TY - JOUR
T1 - 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
AU - Beigelman, Avraham
AU - Isaacson-Schmid, Megan
AU - Sajol, Geneline
AU - Baty, Jack
AU - Rodriguez, Oscar M.
AU - Leege, Erin
AU - Lyons, Kevin
AU - Schweiger, Toni L.
AU - Zheng, Jie
AU - Schechtman, Kenneth B.
AU - Castro, Mario
AU - Bacharier, Leonard B.
N1 - Publisher Copyright:
© 2015 American Academy of Allergy, Asthma & Immunology.
PY - 2015/5
Y1 - 2015/5
N2 - 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.
AB - 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.
KW - Azithromycin
KW - IL-8
KW - respiratory syncytial virus
KW - wheezing
UR - http://www.scopus.com/inward/record.url?scp=84943450826&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2014.10.001
DO - 10.1016/j.jaci.2014.10.001
M3 - Article
C2 - 25458910
AN - SCOPUS:84943450826
SN - 0091-6749
VL - 135
SP - 1171-1178.e1
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 5
ER -