Effects of low-dose clarithromycin added to fluticasone on inflammatory markers and pulmonary function among children with asthma: A randomized clinical trial

BACKGROUND: Macrolides exert anti-inflammatory and immunomodulatory effects beyond their purely antibacterial action, as demonstrated by several bronchial inflammatory disorders, including asthma. METHODS: Fifty-eight children with newly diagnosed mild persistent asthma were selected by using the Global Initiative for Asthma guidelines and were randomly divided into the study (group I) (n = 36) and control (group II) (n = 22) groups. Mycoplasma pneumonia-specific immunoglobulin G and -specific immunoglobulin M antibody levels of each participant were measured by enzyme-linked immunosorbent assay. Clarithromycin 5 mg/kg daily and placebo were given to groups I and II, respectively, for 4 weeks. All of the children had maintenance inhaled corticosteroid (fluticasone propionate, one puff twice [50 μg/puff] daily). Forced expiratory volume in 1 second, forced expiratory flow at 25–75% of the pulmonary volume, exhaled nitric oxide value, total IgE level, absolute eosinophil count, and eosinophilic cation protein value were measured at baseline and at the end of the treatment. RESULTS: There are significantly increased forced expiratory volume in 1 second and forced expiratory flow at 25–75% of the pulmonary volume levels and decreased exhaled nitric oxide values after the 4-week clarithromycin treatment. The study group also had a decreased peripheral blood absolute eosinophil count and eosinophilic cation protein level, but not for the total IgE level, after the treatment. CONCLUSION: Four weeks of sub-antimicrobial doses of clarithromycin may improve pulmonary function and decrease eosinophilic inflammation in children with asthma.