Clarithromycin in the treatment of RSV bronchiolitis: a double-blind, randomised, placebo-controlled trial

Abstract

Respiratory syncytial virus (RSV) bronchiolitis is the most common lower respiratory tract infection in infancy. To date, there is no effective therapy for RSV bronchiolitis.In order to investigate the efficacy of clarithromycin in the treatment of RSV bronchiolitis, the present authors conducted a randomised, double-blind, placebo-controlled trial comparing clarithromycin with placebo in 21 infants with a diagnosis of RSV bronchiolitis. The infants were randomised to receive clarithromycin or placebo daily for 3 weeks. Levels of interleukin (IL)-4, IL-8, eotaxin, and interferon-c were determined in plasma, before and after treatment, using ELISA. Six months after treatment, parents were surveyed as to whether their child had experienced wheezing within the previous 6 months.Treatment with clarithromycin was associated with a statistically significant reduction in the length of hospital stay, the duration of need for supplemental oxygen and the need for b 2 -agonist treatment. There were significant decreases in plasma IL-4, IL-8 and eotaxin levels after 3 weeks of treatment with clarithromycin. Readmission to the hospital within 6 months after discharge was significantly lower in the clarithromycin group.In conclusion, clarithromycin has statistically significant effects on the clinical and laboratory findings in respiratory syncytial virus bronchiolitis. Therefore, clarithromycin treatment may be helpful in reducing the short-term effects of respiratory syncytial virus bronchiolitis.

Audit on the Management of Bronchiolitis: A Single Centre Real World Experience in Bangladesh Can We do Better ?

“…Clarithromycin was proposed to have a possible immunomodulatory effect. More well planned studies to clarify role of macrolides in acutebronchiolitis are required 16 . In children with bronchiolitis and fever, the risk of secondary bacterial infection is low, therefore, routine use of antibiotics is not warranted.…”

“…Corticosteroids have not clearly been shown to be of significant benefit in improving the clinical status of patients with bronchiolitis.However, in some countries they are used routinely 13 . Antibiotic is commonly used in children with bronchiolitis, but should not be indicated unless bacterial infection is suggested [15][16][17][18] . .…”

Long-term macrolide treatment for chronic respiratory disease

“…In a double-blind, randomised, placebo-controlled trial, TAHAN et al [107] evaluated the efficacy of clarithromycin given daily for 3 weeks at a dose of 15 mg?kg -1 in infants aged ,7 months hospitalised for RSV bronchiolitis. Nine subjects were excluded from analysis due to corticosteroid use, leaving 12 in the clarithromycin group and nine in the placebo group.…”

Medicines used in respiratory diseases only seen in children

“…In 1966, FIELD et al [140] reported no positive effect of broad-spectrum b-lactam antibiotics on the course of disease in 52 patients. In 2007, TAHAN et al [141] reported that macrolides reduced length of hospitalisation. A Dutch RCT did not show that azithromycin reduces the duration of hospitalisation [142].…”