Corticosteroids with macrolides

Drugs that may interact with rifabutin include the following Anticoagulants, azole antifungal agents, benzodiazepines, beta blockers, buspirone, corticosteroids, cyclosporine, delavirdine, doxycycline, hydantoins, indinavir, rifamycins, losartan, macrolide antibiotics, methadone, morphine, nelfinavir, quinine, quinidine, theophylline, aminophylline, tricyclic antidepressants, and zolpidem. 

The treatment of SARS involves primarily supportive care and procedures to prevent transmission to others. Owing to the uncertainty associated with the diagnosis of SARS, empirical therapy with broad-spectrum antibiotics should be employed. To date, fluoroquinolones or macrolides typically have been used. Although its efficacy is unproven, patients also have been treated with ribavirin. Owing to the potential benefit of corticosteroids in the presence of progressive pulmonary disease, methylprednisolone also has been used in doses ranging from 80 to 500 mg/day. 

Two other reports describe the development of Cushing s syndrome in patients with cystic fibrosis given inhaled budesonide, and then itraconazole for bronchopulmonary aspergillosis. One patient was also taking clarithromycin, which may have contributed to the increased budesonide effects (see also Corticosteroids+Macrolides , p. 1056). The other patient was a 4-year-old boy who developed Cushing s syndrome 2 weeks after starting treatment with itraconazole 200 mg daily and inhaled budesonide 400 micrograms daily. ... 

Treatment of all forms of airways disease in RA with corticosteroids has yielded variable results, although chronic macrolide therapy has shown some promise (19). 

Some macrohdes have been found to have anti-inflammatory properties and are being used in airway diseases such as panbronchioUtis, cystic fibrosis, bronchiectasis, and asthma. The treatment of OP with erythromycin or clarithromycin has been reported in small series (121—124). After three months of therapy, full or partial remission was achieved in most patients, whereas others required addition of prednisone for disease control. Although their effect appears slower and less constant than with corticosteroids, macrolides might become a therapeutic option in OP, either alone or associated with corticosteroids. This issue requires further studies. 

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