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Yadav S, Shah D, Dalai P, Agrawal-Rajput R. The tale of antibiotics beyond antimicrobials: Expanding horizons. Cytokine 2023; 169:156285. [PMID: 37393846 DOI: 10.1016/j.cyto.2023.156285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/02/2023] [Accepted: 06/24/2023] [Indexed: 07/04/2023]
Abstract
Antibiotics had proved to be a godsend for mankind since their discovery. They were once the magical solution to the vexing problem of infection-related deaths. German scientist Paul Ehrlich had termed salvarsan as the silver bullet to treatsyphilis.As time passed, the magic of newly discovered silver bullets got tarnished with raging antibiotic resistance among bacteria and associated side-effects. Still, antibiotics remain the primary line of treatment for bacterial infections. Our understanding of their chemical and biological activities has increased immensely with advancement in the research field. Non-antibacterial effects of antibiotics are studied extensively to optimise their safer, broad-range use. These non-antibacterial effects could be both useful and harmful to us. Various researchers across the globe including our lab are studying the direct/indirect effects and molecular mechanisms behind these non-antibacterial effects of antibiotics. So, it is interesting for us to sum up the available literature. In this review, we have briefed the possible reason behind the non-antibacterial effects of antibiotics, owing to the endosymbiotic origin of host mitochondria. We further discuss the physiological and immunomodulatory effects of antibiotics. We then extend the review to discuss molecular mechanisms behind the plausible use of antibiotics as anticancer agents.
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Affiliation(s)
- Shivani Yadav
- Immunology Lab, Department of Biotechnology and Bioengineering, Indian Institute of Advanced Research, Gandhinagar, India
| | - Dhruvi Shah
- Immunology Lab, Department of Biotechnology and Bioengineering, Indian Institute of Advanced Research, Gandhinagar, India
| | - Parmeswar Dalai
- Immunology Lab, Department of Biotechnology and Bioengineering, Indian Institute of Advanced Research, Gandhinagar, India
| | - Reena Agrawal-Rajput
- Immunology Lab, Department of Biotechnology and Bioengineering, Indian Institute of Advanced Research, Gandhinagar, India.
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Amoxicillin Did Not Reduce Modic Change Edema in Patients With Chronic Low Back Pain: Subgroup Analyses of a Randomised Trial (the AIM Study). Spine (Phila Pa 1976) 2023; 48:147-154. [PMID: 36223435 PMCID: PMC9812422 DOI: 10.1097/brs.0000000000004513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 10/05/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Exploratory subgroup analyses of a randomised trial [Antibiotics in Modic changes (AIM) study]. OBJECTIVE The aim was to assess the effect of amoxicillin versus placebo in reducing Modic change (MC) edema in patients with chronic low back pain. SUMMARY OF BACKGROUND DATA The AIM study showed a small, clinically insignificant effect of amoxicillin on pain-related disability in patients with chronic low back pain and MC type 1 (edema type) on magnetic resonance imaging (MRI). MATERIALS AND METHODS A total of 180 patients were randomised to receive 100 days of amoxicillin or placebo. MC edema was assessed on MRI at baseline and one-year follow-up. Per-protocol analyses were conducted in subgroups with MC edema on short tau inversion recovery (STIR) or T1/T2-weighted MRI at baseline. MC edema reductions (yes/no) in STIR and T1/T2 series were analyzed separately. The effect of amoxicillin in reducing MC edema was analyzed using logistic regression adjusted for prior disk surgery. To assess the effect of amoxicillin versus placebo within the group with the most abundant MC edema on STIR at baseline ("STIR3" group), we added age, STIR3 (yes/no), and STIR3×treatment group (interaction term) as independent variables and compared the marginal means (probabilities of edema reduction). RESULTS Compared to placebo, amoxicillin did not reduce MC edema on STIR (volume/intensity) in the total sample with edema on STIR at baseline (odds ratio 1.0, 95% CI: 0.5, 2.0; n=141) or within the STIR3 group (probability of edema reduction 0.69, 95% CI: 0.47, 0.92 with amoxicillin and 0.61, 95% CI: 0.43, 0.80 with placebo; n=41). Compared with placebo, amoxicillin did not reduce MC edema in T1/T2 series (volume of the type 1 part of MCs) (odds ratio: 1.0, 95% CI: 0.5, 2.3, n=104). Edema declined in >50% of patients in both treatment groups. CONCLUSIONS From baseline to one-year follow-up, amoxicillin did not reduce MC edema compared with placebo. LEVEL OF EVIDENCE 2.
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Sinopalnikov AI, Rachina SA, Vasilyeva IS, Pigusova NA, Karpova OY. Clarithromycin for community-acquired pneumonia in adults: focus on anti-inflammatory properties. TERAPEVT ARKH 2023; 94:1394-1400. [PMID: 37167184 DOI: 10.26442/00403660.2022.12.202008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
Aim. To evaluate clinical efficacy, anti-inflammatory and immunomodulatory activity of clarithromycin in adults with severe community-acquired pneumonia (sCAP).
Materials and methods. A prospective observational study recruited adult hospitalized patients with verified sCAP. Clarithromycin was prescribed as a component of combination antibiotic therapy (ABT) with a -lactam antibiotic (AB). The choice of -lactam AB was carried out by the attending physician in accordance with national clinical guidelines and routine practice of the medical institution. Along with assessment clinical efficacy, the dynamics of inflammatory markers in blood serum was recorded: C-reactive protein, procalcitonin (PCT), tumor necrosis factor , interleukins 1-beta (IL-1) and interleukin 6 (IL-6). The total duration of ABT was 714 days.
Results. Altogether 20 patients (13 males, 7 females) aged from 18 to 84 years old were enrolled. As a result of the use of combined ABT with -lactam AB and clarithromycin, a significant decrease in the level of C-reactive protein was noted by the 35th day of therapy (from 74.6 to 14.1 mg/l). An increase in serum PCT was observed in half of the patients; during treatment, the level of PCT significantly decreased. Similar dynamics was detected for IL-6 its content in the blood serum decreased by the time of the end of ABT by 6.8 times compared with the baseline. A decrease in the level of tumor necrosis factor to the reference value was observed in most patients already in the early stages by 35 days of ABT. The majority of patients showed positive dynamics of clinical signs and symptoms with resolution of respiratory failure and other complications of sCAP. In almost half of the patients, the criteria for clinical stability were achieved in the early stages, which made it possible to switch to oral ABT.
Conclusion. The results of the study are consistent with literature data indicating a rapid decrease in inflammatory markers when clarithromycin is administered to patients with sCAP. Its results can be a starting point for comparative randomized trials assessing both clinical outcomes and immunological parameters when using different classes of antibiotics for the treatment of sCAP.
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Yamamoto K, Hosogaya N, Sakamoto N, Yoshida H, Ishii H, Yatera K, Izumikawa K, Yanagihara K, Mukae H. Efficacy of clarithromycin in patients with mild COVID-19 pneumonia not receiving oxygen administration: protocol for an exploratory, multicentre, open-label, randomised controlled trial (CAME COVID-19 study). BMJ Open 2021; 11:e053325. [PMID: 34548368 PMCID: PMC8458001 DOI: 10.1136/bmjopen-2021-053325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has emerged worldwide. Although several medications have been approved for treating moderate-to-severe COVID-19, very few treatment strategy has been established for patients with mild COVID-19 who do not require oxygen administration. Clarithromycin is a macrolide antimicrobial agent that has been widely used for bacterial respiratory infectious diseases. Clarithromycin also acts an immunomodulating drug and suppresses cytokine storms in viral respiratory diseases, including influenza. In this study, we aim to evaluate the efficacy of clarithromycin in patients with mild COVID-19. METHODS AND ANALYSIS This is an exploratory, multicentre, open-label, randomised controlled trial. This study was initiated in May 2021 and will end in July 2022. Patients with mild COVID-19 pneumonia who do not require oxygen administration will be enrolled and randomly assigned in a 1:1:1 ratio to group A (administration of clarithromycin 800 mg/day), group B (administration of clarithromycin 400 mg/day) or group C (standard treatment without clarithromycin). The planned number of enrolled patients is 60 (20 patients × three groups). The primary endpoint is the number of days required to improve the clinical symptoms as measured by the severity score. Secondary endpoints include days for recovery of the body temperature, proportion of patients with oxygen administration, inflammatory cytokines, viral load, serum immunoglobulins, peripheral blood lymphocytes, blood biomarkers and pneumonia infiltrations. ETHICS AND DISSEMINATION The study protocol was approved by the Clinical Research Review Board of Nagasaki University in accordance with the Clinical Trials Act in Japan. The study will be conducted in accordance with the Declaration of Helsinki, the Clinical Trials Act and other current legal regulations in Japan. Written informed consent will be obtained from all the participants. The results of this study will be reported as journal publications. TRIAL REGISTRATION NUMBER jRCTs071210011.
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Affiliation(s)
- Kazuko Yamamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
- Clinical Research Center, National Organization Hospital Nagasaki Medical Center, Omura, Japan
| | - Naoki Hosogaya
- Clinical Research Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Noriho Sakamoto
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Haruo Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hiroshi Ishii
- Department of Respiratory Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Katsunori Yanagihara
- Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
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Mehboob S, Rafi ST, Mehjabeen, Khan H. Serum Immunoglobulin E and Serotonin levels in Chronic Supporative Otitis Media Patients with and without treatment. Pak J Med Sci 2021; 37:1414-1418. [PMID: 34475922 PMCID: PMC8377913 DOI: 10.12669/pjms.37.5.2414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/10/2020] [Accepted: 05/30/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To determine the serum immunoglobulin E and serotonin levels of patients with chronic suppurative otitis media (CSOM) with and without treatment. Methods: This is a case-control study carried out in ENT ward of Jinnah Postgraduate Medical Centre Karachi Pakistan from May to September 2018.. Sample (n=160) was divided into four groups (40 individuals per group) as G1: control negative (group-1 without any disease), G2: positive control (patients didn’t received medicines), G3: group (patients treated with co-amoxicillin 1000mg per day) and G4: group (patients treated with ciprofloxacin1000mg per day). After treatment period of One week serum immunoglobulin E and serotonin concentrations were evaluated by Elisa method at 450nm.Statistical evaluation was carried out using one-way ANOVA (p<0.05) followed by post hoc (tukey test) for further group comparison. In order to find out correlation between IgE and serotonin with CSOM Pearson’s correlation was applied. Results: There was no significant (p > 0.05) association found between genders with serotonin as well as with IgE levels in CSOM patients. One way ANOVA showed significant difference (p<0.05) for IgE and serotonin levels and post hoc (tukey test) showed significant higher of IgE levels in CSOM patients of G2 positive control (diseased patients) was observed when compared to the control negative group (healthy individuals) and also from treated groups of G3 and G4. This also showed that serotonin levels were significantly low in G2 (positive control) as well as in treated groups of G3 and G4 in contrast with healthy individuals of group G1. Conclusion: Antibiotics may revert the higher levels of IgE but cannot attenuate the decreased levels of neurotransmitter (serotonin) like healthy individuals, therefore, depression levels of CSOM patients should be monitored, scored and attenuated with proper intervention of antidepressants or counseling.
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Affiliation(s)
- Shafaque Mehboob
- Shafaque Mehboob, Assistant Professor, Institute of Pharmacy, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Sm Tariq Rafi
- SM Tariq Rafi, Vice Chancellor, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mehjabeen
- Mehjabeen, Dean of Pharmacy, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan
| | - Hurtimania Khan
- Hurtimania Khan, Ear, Nose and Throat Department, Jinnah Post Graduate Center, Karachi, Pakistan
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Stoeckle JH, Davies FE, Williams L, Boyle EM, Morgan GJ. The evolving role and utility of off-label drug use in multiple myeloma. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2021; 2:355-373. [PMID: 36046752 PMCID: PMC9400732 DOI: 10.37349/etat.2021.00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022] Open
Abstract
The treatment landscape for multiple myeloma (MM) has dramatically changed over the last three decades, moving from no US Food and Drug Administration approvals and two active drug classes to over 19 drug approvals and at least eight different active classes. The advances seen in MM therapy have relied on both a structured approach to obtaining new labels and cautious off-label drug use. Although there are country and regional differences in drug approval processes, many of the basic principles behind off-label drug use in MM can be summarized into four main categories: 1) use of a therapy prior to the current approval regulations; 2) widespread use of a therapy following the release of promising clinical trial results but prior to drug approval; 3) use of a cheap therapy supported by clinical safety and efficacy data but without commercial backing; and 4) niche therapies for small well-defined patient populations where large clinical trials with sufficient power may be difficult to perform. This review takes a historical approach to discuss how off-label drug use has helped to shape the current treatment approach for MM.
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Affiliation(s)
- James H Stoeckle
- Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Faith E Davies
- Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Louis Williams
- Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Eileen M Boyle
- Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
| | - Gareth J Morgan
- Perlmutter Cancer Center, New York University Langone Health, New York, NY 10016, USA
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Ferreira-Coimbra J, Sarda C, Rello J. Burden of Community-Acquired Pneumonia and Unmet Clinical Needs. Adv Ther 2020; 37:1302-1318. [PMID: 32072494 PMCID: PMC7140754 DOI: 10.1007/s12325-020-01248-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/26/2022]
Abstract
Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.
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Affiliation(s)
- João Ferreira-Coimbra
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Cristina Sarda
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
- CIBERES-Centro de investigación en red de enfermedades respiratorias, Madrid, Spain
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López‐Alcalde J, Rodriguez‐Barrientos R, Redondo‐Sánchez J, Muñoz‐Gutiérrez J, Molero García JM, Rodríguez‐Fernández C, Heras‐Mosteiro J, Marin‐Cañada J, Casanova‐Colominas J, Azcoaga‐Lorenzo A, Hernandez Santiago V, Gómez‐García M. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Cochrane Database Syst Rev 2018; 9:CD009070. [PMID: 30188565 PMCID: PMC6513237 DOI: 10.1002/14651858.cd009070.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a lung infection that can be acquired during day-to-day activities in the community (not while receiving care in a hospital). Community-acquired pneumonia poses a significant public health burden in terms of mortality, morbidity, and costs. Shorter antibiotic courses for CAP may limit treatment costs and adverse effects, but the optimal duration of antibiotic treatment is uncertain. OBJECTIVES To evaluate the efficacy and safety of short-course versus longer-course treatment with the same antibiotic at the same daily dosage for CAP in non-hospitalised adolescents and adults (outpatients). We planned to investigate non-inferiority of short-course versus longer-term course treatment for efficacy outcomes, and superiority of short-course treatment for safety outcomes. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE, Embase, five other databases, and three trials registers on 28 September 2017 together with conference proceedings, reference checking, and contact with experts and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing short- and long-courses of the same antibiotic for CAP in adolescent and adult outpatients. DATA COLLECTION AND ANALYSIS We planned to use standard Cochrane methods. MAIN RESULTS Our searches identified 5260 records. We did not identify any RCTs that compared short- and longer-courses of the same antibiotic for the treatment of adolescents and adult outpatients with CAP.We excluded two RCTs that compared short courses (five compared to seven days) of the same antibiotic at the same daily dose because they evaluated antibiotics (gemifloxacin and telithromycin) not commonly used in practice for the treatment of CAP. In particular, gemifloxacin is no longer approved for the treatment of mild-to-moderate CAP due to its questionable risk-benefit balance, and reported adverse effects. Moreover, the safety profile of telithromycin is also cause for concern.We found one ongoing study that we will assess for inclusion in future updates of the review. AUTHORS' CONCLUSIONS We found no eligible RCTs that studied a short-course of antibiotic compared to a longer-course (with the same antibiotic at the same daily dosage) for CAP in adolescent and adult outpatients. The effects of antibiotic therapy duration for CAP in adolescent and adult outpatients remains unclear.
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Affiliation(s)
- Jesús López‐Alcalde
- Universidad Francisco de Vitoria (UFV) MadridFaculty of MedicineCtra. Pozuelo‐Majadahonda km. 1,800MadridSpain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)Clinical Biostatistics UnitCtra. Colmenar, km. 9.100MadridSpain28034
| | - Ricardo Rodriguez‐Barrientos
- Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Unidad de apoyo a la InvestigaciónJátiva Nº23 2ºcMadridSpain28007
| | - Jesús Redondo‐Sánchez
- Gerencia Asistencial Atención PrimariaCentro de Salud Ramon y CajalJabonería 67MadridSpain28921
| | - Javier Muñoz‐Gutiérrez
- Gerencia Asistencial Atención PrimariaCentro de Salud Buenos AiresPio FelipeMadridSpain28038
| | - José María Molero García
- Gerencia Asistencial Atención PrimariaCentro de Salud San AndrésAlberto Palacios, nº 22MadridMadridSpain28021
| | | | - Julio Heras‐Mosteiro
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
| | - Jaime Marin‐Cañada
- Gerencia Asistencial Atencion Primaria de MadridCentro de Salud Villarejo de SalvanesCalle Hospital 7Villarejo de SalvanesMadridSpain28590
| | - Jose Casanova‐Colominas
- Gerencia Asistencial de Atención PrimariaCentro de Salud Ciudad de los PeriodistasValencia de don Juan 1028034 MadridMadridSpain28034
| | - Amaya Azcoaga‐Lorenzo
- Gerencia Asistencial Atención PrimariaCentro de Salud Los PintoresC/Prolongación Cordoba s/nParlaMadridSpain29981
| | - Virginia Hernandez Santiago
- University of St AndrewsDivision of Population and Behavioural Sciences, School of MedicineNorth HaughDundeeUKKY16 9TF
| | - Manuel Gómez‐García
- Gerencia Asistencial Atención PrimariaCentro de Salud MirasierraC/ Mirador de la Reina nº 117MadridSpain28035
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Arnold FW, Lopardo G, Wiemken TL, Kelley R, Peyrani P, Mattingly WA, Feldman C, Gnoni M, Maurici R, Ramirez JA. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia. Respir Med 2018; 140:115-121. [PMID: 29957272 DOI: 10.1016/j.rmed.2018.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 05/23/2018] [Accepted: 05/28/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. MATERIALS AND METHODS Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. RESULTS Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50-1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30-0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. CONCLUSIONS In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.
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Affiliation(s)
- Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Gustavo Lopardo
- Hospital Professor Bernardo Houssay, Buenos Aires, Argentina.
| | - Timothy L Wiemken
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Robert Kelley
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Paula Peyrani
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - William A Mattingly
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Martin Gnoni
- Good Samaritan Hospital, Cincinnati, OH, United States.
| | - Rosemeri Maurici
- University Hospital, Federal University of Santa Catarina, Santa Catarina, Brazil.
| | - Julio A Ramirez
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Louisville, Louisville, KY, United States.
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Lee N, Wong CK, Chan MCW, Yeung ESL, Tam WWS, Tsang OTY, Choi KW, Chan PKS, Kwok A, Lui GCY, Leung WS, Yung IMH, Wong RYK, Cheung CSK, Hui DSC. Anti-inflammatory effects of adjunctive macrolide treatment in adults hospitalized with influenza: A randomized controlled trial. Antiviral Res 2017; 144:48-56. [PMID: 28535933 DOI: 10.1016/j.antiviral.2017.05.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION - Macrolides can ameliorate inflammation in respiratory diseases, providing clinical benefits. Data in influenza is lacking. METHOD - A randomized, open-label, multicenter trial among adults hospitalized for laboratory-confirmed influenza was conducted. Study treatments of oseltamivir and azithromycin (500 mg/day), or oseltamivir alone, both for 5 days, were allocated at 1:1 ratio. The primary outcome was plasma cytokine/chemokine concentration change over time (Day 0-10); secondary outcomes were viral load and symptom score changes. Generalized Estimating Equation (GEE) models were used to analyze longitudinal data. RESULTS - Fifty patients were randomized to the oseltamivir-azithromycin or oseltamivir groups, with comparable baseline characteristics (age, 57 ± 18 years; A/H3N2, 70%), complications (72%), and viral load. Pro-inflammatory cytokines IL-6 (GEE: β -0.037, 95%CI-0.067,-0.007, P = 0.016; reduction from baseline -83.4% vs -59.5%), CXCL8/IL-8 (β -0.018, 95%CI-0.037,0.000, P = 0.056; -80.5% vs -58.0%), IL-17 (β -0.064, 95%CI-0.117,-0.012, P = 0.015; -74.0% vs -34.3%), CXCL9/MIG (β -0.010, 95%CI-0.020,0.000, P = 0.043; -71.3% vs -56.0%), sTNFR-1, IL-18, and CRP declined faster in the oseltamivir-azithromycin group. There was a trend toward faster symptom resolution (β -0.463, 95%CI-1.297,0.371). Viral RNA decline (P = 0.777) and culture-negativity rates were unaffected. Additional ex vivo studies confirmed reduced induction of IL-6 (P = 0.017) and CXCL8/IL-8 (P = 0.005) with azithromycin. CONCLUSION - We found significant anti-inflammatory effects with adjunctive macrolide treatment in adults with severe influenza infections. Virus control was unimpaired. Clinical benefits of a macrolide-containing regimen deserve further study. [ClinicalTrials.gov NCT01779570].
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Affiliation(s)
- Nelson Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong.
| | - Chun-Kwok Wong
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Martin C W Chan
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
| | - Esther S L Yeung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Wilson W S Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - Owen T Y Tsang
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Kin-Wing Choi
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Paul K S Chan
- Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong; Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
| | - Angela Kwok
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong
| | - Grace C Y Lui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wai-Shing Leung
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Irene M H Yung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Rity Y K Wong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Catherine S K Cheung
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - David S C Hui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong.
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Arnold FW, Bordon J, Fernandez-Botran R, Rane MJ, Uriarte SM, Kelley R, Wiemken TL, Peyrani P, Ramirez JA. Macrolide Use and Neutrophil Function/Cytokine Levels in Hospitalized Patients with Community-Acquired Pneumonia: A Pilot Study. Lung 2015; 194:155-62. [PMID: 26553025 DOI: 10.1007/s00408-015-9822-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/30/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE 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.
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Affiliation(s)
- Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA.
| | - Jose Bordon
- Section of Infectious Diseases, Providence Hospital, Washington, DC, USA
| | - Rafael Fernandez-Botran
- Department of Pathology and Laboratory Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Madhavi J Rane
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Silvia M Uriarte
- Division of Nephrology and Hypertension, Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Robert Kelley
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA
| | - Timothy L Wiemken
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA
| | - Paula Peyrani
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA
| | - Julio A Ramirez
- Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, 501 E. Broadway; Suite 140 B, Louisville, KY, 40202, USA
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12
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Trotti LM, Saini P, Bliwise DL, Freeman AA, Jenkins A, Rye DB. Clarithromycin in γ-aminobutyric acid-Related hypersomnolence: A randomized, crossover trial. Ann Neurol 2015; 78:454-65. [PMID: 26094838 DOI: 10.1002/ana.24459] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 05/22/2015] [Accepted: 05/31/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Some central hypersomnolence syndromes are associated with a positive allosteric modulator of γ-aminobutyric acid (GABA)-A receptors in cerebrospinal fluid. Negative allosteric modulators of GABA-A receptors, including clarithromycin, have been reported to reduce sleepiness in these patients. We sought to systematically assess the effects of clarithromycin on objective vigilance and subjective sleepiness. METHODS This was a 5-week, randomized, placebo-controlled, double-blind, crossover trial of clarithromycin 500mg with breakfast and lunch, in patients with hypersomnolence syndromes (excluding narcolepsy with cataplexy) and evidence for abnormal cerebrospinal fluid potentiation of GABA-A receptors. The study occurred at a university-affiliated medical center. The primary outcome measure was median reaction time on the psychomotor vigilance task (PVT) at week 2 in each condition. Secondary outcomes included the Epworth Sleepiness Scale, Stanford Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Pittsburgh Sleep Quality Index, SF-36, and additional PVT measures. RESULTS Twenty-three patients began treatment. Three patients dropped out, and final analyses were performed on 20 complete cases. Median reaction time was not significantly different between clarithromycin and placebo. Subjective measures of sleepiness were significantly improved on clarithromycin versus placebo. Altered taste perception occurred, but was the only side effect more common on clarithromycin than placebo. No serious adverse events occurred. INTERPRETATION Subjective sleepiness, but not psychomotor vigilance, improved during a 2-week course of clarithromycin. Although additional studies are needed, this suggests that clarithromycin may be a reasonable treatment option in patients with treatment-refractory hypersomnolence. This trial was registered at ClinicalTrials.gov (NCT01146600) and supported by the American Sleep Medicine Foundation.
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Affiliation(s)
| | | | | | | | - Andrew Jenkins
- Department of Anesthesia, Emory University School of Medicine, Atlanta, GA
| | - David B Rye
- Department of Neurology and Emory Sleep Center
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Lorenzo MJ, Moret I, Sarria B, Cases E, Cortijo J, Méndez R, Molina J, Gimeno A, Menéndez R. Lung inflammatory pattern and antibiotic treatment in pneumonia. Respir Res 2015; 16:15. [PMID: 25849726 PMCID: PMC4328072 DOI: 10.1186/s12931-015-0165-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 01/05/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND In community-acquired pneumonia host inflammatory response against the causative microorganism is necessary for infection resolution. However an excessive response can have deleterious effects. In addition to antimicrobial effects, macrolide antibiotics are known to possess immunomodulatory properties. METHODS A prospective study was performed on 52 admitted patients who developed an inadequate response after 72 hours of antibiotic treatment - non-responders community-acquired pneumonia - (blood and bronchoalveolar lavage), and two control groups: 1) community-acquired pneumonia control (blood) and 2) non-infection control (blood and bronchoalveolar lavage). Cytokine profiles (interleukin (IL)-6, IL-8, IL-10), tumour necrosis factor α and clinical outcomes were assessed. RESULTS Non-responders patients treated with macrolide containing regimens showed significantly lower levels of IL-6 and TNF-α in bronchoalveolar lavage fluid and lower IL-8 and IL-10 in blood than those patients treated with non-macrolide regimens. Clinical outcomes showed that patients treated with macrolide regimens required fewer days to reach clinical stability (p < 0.01) and shorter hospitalization periods (p < 0.01). CONCLUSIONS After 72 hours of antibiotic effect, patients who received macrolide containing regimens exhibited lower inflammatory cytokine levels in pulmonary and systemic compartments along with faster stabilization of infectious parameters.
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14
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Ghosh N, Tucker N, Zahurak M, Wozney J, Borrello I, Huff CA. Clarithromycin overcomes resistance to lenalidomide and dexamethasone in multiple myeloma. Am J Hematol 2014; 89:E116-20. [PMID: 24723438 DOI: 10.1002/ajh.23733] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 03/25/2014] [Accepted: 04/07/2014] [Indexed: 12/17/2022]
Abstract
The combination of clarithromycin, lenalidomide and dexamethasone (BiRd) has led to highly durable responses in newly diagnosed myeloma. However, the ability of clarithromycin to overcome resistance to lenalidomide and dexamethasone (Rd) is not known. To study this, we performed a retrospective analysis of 24 patients with myeloma for which clarithromycin was added to Rd at the time of progression on Rd. The median number of prior therapies was 3 (range 1-8). The best response was complete response (CR) in one (4.2%), very good partial response (VGPR) in one (4.2%) and partial response in eight (33.3%) patients. Ten patients, 41.7% (95% CI: 22.1, 63.4), achieved ≥PR. The median time to response was 4.4 months (range 1-13.6 months) and the median duration of response was 6.9 months (range 3-52.2 months). The clinical benefit rate (CR + VGPR + PR + MR) was 45.8% (95% CI 25.6, 67.2). The median progression-free survival was 4 months. Median overall survival was 25 months with a median follow-up of 27.5 months. The regimen was well tolerated and only 2 patients needed a clarithromycin dose reduction. Addition of clarithromycin to Rd can overcome resistance to Rd in a subset of patients and lead to durable clinical responses.
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Affiliation(s)
- Nilanjan Ghosh
- Levine Cancer Institute, Carolinas Healthcare System; Charlotte North Carolina
| | - Noah Tucker
- The Sidney Kimmel Comprehensive Cancer Center and Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Marianna Zahurak
- The Sidney Kimmel Comprehensive Cancer Center and Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Jocelyn Wozney
- The Sidney Kimmel Comprehensive Cancer Center and Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Ivan Borrello
- The Sidney Kimmel Comprehensive Cancer Center and Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Carol Ann Huff
- The Sidney Kimmel Comprehensive Cancer Center and Department of Oncology; The Johns Hopkins University School of Medicine; Baltimore Maryland
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15
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Kiesewetter B, Lukas J, Kuchar A, Mayerhoefer ME, Müllauer L, Raderer M. Clarithromycin Leading to Complete Remission in the First-Line Treatment of Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma. J Clin Oncol 2014; 33:e130-2. [PMID: 24778391 DOI: 10.1200/jco.2013.49.8006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Meijvis SCA, van de Garde EMW, Rijkers GT, Bos WJW. Treatment with anti-inflammatory drugs in community-acquired pneumonia. J Intern Med 2012; 272:25-35. [PMID: 22583070 DOI: 10.1111/j.1365-2796.2012.02554.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pneumonia exhibits a broad range of severity, from mildly symptomatic at one end to fulminant septic shock and death at the other. Although an adequate inflammatory response is necessary for the clearance of microorganisms, excessive inflammation can lead to ongoing local and systemic damage. Because of this extended inflammatory response despite appropriate antibiotic therapy, as well as increasing antibiotic resistance, adjuvant therapy for pneumonia that can favourably modify the immune response has become an increasingly relevant approach to improve prognosis. Different adjuvant treatment options for pneumonia have recently been proposed. Promising treatment options include corticosteroids, statins, macrolides and Toll-like receptor antagonists. The aim of this review is to summarize the inflammatory response during pneumonia and discuss the current knowledge and future perspectives regarding the anti-inflammatory treatment options for patients with pneumonia.
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Affiliation(s)
- S C A Meijvis
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
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Sepsis Immunopathology: Perspectives of Monitoring and Modulation of the Immune Disturbances. Arch Immunol Ther Exp (Warsz) 2012; 60:123-35. [DOI: 10.1007/s00005-012-0166-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Accepted: 11/07/2011] [Indexed: 02/02/2023]
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Kovaleva A, Remmelts HHF, Rijkers GT, Hoepelman AIM, Biesma DH, Oosterheert JJ. Immunomodulatory effects of macrolides during community-acquired pneumonia: a literature review. J Antimicrob Chemother 2011; 67:530-40. [DOI: 10.1093/jac/dkr520] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Canzoneri BJ, Grotegut CA, Swamy GK, Brancazio LR, Sinclair T, Heine PR, Murtha AP. Maternal serum interleukin-6 levels predict impending funisitis in preterm premature rupture of membranes after completion of antibiotics. J Matern Fetal Neonatal Med 2011; 25:1329-32. [PMID: 22046977 DOI: 10.3109/14767058.2011.632794] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine if maternal serum interleukin-6 (IL-6) levels remain predictive of funisitis after completion of antibiotic administration in preterm premature rupture of membranes (PPROM). METHODS A secondary analysis of a prospective cohort study. Daily blood samples obtained from PPROM subjects were analyzed for IL-6 by enzyme-linked immunosorbent assay. Subjects (N = 39) delivered >7 days post admission and were divided into those with and without funisitis. Data were analyzed using Mann-Whitney U test. RESULTS Maternal serum IL-6 levels obtained 24-48 hours and 48-72 hours before delivery are elevated in PPROM subjects with funisitis compared to those without funisitis (6.3 vs. 2.7 pg/ml, P < 0.03; 6.1 vs. 1.7 pg/ml, P < 0.02). Receiver operator characteristic curve revealed an IL-6 level of 1.98 pg/ml had sensitivity of 86.7%, specificity of 46.7%, positive predictive value of 61.9% and negative predictive value of 77.8%. CONCLUSION This data suggests that maternal serum IL-6 levels continue to be predictive of PPROM subjects destined to develop funisitis after completion of antibiotics.
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Affiliation(s)
- Bernard J Canzoneri
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Mechanisms of action and clinical application of macrolides as immunomodulatory medications. Clin Microbiol Rev 2010; 23:590-615. [PMID: 20610825 DOI: 10.1128/cmr.00078-09] [Citation(s) in RCA: 438] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Macrolides have diverse biological activities and an ability to modulate inflammation and immunity in eukaryotes without affecting homeostatic immunity. These properties have led to their long-term use in treating neutrophil-dominated inflammation in diffuse panbronchiolitis, bronchiectasis, rhinosinusitis, and cystic fibrosis. These immunomodulatory activities appear to be polymodal, but evidence suggests that many of these effects are due to inhibition of extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation and nuclear factor kappa B (NF-kappaB) activation. Macrolides accumulate within cells, suggesting that they may associate with receptors or carriers responsible for the regulation of cell cycle and immunity. A concern is that long-term use of macrolides increases the emergence of antimicrobial resistance. Nonantimicrobial macrolides are now in development as potential immunomodulatory therapies.
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Padrones S, Garcia-Vidal C, Fernández-Serrano S, Fernández A, Masuet C, Carratalà J, Coromines M, Ardanuy C, Gudiol F, Manresa F, Dorca J. Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia. Eur J Clin Microbiol Infect Dis 2010; 29:1243-51. [PMID: 20567869 DOI: 10.1007/s10096-010-0993-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 06/01/2010] [Indexed: 11/28/2022]
Abstract
The aim of this study was to compare the evolution of systemic cytokine levels over time in patients with pneumococal pneumonia treated either with β-lactam monotherapy or with combination therapy (β-lactam plus fluoroquinolone). Prospective observational study of hospitalized non-immunocompromised adults with PP. Concentrations of IL-6, IL-8, IL-10, and TNF-α were determined on days 0, 1, 2, 3, 5, and 7. Patients on β-lactam monotherapy were compared with those receiving combination therapy. Fifty-two patients were enrolled in the study. Concentrations of IL-6, IL-8, and IL-10 decreased rapidly in the first days after admission, in accordance with the mean time to defervescence. High levels of IL-6 were found in patients with the worst outcomes, measured by the need for intensive care unit admission and mortality. No major differences in demographic or clinical characteristics or severity of disease were found between patients treated with β-lactam monotherapy and those treated with combination therapy. IL-6 levels fell more rapidly in patients with combination therapy in the first 48 h (p = 0.016). Our data suggest that systemic expression of IL-6 production in patients with PP correlates with prognosis. Initial combination antibiotic therapy produces a faster decrease in this cytokine in the first 48 h.
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Affiliation(s)
- S Padrones
- Respiratory Medicine, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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22
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Macrolides beyond the conventional antimicrobials: a class of potent immunomodulators. Int J Antimicrob Agents 2007; 31:12-20. [PMID: 17935949 DOI: 10.1016/j.ijantimicag.2007.08.001] [Citation(s) in RCA: 141] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Accepted: 08/04/2007] [Indexed: 11/22/2022]
Abstract
The historical change in the natural course of diffuse panbronchiolitis (DPB), a fatal disorder of the airways, following the introduction of erythromycin in its treatment has focused attention of researchers on the anti-inflammatory properties of macrolides. Chronic inflammation of the airways accompanied by infiltration by neutrophils and overproduction of mucus and pro-inflammatory cytokines is observed in bronchial asthma, cystic fibrosis (CF), DPB, chronic obstructive pulmonary disease (COPD) and bronchiectasis. The airways of these patients are often colonised by mucoid Pseudomonas aeruginosa attached to epithelium by a biofilm. Bacteria intercommunicate for biofilm formation by a system of lactones known as quorum sensing. Macrolides inhibit mobility and quorum sensing of P. aeruginosa; they also decrease production of mucus by epithelial cells and biosynthesis of pro-inflammatory cytokines from monocytes and epithelial cells by inhibiting nuclear factor-kappaB. Large, randomised clinical trials for the management of these disorders with macrolides are not available, with the sole exception of four trials denoting benefit following long-term administration of azithromycin in patients with CF. That benefit is consistent with an increase in forced expiratory volume in 1s (FEV(1)) and a decrease in the rate of bacterial exacerbations. Studies with small numbers of patients with COPD revealed attenuation of the inflammatory reaction by macrolides. Experimental studies of Gram-negative sepsis have shown considerable attenuation of the systemic inflammatory response following intravenous administration of clarithromycin. Results of the effects of clarithromycin in patients with ventilator-associated pneumonia and sepsis in a large, randomised study of 200 patients are awaited.
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Michelow IC, Katz K, McCracken GH, Hardy RD. Systemic cytokine profile in children with community-acquired pneumonia. Pediatr Pulmonol 2007; 42:640-5. [PMID: 17534977 DOI: 10.1002/ppul.20633] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Characterization of the systemic cytokine response in community-acquired pneumonia (CAP) may facilitate our understanding of the host immune response and provide a prognostic as well as diagnostic tool. Systemic cytokine characterization of CAP has been limited largely to a few integral cytokines in adults. METHODS Analyses were performed to investigate whether significant relationships existed between an expanded serum cytokine profile and etiologies, manifestations, and outcomes of pediatric CAP. The serum concentrations of 15 cytokines were investigated in 55 hospitalized children with well-characterized CAP. RESULTS Comparison of median cytokine concentrations among patients with CAP caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae, Streptococcus pneumoniae, viruses, mixed infections, or unidentified pathogens revealed significant differences in IFN-alpha, IL-6, IL-17, GM-CSF, and TNF-alpha concentrations. The mixed infections category had significantly elevated concentrations of IFN-alpha, IL-6, GM-CSF, and TNF-alpha. There were significant correlations between concentrations of IL-6 and markers of disease severity (white blood cell band-forms, procalcitonin, and unequivocal consolidation). No single cytokine could reliably differentiate the etiologic cause of pneumonia. CONCLUSIONS IL-6 is the only one of 15 serum cytokines studied that correlated with indicators of disease severity in childhood CAP. The applicability of cytokine profiles to identify microbiologic etiologies of pneumonia remains to be defined.
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Affiliation(s)
- Ian C Michelow
- Department of Pediatrics (Divisions of Infectious Diseases), University of Texas Southwestern Medical Center, Dallas, TX, USA
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