Lung Inflammatory Pattern and Antibiotic Treatment in Pneumonia

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2015 Apr 8

PMID 25849726

Citations 16

Authors

Maria-Jose Lorenzo

Ines Moret

Benjamin Sarria

Enrique Cases

Julio Cortijo

Raul Mendez

Jose Molina

Alejandra Gimeno

Rosario Menendez

Affiliations

Soon will be listed here.

Abstract

Background: In community-acquired pneumonia host inflammatory response against the causative microorganism is necessary for infection resolution. However an excessive response can have deleterious effects. In addition to antimicrobial effects, macrolide antibiotics are known to possess immunomodulatory properties.

Methods: A prospective study was performed on 52 admitted patients who developed an inadequate response after 72 hours of antibiotic treatment - non-responders community-acquired pneumonia - (blood and bronchoalveolar lavage), and two control groups: 1) community-acquired pneumonia control (blood) and 2) non-infection control (blood and bronchoalveolar lavage). Cytokine profiles (interleukin (IL)-6, IL-8, IL-10), tumour necrosis factor α and clinical outcomes were assessed.

Results: Non-responders patients treated with macrolide containing regimens showed significantly lower levels of IL-6 and TNF-α in bronchoalveolar lavage fluid and lower IL-8 and IL-10 in blood than those patients treated with non-macrolide regimens. Clinical outcomes showed that patients treated with macrolide regimens required fewer days to reach clinical stability (p < 0.01) and shorter hospitalization periods (p < 0.01).

Conclusions: After 72 hours of antibiotic effect, patients who received macrolide containing regimens exhibited lower inflammatory cytokine levels in pulmonary and systemic compartments along with faster stabilization of infectious parameters.

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References

Demartini G, Esposti D, Marthyn P, Lapidari A, Fraschini F, Scaglione F . Effect of multiple doses of clarithromycin and amoxicillin on IL-6, IFNgamma and IL-10 plasma levels in patients with community acquired pneumonia. J Chemother. 2004; 16(1):82-5. DOI: 10.1179/joc.2004.16.1.82. View

Ioanas M, Ferrer M, Cavalcanti M, Ferrer R, Ewig S, Filella X . Causes and predictors of nonresponse to treatment of intensive care unit-acquired pneumonia. Crit Care Med. 2004; 32(4):938-45. DOI: 10.1097/01.ccm.0000114580.98396.91. View

Martinez J, Horcajada J, Almela M, Marco F, Soriano A, Garcia E . Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia. Clin Infect Dis. 2003; 36(4):389-95. DOI: 10.1086/367541. View

Culic O, Erakovic V, Parnham M . Anti-inflammatory effects of macrolide antibiotics. Eur J Pharmacol. 2001; 429(1-3):209-29. DOI: 10.1016/s0014-2999(01)01321-8. View

Arancibia F, Ewig S, Martinez J, Ruiz M, Bauer T, Marcos M . Antimicrobial treatment failures in patients with community-acquired pneumonia: causes and prognostic implications. Am J Respir Crit Care Med. 2000; 162(1):154-60. DOI: 10.1164/ajrccm.162.1.9907023. View

Mortensen E, Restrepo M, Anzueto A, Pugh J . The impact of empiric antimicrobial therapy with a β-lactam and fluoroquinolone on mortality for patients hospitalized with severe pneumonia. Crit Care. 2006; 10(1):R8. PMC: 1550860. DOI: 10.1186/cc3934. View

Amado-Rodriguez L, Gonzalez-Lopez A, Lopez-Alonso I, Aguirre A, Astudillo A, Batalla-Solis E . Anti-inflammatory effects of clarithromycin in ventilator-induced lung injury. Respir Res. 2013; 14:52. PMC: 3667083. DOI: 10.1186/1465-9921-14-52. View

Steel H, Cockeran R, Anderson R, Feldman C . Overview of community-acquired pneumonia and the role of inflammatory mechanisms in the immunopathogenesis of severe pneumococcal disease. Mediators Inflamm. 2014; 2013:490346. PMC: 3886318. DOI: 10.1155/2013/490346. View

Paats M, Bergen I, Hanselaar W, van Zoelen E, Hoogsteden H, Hendriks R . Local and systemic cytokine profiles in nonsevere and severe community-acquired pneumonia. Eur Respir J. 2012; 41(6):1378-85. DOI: 10.1183/09031936.00060112. View

10.

Crisafulli E, Menendez R, Huerta A, Martinez R, Montull B, Clini E . Systemic inflammatory pattern of patients with community-acquired pneumonia with and without COPD. Chest. 2012; 143(4):1009-1017. DOI: 10.1378/chest.12-1684. View

11.

Rodrigo C, McKeever T, Woodhead M, Lim W . Single versus combination antibiotic therapy in adults hospitalised with community acquired pneumonia. Thorax. 2012; 68(5):493-5. DOI: 10.1136/thoraxjnl-2012-202296. View

12.

Steel H, Theron A, Cockeran R, Anderson R, Feldman C . Pathogen- and host-directed anti-inflammatory activities of macrolide antibiotics. Mediators Inflamm. 2012; 2012:584262. PMC: 3388425. DOI: 10.1155/2012/584262. View

13.

Meijvis S, Garde E, Rijkers G, Bos W . Treatment with anti-inflammatory drugs in community-acquired pneumonia. J Intern Med. 2012; 272(1):25-35. DOI: 10.1111/j.1365-2796.2012.02554.x. View

14.

Spyridaki A, Raftogiannis M, Antonopoulou A, Tsaganos T, Routsi C, Baziaka F . Effect of clarithromycin in inflammatory markers of patients with ventilator-associated pneumonia and sepsis caused by Gram-negative bacteria: results from a randomized clinical study. Antimicrob Agents Chemother. 2012; 56(7):3819-25. PMC: 3393410. DOI: 10.1128/AAC.05798-11. View

15.

Kovaleva A, Remmelts H, Rijkers G, Hoepelman A, Biesma D, Oosterheert J . Immunomodulatory effects of macrolides during community-acquired pneumonia: a literature review. J Antimicrob Chemother. 2011; 67(3):530-40. DOI: 10.1093/jac/dkr520. View

16.

Fine M, Auble T, Yealy D, Hanusa B, Weissfeld L, Singer D . A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997; 336(4):243-50. DOI: 10.1056/NEJM199701233360402. View

17.

Halm E, Fine M, Marrie T, Coley C, Kapoor W, Obrosky D . Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA. 1998; 279(18):1452-7. DOI: 10.1001/jama.279.18.1452. View

18.

Wales D, Woodhead M . The anti-inflammatory effects of macrolides. Thorax. 1999; 54 Suppl 2:S58-62. PMC: 1765933. DOI: 10.1136/thx.54.2008.s58. View

19.

Monton C, Torres A, Filella X, Xaubet A, de la Bellacasa J . Cytokine expression in severe pneumonia: a bronchoalveolar lavage study. Crit Care Med. 1999; 27(9):1745-53. DOI: 10.1097/00003246-199909000-00008. View

20.

Menendez R, Torres A, Rodriguez de Castro F, Zalacain R, Aspa J, Martin Villasclaras J . Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis. 2004; 39(12):1783-90. DOI: 10.1086/426028. View