Macrolide antibiotics and bronchiolitis obliterans following lung transplantation

Crowley, Seamus; Egan, Jim

doi:10.1586/14787210.3.6.923

Cited by 11 publications

(8 citation statements)

References 59 publications

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“…Several potential mechanisms can explain the beneficial effect of macrolides, such as an effect on Pseudomonas aeruginosa colonisation and gastro-oesophageal reflux (GER), changes in immunosuppressive trough levels and interaction with the innate immune system (neutrophils/interleukin (IL)-8) were the most prevailing [6].…”

Section: Anti-inflammatory Effect Of Azithromycin In Bosmentioning

confidence: 99%

A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy

Vanaudenaerde

Meyts²,

Vos³

et al. 2008

Eur Respir J

151

110

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Bronchiolitis obliterans syndrome (BOS) is the most important cause of late mortality following lung transplantation, resulting in major morbidity and a huge burden on healthcare resources. Treatment options are limited, resulting in a mere stabilisation of the lung function decline. Recent introduction of the macrolide antibiotic azithromycin raised new hope after demonstrating lung function improvement in subsets of patients.The present study aimed to provide an overview of the clinical effects on azithromycin in the setting of BOS after lung transplantation, with special emphasis on the anti-inflammatory actions. Moreover, the authors proposed a new frame of thinking centred on a dichotomy in the pathogenesis and clinical phenotype of BOS. Subsets of BOS patients were identified who do or do not respond to azithromycin (regarding forced expiratory volume in one second (FEV1), bronchoalveolar lavage (BAL) neutrophilia/interleukin-8). These observations have shed new light on the current belief that BOS represents a homogenous clinical entity in which the neutrophil is the main culprit.Recent clinical observations, supported by research findings, have revealed a dichotomy in the clinical spectrum of BOS with neutrophilic (partially) reversible allograft dysfunction (responding to azithromycin) and fibroproliferative BOS (not responding to azithromycin). This concept is reinforced by unique data obtained in BOS patients, consisting of histology specimens, physical and radiological examination, FEV1 and BAL examination.The acceptance of this dichotomy can improve understanding of the heterogeneous pathological condition that constitutes bronchiolitis obliterans syndrome, thus encouraging a more accurate diagnosis and, ultimately, better tailored treatment for each bronchiolitis obliterans syndrome patient.

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Section: Anti-inflammatory Effect Of Azithromycin In Bosmentioning

confidence: 99%

A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy

Vanaudenaerde

Meyts²,

Vos³

et al. 2008

Eur Respir J

151

110

View full text Add to dashboard Cite

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“…5) Obliterative bronchiolitis is a form of chronic allograft dysfunction in lung transplant recipients and has been reported to be a condition in which macrolide therapy may be indicated. 6) Although the efficacy and adverse effects of macrolides for chronic respiratory disease in children requires further evaluation in prospective studies, we anticipate that long-term, low-dose macrolides may be beneficial in treating respiratory complications in pediatric HTx recipients when administered in addition to conventional therapeutic options such as expectorants, other antimicrobial agents, immunoglobulins, and chest physiotherapy. In pediatric HTx recipients, the respiratory tract is the most common site of infection.…”

Section: Discussionmentioning

confidence: 99%

“…At age 4 he was di-Vol 55 No 6 LONG-TERM, LOW-DOSE MACROLIDE IN HEART TRANSPLANT agnosed with suspected PTLD and treated with anti-CD20 antibody (rituximab) and immunoglobulin. Around the same time, he had repeated fevers and respiratory symptoms such as cough with expectoration.…”

Section: Case Reportsmentioning

confidence: 99%

The Successful Management of Respiratory Complications With Long-Term, Low-Dose Macrolide Administration in Pediatric Heart Transplant Recipients

et al. 2014

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SummaryWe report three pediatric heart transplant (HTx) patients whose respiratory symptoms were successfully controlled with long-term, low-dose macrolide administration (clarithromycin: CAM; approximately 2.5 mg/kg bid). The first case was an 18-year-old boy who underwent HTx at the age of three for dilated cardiomyopathy (DCM). Beginning at age 5, he had repeated fevers and respiratory symptoms. He was diagnosed with chronic sinusitis at age 11 and sinobronchial syndrome with mild bronchiectasis at age 14. Administration of long-term, low-dose CAM and otolaryngeal topical therapy led to significant improvement of his symptoms. The second case was a 7-year-old boy who underwent HTx for DCM at age one. Starting at age 4, he had repeated fevers and cough due to atelectasis and pneumonia. As antibiotics and respiratory physical therapy proved ineffective, he received long-term, low-dose CAM, resulting in successful control of his atelectasis and recurrent pneumonia. The third case was a 13-year-old boy who underwent HTx at age 6 for DCM. He had chronic sinusitis starting at age 7, and was diagnosed with obstructive sleep apnea syndrome at age 10. Adenotonsillectomy and continuous positive airway pressure support therapy were indicated. At age 13, long-term, lowdose CAM administration was started following mycoplasma infection. In all three cases, the levels of calcineurin inhibitors (cyclosporine and tacrolimus) and everolimus were kept in the optimal range with careful drug monitoring. Longterm, low-dose macrolide administration effectively prevents and treats respiratory complications in pediatric HTx patients as long as attention is paid to potential drug interactions. (Int Heart J 2014; 55: 560-563) Key words: Respiratory symptoms, Adenotonsillectomy, Continuous positive airway pressure support therapy, Calcineurin inhibitors C hronic respiratory complications significantly affect quality of life of pediatric heart transplant (HTx) patients. The potential benefits of macrolides related to immunoregulatory and anti-inflammatory function make them interesting candidates for research. We report 3 patients whose respiratory symptoms were successfully controlled with longterm, low-dose macrolide administration. Case ReportsA summary of the cases is presented in the Table. The first case was an 18-year-old boy who underwent heart transplantation at age 3 for dilated cardiomyopathy (DCM). Since the age of 5, he had repeated fever and respiratory symptoms such as cough with expectoration, rhinorrhea and nasal obstruction. Because he had an episode of monomorphic T-cell post-transplant lymphoproliferative disorder (PTLD) at age 10, his post-transplant immunosuppressive regimen was changed from cyclosporine to everolimus. Chemotherapy was administered and PTLD-affected sites in the ileum were resected. Immunoglobulin replacement therapy was also initiated. No relapse of PTLD was observed; however, he was diagnosed with chronic sinusitis at age 11 and recurrent lower respiratory infections continued. Computed tomogra...

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“…Cependant, le traitement de la BPCO cliniquement stable par la clarithromycine ne semble pas apporter d'avantages cliniques [27]. Récemment, les macrolides ont donné des résultats thérapeuti-ques encourageants dans la bronchiolite oblitérante, une BPCO définie par la présence d'un granulome inflammatoire obstruant la lumière des bronchioles et des canaux alvéolaires [28,29]. La PBD et la mucoviscidose sont deux cibles privilé-giées de l'action des macrolides.…”

Section: Macrolidesunclassified

Immunomodulation médiée par les agents antibactériens

Labro

2006

Réanimation

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Macrolide antibiotics and bronchiolitis obliterans following lung transplantation

Cited by 11 publications

References 59 publications

A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy

A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy

The Successful Management of Respiratory Complications With Long-Term, Low-Dose Macrolide Administration in Pediatric Heart Transplant Recipients

Immunomodulation médiée par les agents antibactériens

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