Long-term clarithromycin decreases prednisone requirements in elderly patients with prednisone-dependent asthma

Prolonged use of prednisone is associated with serious side effects, such a s osteoporosis, particularly among elderly individuals. Macrolide antibioti cs exhibit anti-inflammatory effects that are distinct from their antimicro bial properties. Thus, the purpose of this case report is to describe the e ffects of prolonged treatment with clarithromycin, 500 mg bid, in reducing prednisone requirements in three elderly patients with prednisone-dependent asthma, Three patients (one woman and two men) aged 63 to 69 years, who ha d been treated with 5 to 10 mg prednisone daily for at least the last 12 mo nths, were given clarithromycin, 500 mg bid. They were followed regularly f or changes in daily prednisone dose, spirometry, quality of life, and adver se events. The prednisone dose was tapered in a stepwise fashion at each cl inic visit. Within 3 to 6 months of initiation of treatment with clarithrom ycin, and throughout the 12-month follow-up, two of three patients disconti nued prednisone therapy, while the third patient displayed increased spirom etry readings and noted an increasingly better quality of life, Pulmonary f unction tests were stable or improved over this time period, with no report ed adverse events, including increased rate of infections. One patient rela psed upon discontinuation of clarithromycin therapy but has since responded to re-initiation of treatment. Long-term oral clarithromycin may have a ro le in reducing prednisone requirements in elderly patients with prednisone- dependent asthma.