Macrolide therapy in cryptogenic organizing pneumonia: A case report and literature review

Abstract

Cryptogenic organizing pneumonia (COP) is a pulmonary disorder associated with nonspecific clinical presentations. The macrolide class of antimicrobial agents is widely used to treat infectious and inflammatory respiratory diseases in humans. The present study reports a case of COP that was effectively treated with azithromycin in combination with glucocorticoid. A literature review of similar cases is also presented. It was found that all COP patients in the literature received macrolide treatment, including six cases with unknown clinical outcomes. For the remaining 29 patients, 20 patients initially received the macrolide as a single therapy and 4/5 of them (16 cases) were cured with a treatment time of 3–14 months, while 1/5 (4 cases) showed no improvement after treatment for 1 month and were switched to a glucocorticoid or combination treatment with a glucocorticoid, after which the disease was finally well-controlled. Side-effects of macrolide were rare. Based on this analysis, it is recommended that macrolides can be used as a first-line therapy in patients with mild COP. For patients with recurrent COP, it is suggested that macrolides should be used as an adjunctive therapy with other treatments, such as a glucocorticoid.

Clarithromycin Decreases IL-6 Concentration in Serum and BAL Fluid in Patients with Cryptogenic Organizing Pneumonia

“…It has previously been reported that not all patients respond to CAM treatment [20][21][22]. In the present study, 15% of the patients responded only partially or did not respond to CAM treatment.…”

“…The efficacy of these antibiotics in COP has been demonstrated in few studies [20][21] and in previous research by the present authors [22]. Macrolides influence the production and release of proinflammatory cytokines [23].…”

Long-term macrolides in diffuse interstitial lung diseases

“…Moreover, in many published cases, macrolides were not used alone but in association with steroids or other immunosuppressive agents, making it impossible to evaluate their actual efficacy [51]. In conclusion, given the lack of large-scale prospective studies, at present there is no definitive data on the efficacy of macrolide therapy either as a first-line or as an adjuvant agent.…”

“…In most studies, macrolides were not used alone as a first choice, but in combination with corticosteroids to reduce the dosage or to replace them in the case of ineffectiveness or when intolerable steroid-related side-effects occurred [46,[51][52][53]]. An example is the case reported by CHANG et al [52], where clarithromycin therapy (500 mg·day ) and azathioprine had proven to be ineffective and related to side-effects.…”

Successful treatment of three patients with organizing pneumonia associated with rheumatoid arthritis using clarithromycin and prednisolone

“…After that, the disease was wellcontrolled. The remaining nine patients were later treated with macrolides due to poor efficacy or side effects of GCs (16). It was speculated that the beneficial effects of macrolides may be due to not only their immunosuppressive effect on polymorphonuclear cells and their products but also their influence on T-cells (9).…”