Randomized trial to evaluate azithromycin's effects on serum and upper airway IL-8 levels and recurrent wheezing in infants with respiratory syncytial virus bronchiolitis

Avraham Beigelman, Megan Isaacson-Schmid, Geneline Sajol, Jack Baty, Oscar M. Rodriguez, Erin Leege, Kevin Lyons, Toni L. Schweiger, Jie Zheng, Kenneth B. Schechtman, Mario Castro, Leonard B. Bacharier

Research output: Contribution to journalArticlepeer-review

72 Scopus citations

Abstract

Background Respiratory syncytial virus (RSV) bronchiolitis in infancy is a major risk factor for recurrent wheezing and asthma. Because azithromycin attenuated neutrophilic airway inflammation in a murine viral bronchiolitis model, demonstration of similar effects in human subjects might provide a strategy for the prevention of postbronchiolitis recurrent wheezing. Objectives We sought to investigate whether azithromycin treatment during RSV bronchiolitis reduces serum and nasal lavage IL-8 levels and the occurrence of postbronchiolitis recurrent wheezing. Method We performed a randomized, double-masked, placebo-controlled proof-of-concept trial in 40 otherwise healthy infants hospitalized with RSV bronchiolitis who were treated with azithromycin or placebo for 14 days. IL-8 levels were measured in nasal lavage fluid and serum on randomization, day 8, and day 15 (nasal lavage only). The occurrence of wheezing episodes was assessed monthly over the ensuing 50 weeks. Results Compared with placebo, azithromycin treatment did not reduce serum IL-8 levels at day 8 (P =.6) but resulted in a greater decrease in nasal lavage fluid IL-8 levels by day 15 (P =.03). Twenty-two percent of azithromycin-treated participants experienced at least 3 wheezing episodes compared with 50% of participants in the placebo group (P =.07). Azithromycin treatment resulted in prolonged time to the third wheezing episode (P =.048) and in fewer days with respiratory symptoms over the subsequent year in comparison with placebo (36.7 vs 70.1 days, P =.01). Conclusion In this proof-of-concept study azithromycin treatment during RSV bronchiolitis reduced upper airway IL-8 levels, prolonged the time to the third wheezing episode, and reduced overall respiratory morbidity over the subsequent year.

Original languageEnglish
Pages (from-to)1171-1178.e1
JournalJournal of Allergy and Clinical Immunology
Volume135
Issue number5
DOIs
StatePublished - May 2015

Keywords

  • Azithromycin
  • IL-8
  • respiratory syncytial virus
  • wheezing

Fingerprint Dive into the research topics of 'Randomized trial to evaluate azithromycin's effects on serum and upper airway IL-8 levels and recurrent wheezing in infants with respiratory syncytial virus bronchiolitis'. Together they form a unique fingerprint.

Cite this