title: Macrolide Use and Neutrophil Function/Cytokine Levels in Hospitalized Patients with Community-Acquired Pneumonia: A Pilot Study.
abstract: OBJECTIVE
  The objective of this study was to measure plasma cytokine levels and blood neutrophil functions as well as clinical outcomes in hospitalized patients with community-acquired pneumonia (CAP) treated with or without macrolide use--a known modulator of inflammatory response.
  
  
  METHODS
  Subjects with CAP had peripheral blood analyzed for some neutrophil functions (degranulation of secretory vesicles and specific granules, respiratory burst response and phagocytosis) and ten cytokine levels measured in serum and sputum supernatants. Neutrophil function in healthy volunteers was also measured for reference. Values were measured on the day of enrollment, days 2-4 and 5-7, depending on a patient's length of stay. Early and late clinical outcomes were also evaluated. All values were compared between those treated with or without a macrolide.
  
  
  RESULTS
  A total of 40 subjects were in this study; 14 received macrolide treatment, and 26 did not. Neutrophil function in the macrolide group was not significantly different compared to the non-macrolide group. None of the median cytokine levels or IQRs were statistically significant between the groups. However, a trend toward decreased IL-6, IL-8, and IFN-γ levels, and favorable clinical outcomes were present in the macrolide group.
  
  
  CONCLUSIONS
  This pilot study showed no statistical difference between cytokine levels or neutrophil activity for CAP patients prescribed a macrolide containing regimen. Considering the trend of lower cytokine levels in the macrolide group when comparing the 5- to 7-day time period with the non-macrolide group, a full study with an appropriate sample size may be warranted.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA. f.arnold@louisville.edu.
authors.forename: Forest W
authors.initials: FW
authors.lastname: Arnold
authors.affiliation: Section of Infectious Diseases, Providence Hospital, Washington, DC, USA.
authors.forename: Jose
authors.initials: J
authors.lastname: Bordon
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernandez-Botran
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Madhavi J
authors.initials: MJ
authors.lastname: Rane
authors.affiliation: Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.
authors.forename: Silvia M
authors.initials: SM
authors.lastname: Uriarte
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Kelley
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Wiemken
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA.
authors.forename: Julio A
authors.initials: JA
authors.lastname: Ramirez
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D015550:Cell Degranulation; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000276:immunology; D016207:Cytokines / Q000097:blood* / Q000187:drug effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology / Q000502:physiology*; D010587:Phagocytosis; D010865:Pilot Projects; D011014:Pneumonia / Q000188:drug therapy* / Q000276:immunology*; D011446:Prospective Studies; D016897:Respiratory Burst
chemical_list: D000900:Anti-Bacterial Agents; D016207:Cytokines; D015850:Interleukin-6; D016209:Interleukin-8; D007371:Interferon-gamma; D017963:Azithromycin
keywords: Anti-inflammatory cytokines; Community-acquired pneumonia; Mortality; Neutrophil function; Pro-inflammatory cytokines