Chest
Volume 118, Issue 6, December 2000, Pages 1826-1827
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Selected Reports
Long-term Clarithromycin Decreases Prednisone Requirements in Elderly Patients With Prednisone-Dependent Asthma

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Prolonged use of prednisone is associated with serious side effects, such as osteoporosis, particularly among elderly individuals. Macrolideantibiotics exhibit anti-inflammatory effects that are distinct fromtheir antimicrobial properties. Thus, the purpose of this case reportis to describe the effects of prolonged treatment with clarithromycin,500 mg bid, in reducing prednisone requirements in three elderlypatients with prednisone-dependent asthma. Three patients (one womanand two men) aged 63 to 69 years, who had been treated with 5 to 10 mgprednisone daily for at least the last 12 months, were givenclarithromycin, 500 mg bid. They were followed regularly for changes indaily prednisone dose, spirometry, quality of life, and adverse events. The prednisone dose was tapered in a stepwise fashion at each clinicvisit. Within 3 to 6 months of initiation of treatment withclarithromycin, and throughout the 12-month follow-up, two of threepatients discontinued prednisone therapy, while the third patientdisplayed increased spirometry readings and noted an increasinglybetter quality of life. Pulmonary function tests were stable orimproved over this time period, with no reported adverse events, including increased rate of infections. One patient relapsed upondiscontinuation of clarithromycin therapy but has since responded tore-initiation of treatment. Long-term oral clarithromycin may havea role in reducing prednisone requirements in elderly patients withprednisone-dependent asthma.

Section snippets

Case Report

This case report begins to address the issue by describing threeelderly patients with prednisone-dependent asthma who reduced ordiscontinued oral prednisone therapy after long-term treatment withclarithromycin, a 14-membered ring macrolide.

Discussion

The new finding from these case reports is that long-term (12months) treatment with oral clarithromycin, 500 mg bid, is associatedwith a significant reduction in prednisone dependency in elderlypatients with prednisone-dependent asthma. Importantly, this phenomenonwas associated with a significant improvement in asthma coupled with noreported adverse events, including an increased rate of infection. Thesalutary effects of clarithromycin were observed only after severalweeks of continuous

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This study was supported in part by a grant from Abbott Laboratories.

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