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Effect of 14-membered ring macrolide therapy on chronic respiratory tract infections and polymorphonuclear leukocyte
1Department of Internal Medicine, Hamamatsu University School of Medicine.
Abstract:
We studied the efficacy of the long-term administration of 14-membered ring macrolides in treating patients with diffuse panbronchiolitis (DPB) (34 patients) and bronchiectasis (BE) (40 patients). Oral administration of erythromycin (400 or 600 mg), roxithromycin (150 or 300 mg) or clarithromycin (200 or 400 mg) given daily for at least 2 months, was evaluated. The efficacy of erythromycin, roxithromycin, and clarithromycin in DPB was 19/24 (79%), 6/7 (86%), and 2/3 (67%), respectively. Efficacy of these agents in BE exceeded 50%. We determined the effect of these macrolides on the activity of polymophonuclear leukocytes (PMNs) obtained from healthy volunteers. There were no significant differences between the effects of these 14-membered ring macrolides and josamycin, a 16-membered ring macrolide which was previously found to be ineffective in treating DPB. Thus, the effectiveness of the 14-membered ring macrolides in treating DPB appears to depend on mechanism(s) other than alterations in PMN activity.
Insights
Long-term use of 14-membered ring macrolides like erythromycin, roxithromycin, and clarithromycin shows significant efficacy in treating diffuse panbronchiolitis (DPB) and bronchiectasis (BE). Their effectiveness in DPB may stem from mechanisms beyond altering polymorphonuclear leukocyte (PMN) activity.
Area of Science:
- Respiratory Medicine
- Pharmacology
Background:
- Diffuse panbronchiolitis (DPB) and bronchiectasis (BE) are chronic respiratory conditions requiring effective long-term management.
- Macrolide antibiotics are utilized for their anti-inflammatory and antimicrobial properties.
Purpose of the Study:
- To evaluate the long-term efficacy of 14-membered ring macrolides in treating DPB and BE.
- To investigate the potential mechanisms of action, specifically the effect on polymorphonuclear leukocyte (PMN) activity.
Main Methods:
- A study involving 34 patients with DPB and 40 patients with BE.
- Oral administration of erythromycin, roxithromycin, or clarithromycin for at least two months.
- Assessment of macrolide effects on PMN activity from healthy volunteers.
Main Results:
- Efficacy rates for erythromycin, roxithromycin, and clarithromycin in DPB were 79%, 86%, and 67%, respectively.
- Treatment efficacy for bronchiectasis exceeded 50% for the studied macrolides.
- No significant differences in PMN activity modulation were observed between effective 14-membered ring macrolides and ineffective josamycin (a 16-membered ring macrolide).
Conclusions:
- 14-membered ring macrolides demonstrate significant long-term therapeutic value in managing DPB and BE.
- The therapeutic benefits of these macrolides in DPB likely involve mechanisms independent of direct effects on PMN activity.