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Effect of clarithromycin on experimental rhinovirus-16 colds: a randomized, double-blind, controlled trial
J A Abisheganaden1, P C Avila, J L Kishiyama
1Division of Allergy and Immunology, Department of Medicine and the Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA.
Purpose:
Macrolide antibiotics are frequently prescribed to patients with symptoms of a common cold. Despite their lack of proven antiviral activity, macrolide antibiotics may have anti-inflammatory actions, such as inhibition of mucus secretion and production of interleukins 6 and 8 by epithelial cells. Because the symptoms of rhinovirus colds are attributed to the inflammatory response to infection, we studied the effects of treatment with clarithromycin on the symptomatic and inflammatory response to nasal inoculation with rhinovirus.
Subjects And Methods:
We performed a prospective, double-blind, controlled trial in 24 healthy subjects who were seronegative for antibodies to rhinovirus-16. Subjects were randomly assigned to receive either clarithromycin (500 mg) or trimethoprim-sulfamethoxazole (800/160 mg, as a control antibiotic) twice a day for 8 days, beginning 24 hours before inoculation with rhinovirus-16.
Results:
All 12 subjects in each group were infected and developed symptomatic colds. The groups did not differ in the intensity of cold symptoms (median [25th to 75th percentile] score in the clarithromycin group of 25 [5 to 33] versus 21 [11 to 26] in the trimethoprim-sulfamethoxazole group, P = 0.86), weight of nasal secretions (25 g [8 to 56 g] versus 12 g [5 to 28 g], P = 0.27), or decline in nasal peak flow during the 8 days following viral inoculation. In both groups, similar and significant increases from baseline were observed in the numbers of total cells and neutrophils, and in the concentrations of interleukins 6 and 8, in nasal lavage fluid during the cold. The changes that we observed did not differ from those in an untreated historical control group.
Conclusions:
We conclude that clarithromycin treatment has little or no effect on the severity of cold symptoms or the intensity of neutrophilic nasal inflammation in experimental rhinovirus-16 colds.
Insights
Clarithromycin did not significantly reduce cold symptoms or inflammation in a study of experimental rhinovirus infections. This macrolide antibiotic showed no benefit over a control antibiotic in managing common cold symptoms.
Area of Science:
- Infectious Diseases
- Pharmacology
- Immunology
Background:
- Macrolide antibiotics are commonly prescribed for common cold symptoms despite lacking proven antiviral activity.
- Macrolides may possess anti-inflammatory properties, potentially reducing mucus and interleukin production by epithelial cells.
- Cold symptoms are largely due to the inflammatory response to viral infection.
Purpose of the Study:
- To investigate the effects of clarithromycin on symptomatic and inflammatory responses to rhinovirus infection.
- To assess if clarithromycin's potential anti-inflammatory actions benefit patients with experimental rhinovirus colds.
Main Methods:
- A prospective, double-blind, controlled trial involving 24 healthy subjects.
- Subjects received either clarithromycin or trimethoprim-sulfamethoxazole (control) for 8 days, starting 24 hours before rhinovirus-16 inoculation.
- Outcomes measured included cold symptom intensity, nasal secretion weight, nasal peak flow, and inflammatory markers in nasal lavage fluid.
Main Results:
- All subjects in both groups developed symptomatic colds.
- No significant differences were observed between clarithromycin and control groups in symptom severity, nasal secretions, or nasal peak flow.
- Both groups showed similar increases in inflammatory cells and cytokines (interleukins 6 and 8) in nasal lavage fluid, comparable to untreated historical controls.
Conclusions:
- Clarithromycin treatment demonstrated minimal to no effect on the severity of common cold symptoms.
- The study found no significant impact of clarithromycin on the intensity of neutrophilic nasal inflammation in experimental rhinovirus colds.