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Mycoplasma


The Journal of Infectious Diseases 2008;198:1180–1188
© 2008 by the Infectious Diseases Society of America. All rights reserved.

 

MAJOR ARTICLE

 

The Impact of Steroids Given with Macrolide Therapy on Experimental Mycoplasma pneumoniae Respiratory Infection

 

C. Tagliabue,1 , C. M. Salvatore,2 , C. Techasaensiri,2 , A. Mejias,2 , J. P. Torres,2 , K. Katz,2 , A. M. Gomez,4 , S. Esposito,1 , N. Principi,1 and R. D. Hardy 2,3

  1. Institute of Pediatrics, University of Milan Fondazione Istituto di Ricovero e Cura a Carattere Scientifico “Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena,” Milan, Italy; Departments of
  2. Pediatrics,
  3. Internal Medicine, and
  4. Pathology, University of Texas Southwestern Medical Center, Dallas

 

Electronically published 21 August 2008.

 

Reprints or correspondence: Dr. R. Doug Hardy, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, Texas 75390‐9063 (robert.hardy@utsouthwestern.edu).

 

Abstract

 

Background

Systemic steroids have been advocated in addition to antimicrobial therapy for severe Mycoplasma pneumoniae pneumonia. We evaluated the efficacy of clarithromycin, dexamethasone, and combination therapy for M. pneumoniae respiratory infection.

 

Methods

Mice infected with M. pneumoniae were treated with clarithromycin, dexamethasone, combined clarithromycin/dexamethasone, or placebo daily; mice were evaluated at baseline and after 1, 3, and 6 days of therapy. Outcome variables included M. pneumoniae culture, lung histopathologic score (HPS), and bronchoalveolar lavage cytokine, chemokine, and growth factor concentrations.

 

Results

Clarithromycin monotherapy resulted in the greatest reductions in M. pneumoniae concentrations. After 3 days of treatment, combination therapy significantly reduced lung HPS compared with placebo, clarithromycin, and dexamethasone alone, whereas, after 6 days of therapy, clarithromycin alone and combination therapy significantly reduced lung HPS compared with placebo. Concentrations of interleukin (IL)–12 p40, RANTES, macrophage chemotactic protein–1, and cytokine‐induced neutrophil chemoattractant were significantly lower in mice treated with clarithromycin alone and/or combination therapy compared with dexamethasone alone and/or placebo; combination therapy resulted in a significantly greater reduction than clarithromycin alone for IL‐12 p40 and RANTES.

 

Conclusions

Although monotherapy with clarithromycin had the greatest effect on reducing concentrations of M. pneumoniae, combination therapy had the greatest effect on decreasing levels of cytokines and chemokines as well as pulmonary histologic inflammation.

 

Copyright © The Journal of Infectious Diseases - All rights reserved
http://www.journals.uchicago.edu/JID/

 

Full Text article at : http://www.journals.uchicago.edu/doi/full/10.1086/591915

 

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