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Mycoplasma pneumoniae and Chlamydia pneumoniae in asthma: effect of clarithromycin.

Chest 2002 Jun;121(6):1782-8 (ISSN: 0012-3692)

Kraft M; Cassell GH; Pak J; Martin RJ [Related Authors]
Department of Medicine, National Jewish Medical and Research Center and the University of Colorado Health Sciences Center, Denver, CO 80206, USA.

STUDY OBJECTIVES: To determine the effect of clarithromycin therapy in patients with asthma.

DESIGN: Randomized, double blind, placebo-controlled trial.

SETTING: A tertiary referral center.

PATIENTS OR PARTICIPANTS: Fifty-five subjects with chronic, stable asthma recruited from the general Denver, CO, community.

INTERVENTIONS: Patients underwent airway evaluation for Mycoplasma pneumoniae and Chlamydia pneumoniae by polymerase chain reaction (PCR) and culture, followed by treatment with clarithromycin, 500 bid, or placebo for 6 weeks.

MEASUREMENTS AND RESULTS: Outcome variables were lung function, sinusitis as measured by CT, and the inflammatory mediators tumor necrosis factor (TNF)-alpha, interleukin (IL)-2, IL-4, IL-5, and IL-12 messenger RNA (mRNA) measured via in situ hybridization, in airway biopsies, and BAL. Mycoplasma or chlamydia were detected by PCR in 31 of 55 asthmatics. Treatment resulted in a significant improvement in the FEV(1), but only in the PCR-positive subjects (2.50 +/- 0.16 to 2.69 +/- 0.19 L, mean +/- SEM; p = 0.05). This was not appreciated in the PCR-negative subjects (2.59 +/- 0.24 to 2.54 +/- 0.18 L, p = 0.85) or the PCR-positive or PCR-negative subjects who received placebo. Sinus CTs revealed no change in sinusitis with clarithromycin treatment. In situ hybridization revealed no significant difference in baseline airway tissue or BAL-mediator expression between the PCR-positive and PCR-negative subjects. However, the PCR-positive subjects who received clarithromycin demonstrated a reduction in TNF-alpha (p = 0.006), IL-5 (p = 0.007), and IL-12 (p = 0.004) mRNA in BAL and TNF-alpha mRNA in airway tissue (p = 0.0009). The PCR-negative subjects who received clarithromycin only demonstrated a reduction in TNF-alpha (p = 0.01) and IL-12 (p = 0.002) mRNA in BAL and TNF-alpha mRNA in airway tissue (p = 0.004). There were no significant differences in cytokine expression in those subjects who received placebo. CONCLUSIONS: These observations support the hypothesis that clarithromycin therapy improves lung function, but only in those subjects with positive PCR findings for M pneumoniae or C pneumoniae.

Major Subject Heading(s) Minor Subject Heading(s) CAS Registry / EC Numbers
    • Antibiotics, Macrolide [therapeutic use]
    • Asthma [drug therapy] [microbiology]
    • Chlamydophila pneumoniae [isolation & purification]
    • Clarithromycin [therapeutic use]
    • Mycoplasma pneumoniae [isolation & purification]
  • Adult
  • Asthma [immunology] [physiopathology]
  • Double-Blind Method
  • Forced Expiratory Volume
  • Interleukins [biosynthesis]
  • Polymerase Chain Reaction
  • Tumor Necrosis Factor [biosynthesis]
    • 0 (Antibiotics, Macrolide)
    • 0 (Interleukins)
    • 0 (Tumor Necrosis Factor)
    • 81103-11-9 (Clarithromycin)

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