Macrolides asthma

Davies, R.X and Pepys, X (1975). Asthma due to inhaled chemical agents—The macrolide antibiotic spiramycin. Clin. Allergy 5 99-107. 

Hatipoglu U, Rubinstein I. Low-dose, long-term macrolide therapy in asthma an overview. Clin Mol Allergy 2004 Mar 16 2(1) 4. 

Antimicrobials are over prescribed for exacerbations of asthma. Respiratory tract infections do cause increased airflow obstruction and hyperresponsiveness, but viral rather than bacterial pathogens are the commonest culprits. Antimicrobials should be prescribed only if there is high suspicion of a bacterial respiratory tract infection, e.g. purulent sputum. Note that macrolide antibiotics, such as erythromycin and clarithromycin, interfere with theophylline metabolism. 

Some macrolides have a dose- and time-related effect on methylprednisolone elimination, resulting in a prolonged half-life and reduced clearance (157). These changes were considered advantageous (steroid sparing) in patients with asthma (158,159). However, a retrospective analysis of 3995 patients treated with azithromycin did not show any pharmacokinetic interaction in patients who were also taking methylprednisolone (127,128). 

Johnston SL Macrolide antibiotics and asthma treatment. J Allergy Clin Immunol 2006 117 1233-1236. 

Today, EM treatment has been established as a basic treatment for DPB. Furthermore, erythromycin has been widely applied in treating chronic airway inflammatory disorders, not only in lower airway diseases (DPB, chronic bronchitis, bronchiectasis, or bronchial asthma [31-33]) but also upper airway diseases (chronic sinusitis or exudative otitis media). Other forms of 14-membered ring macrolides, i.e., clarithromycin (CAM) [34-36] and roxithromycin (RXM) [37] have also been used for a similar purpose. 

There is increasing evidence that long-term administration of macrolide antibiotics provides a marked reduction in the volume of airway secretions in some patients with asthma [31], bronchorrhea [46], chronic bronchitis, and DPB [15,... 

Erythromycin is a macrolide antibiotic widely used for the treatment of upper and lower respiratory tract infections. Recent reports further showed that EM and its analogues are effective for the treatment of chronic airway diseases such as DPB, bronchial asthma, and chronic sinusitis [5, 15, 32]. This effectiveness is considered to be apart from their antimicrobial actions, because they are effective at half of the recommended dosage and even in cases without concomitant infection. Its precise mechanisms, however, remain unclear. Several cytokines including IL-1, TNF-a, and IL-8 have been reported to be elevated in HALF from patients with such airway inflammatory diseases (Table II), and to be decreased... 

To assess the effect of macrolide antibiotics on IL-8 production by inflamed airway epithelium, bronchial epithelial cells were obtained from 10 patients (3 with DPB, 5 with sinobronchial syndrome, 1 with nonatopic asthma associated with chronic sinusitis, and 1 with diffuse bronchiectasis, mean age of 54.8, all were non-or ex-smokers) under fiber optic bronchoscopy as previously reported [64, 65]. Spontaneous IL-8 release by airway epithelial cells from inflamed airways was significantly suppressed with the addition of EM and CAM, but not with ABPC in vitro [60]. Khair et al. [19] reported that EM inhibited release of IL-8 as well as of IL-6 from H. influenzae endotoxin-stimulated normal bronchial epithelial cells. 

Reports of macrolides causing adverse reactions in humans relate primarily to medicated stockfeed and parenteral formulations for injection. Farmworkers exposed to stockfeed medicated with spiramycin and tylosin have developed dermatitis and bronchial asthma. In addition, accidental needlesticks with needles contaminated with tilmicosin have caused minor local reactions, whereas accidental self-administration of injectable formulations of tilmicosin has resulted in serious cardiac effects and death. 

Cromwell O, Pepys J, Parish WE, Hughes EG (1979) Specific IgE antibodies to platinum salts in sensitized workers. Clin Allergy 9 109-117 Davies RJ, Pepys J (1975) Asthma due to inhaled chemical agents - the macrolide antibiotic spiramycin. Clin Allergy 5 99-108... 

Davies RJ, Pepys J (1975) Asthma due to enhaled chemical agents - the macrolide antibiotic spiramycin. Clin Allergy 5 99-107... 

Allergies to macrolide antibiotics are said to occur with an incidence of 0.4-3 %. Apart from the very occasional case report of anaphylaxis, the most commonly seen symptoms include urticaria, often generalized, angio-edema, pruritus, asthma, tachycardia, and delayed cutaneous reactions presenting as maculopapular exanthema. 

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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