Clarithromycin for community-acquired pneumonia in adults: focus on anti-inflammatory properties

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Abstract

Aim. To evaluate clinical efficacy, anti-inflammatory and immunomodulatory activity of clarithromycin in adults with severe community-acquired pneumonia (sCAP).

Materials and methods. A prospective observational study recruited adult hospitalized patients with verified sCAP. Clarithromycin was prescribed as a component of combination antibiotic therapy (ABT) with a β-lactam antibiotic (AB). The choice of β-lactam AB was carried out by the attending physician in accordance with national clinical guidelines and routine practice of the medical institution. Along with assessment clinical efficacy, the dynamics of inflammatory markers in blood serum was recorded: C-reactive protein, procalcitonin (PCT), tumor necrosis factor α, interleukins 1-beta (IL-1) and interleukin 6 (IL-6). The total duration of ABT was 7–14 days.

Results. Altogether 20 patients (13 males, 7 females) aged from 18 to 84 years old were enrolled. As a result of the use of combined ABT with β-lactam AB and clarithromycin, a significant decrease in the level of C-reactive protein was noted by the 3–5th day of therapy (from 74.6 to 14.1 mg/l). An increase in serum PCT was observed in half of the patients; during treatment, the level of PCT significantly decreased. Similar dynamics was detected for IL-6 – its content in the blood serum decreased by the time of the end of ABT by 6.8 times compared with the baseline. A decrease in the level of tumor necrosis factor α to the reference value was observed in most patients already in the early stages – by 3–5 days of ABT. The majority of patients showed positive dynamics of clinical signs and symptoms with resolution of respiratory failure and other complications of sCAP. In almost half of the patients, the criteria for clinical stability were achieved in the early stages, which made it possible to switch to oral ABT.

Conclusion. The results of the study are consistent with literature data indicating a rapid decrease in inflammatory markers when clarithromycin is administered to patients with sCAP. Its results can be a starting point for comparative randomized trials assessing both clinical outcomes and immunological parameters when using different classes of antibiotics for the treatment of sCAP.

About the authors

Alexander I. Sinopalnikov

Russian Medical Academy of Continuous Professional Education

Email: rachina_s_a@staff.sechenov.ru
ORCID iD: 0000-0002-1990-2042

д-р мед. наук, проф., зав. каф. пульмонологии ФГБОУ ДПО РМАНПО

Russian Federation, Moscow

Svetlana A. Rachina

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: rachina_s_a@staff.sechenov.ru
ORCID iD: 0000-0002-3329-7846

д-р мед. наук, проф. РАН, зав. каф. госпитальной терапии №2 Института клинической медицины им. С.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow

Irina S. Vasilyeva

Sechenov First Moscow State Medical University (Sechenov University)

Email: rachina_s_a@staff.sechenov.ru
ORCID iD: 0000-0003-2654-1561

канд. мед. наук, ассистент каф. госпитальной терапии №2 Института клинической медицины им. С.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow

Nina A. Pigusova

Clinical Hospital №8

Email: rachina_s_a@staff.sechenov.ru
ORCID iD: 0000-0003-1779-5623

врач-пульмонолог отд-ния пульмонологии ФГБУЗ «КБ №8»

Russian Federation, Obninsk

Olga Y. Karpova

Sechenov First Moscow State Medical University (Sechenov University)

Email: rachina_s_a@staff.sechenov.ru
ORCID iD: 0000-0003-2912-6793

канд. мед. наук, доц. каф. госпитальной терапии №2 Института клинической медицины им. С.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)

Russian Federation, Moscow

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2. Fig. 1 Anti-inflammatory and immunomodulatory effects of macrolides [20].

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3. Fig. 2. Dynamics of C-reactive protein in patients with sCAP treated with combination of antibiotics, M (Q25; Q75), mg/l.

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4. Fig. 3. Dynamics of procalcitonin in patients with sCAP treated with combination of ABs, M (Q25; Q75), ng/ml.

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