls. Moreover, treated children presented reduced duration of the index episode (5.0 ± 1 vs. 7.5 ± 1 days, p < 0.00001). Lung function did not differ between groups.
  
  
  CONCLUSIONS
  When added to regular treatment, a 3-wk course of clarithromycin was associated with an increase in the number of symptom-free days, reductions in the number and severity of days with loss of control following index episode, and a decrease in the duration of the initial asthma exacerbation.
authors.affiliation: Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Koutsoubari
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Papaevangelou
authors.forename: George N
authors.initials: GN
authors.lastname: Konstantinou
authors.forename: Heidi
authors.initials: H
authors.lastname: Makrinioti
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Xepapadaki
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kafetzis
authors.forename: Nikolaos G
authors.initials: NG
authors.lastname: Papadopoulos
mesh_terms: D000208:Acute Disease; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D017291:Clarithromycin / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D000900:Anti-Bacterial Agents; D017291:Clarithromycin