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Published Online, 13 July 2004, www.theannals.com, DOI 10.1345/aph.1D634.
 The Annals of Pharmacotherapy: Vol. 38, No. 9, pp. 1400-1405. DOI 10.1345/aph.1D634
© 2004 Harvey Whitney Books Company.
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PULMONARY

The Effect of Clarithromycin on Inflammatory Markers in Chronic Obstructive Pulmonary Disease: Preliminary Data

Ilknur Basyigit, MD

Assistant Professor, Chest Disease Department, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

Fusun Yildiz, MD

Associate Professor, Chest Disease Department, Faculty of Medicine, Kocaeli University

Sevgiye Kacar Ozkara, MD

Assistant Professor, Pathology Department, Faculty of Medicine, Kocaeli University

Elif Yildirim, MD

Research Fellow, Chest Disease Department, Faculty of Medicine, Kocaeli University

Hasim Boyaci, MD

Assistant Professor, Chest Disease Department, Faculty of Medicine, Kocaeli University

Ahmet Ilgazli, MD

Associate Professor, Chest Disease Department, Faculty of Medicine, Kocaeli University

Reprints: Ilknur Basyigit MD, Chest Disease Department, Kocaeli University, Kocaeli, Turkey, PK 14 Derince 41900, Kocaeli/TURKEY, fax 90 262 233 54 88, dr_basyigit{at}yahoo.com

BACKGROUND: Clarithromycin is an antimicrobial agent that can be used for treatment of chronic obstructive pulmonary disease (COPD) exacerbations with bronchodilator therapy. However, it has also been shown that clarithromycin has antiinflammatory effects by the inhibition of cytokine production.

OBJECTIVE: To evaluate the antiinflammatory effect of clarithromycin on serum and sputum interleukin-8 (IL-8), tumor necrosis factor-{alpha} (TNF-{alpha}), and leukotriene B4 levels in patients with COPD.

METHODS: Thirty men with mild to moderate COPD were enrolled in this prospective, single-center, double-blind, placebo-controlled study. None of the patients was receiving systemic or inhaled corticosteroids during the study. Subjects received either clarithromycin or placebo for 14 days. Before and after this treatment period, spirometric tests and arterial blood gas analysis were performed, blood was drawn for measurement of serum inflammatory markers, and sputum was induced.

RESULTS: There were no statistically significant differences in baseline clinical or laboratory parameters between the groups. After the treatment, the induced sputum total cell counts, and IL-8 and TNF-{alpha} levels decreased significantly in the clarithromycin group compared with pretreatment levels (mean ± SD IL-8 1606 ± 367.3 vs 882 ± 143.6 pg/mL, p = 0.001; TNF-{alpha} 638.2 ± 287.5 vs 390 ± 235 pg/mL, p = 0.001). Similarly, decreases in serum inflammatory markers were found in the clarithromycin group while there was no significant change in the placebo group.

CONCLUSIONS: This study demonstrated that the decrease in IL-8 and TNF-{alpha} levels might be related to the antiinflammatory effect of clarithromycin. Thus, we suggest that the use of clarithromycin in COPD exacerbations may either treat the infection or help control the inflammation. Future studies are needed to determine the clinical significance of these findings.

Key Words: chronic obstructive pulmonary disease, clarithromycin, inflammation, interleukin-8, tumor necrosis factor-{alpha}

Published Online, July 13, 2004. www.theannals.com, DOI 10.1345/aph.1D634


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