Effect of clarithromycin on experimental rhinovirus-16 colds: A randomized, double-blind, controlled trial

PURPOSE: Macrolide antibiotics are frequently prescribed to patients with s ymptoms of a common cold. Despite their lack of proven antiviral activity, macrolide antibiotics may have antiinflammatory actions, such as inhibition of mucus secretion and production of interleukins 6 and 8 by epithelial ce lls. Because the symptoms of rhinovirus colds are attributed to the inflamm atory response to infection, we studied the effects of treatment with clari thromycin on the symptomatic and inflammatory response to nasal inoculation with rhinovirus. SUBJECTS AND METHODS: We performed a prospective, double-blind, controlled trial in 24 healthy subjects who were seronegative for antibodies to rhinov irus-16. Subjects were randomly assigned to receive either clarithromycin ( 500 mg) or trimethoprim-sulfamethoxazole (800/160 mg, as a control antibiot ic) twice a day for 8 days, beginning 24 hours before inoculation with rhin ovirus-16. RESULTS: All 12 subjects in each group were infected and developed symptoma tic colds. The groups did not differ in the intensity of cold symptoms (med ian [25th to 75th percentile] score in the clarithromycin group of 25 [5 to 33] versus 21 [11 to 26] in the trimethoprim-sulfamethoxazole group, P = 0 .86), weight of nasal secretions (25 g [8 to 56 g] versus 12 g [5 to 28 g], P = 0.27), or decline in nasal peak flow during the 8 days following viral inoculation. In both groups, similar and significant increases from baseli ne were observed in the numbers of total cells and neutrophils, and in the concentrations of interleukins 6 and 8, in nasal lavage fluid during the co ld. The changes that we observed did not differ from those in an untreated historical control group. CONCLUSIONS: We conclude that clarithromycin treatment has little or no eff ect on the severity of cold symptoms or the intensity of neutrophilic nasal inflammation in experimental rhinovirus-16 colds. (C) 2000 by Excerpta Med ica, Inc.