Effect of clarithromycin on cytokines and chemokines in children with an acute exacerbation of recurrent wheezing: a double-blind, randomized, placebo-controlled trial

Background: Clarithromycin is postulated to possess immunomodulatory properties in addition to its antimicrobial activity. Objective: To evaluate the effect of clarithromycin on serum and nasopharyngeal cytokine and chemokine concentrations in children with an acute exacerbation of recurrent wheezing. Methods: Children with a history of recurrent wheezing or asthma and who presented with an acute exacerbation of wheezing were enrolled in a double-blind, randomized trial of clarithromycin vs placebo. Concentrations of tumor necrosis factor a (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-1 beta (IL-1 beta), IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, granulocyte-macrophage colony-stimulating factor, RANTES, eotaxin, macrophage inflammatory protein la, macrophage inflammatory protein 10, and monocyte chemoattractant protein I were measured in serum and/or nasopharyngeal aspirates before, during, and after therapy. Mycoplasma pneumoniae and Chlamydophila pneumoniae infection were evaluated for by polymerase chain reaction and serologic testing. Results: Nasopharyngeal concentrations of TNF-alpha, IL-1 beta, and IL-10 were significantly and persistently lower in children treated with clarithromycin compared with placebo. There tended to be a greater effect of clarithromycin on nasopharyngeal cytokine concentrations in patients with evidence of M pneumoniae or C pneumoniae infection. No significant differences were detected in serum cytokines for children treated with clarithromycin compared with placebo. Conclusion: Clarithromycin therapy reduces mucosal TNF-alpha, IL-1 beta, and IL-10 concen trations in children with an acute exacerbation of recurrent wheezing.