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Long-term Clarithromycin Decreases Prednisone Requirements in Elderly Patients With Prednisone-Dependent Asthma^*

^* From the University of Illinois at Chicago (Drs. Garey, Rubinstein, Gotfried, and Danziger; Mssrs. Varma and Khan), Chicago, IL; and The Good Samaritan Regional Medical Center (Dr. Gotfried), Phoenix, AZ.

Correspondence to: Israel Rubinstein, MD, FCCP, Section of Respiratory and Critical Care Medicine, Department of Medicine, University of Illinois at Chicago, 840 S. Wood St (M/C 787), Chicago, IL 60612-7323; e-mail: IRubinst{at}uic.edu

Prolonged use of prednisone is associated with serious side effects, such as osteoporosis, particularly among elderly individuals. Macrolide antibiotics exhibit anti-inflammatory effects that are distinct from their antimicrobial properties. Thus, the purpose of this case report is to describe the effects 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 had been treated with 5 to 10 mg prednisone daily for at least the last 12 months, were given clarithromycin, 500 mg bid. They were followed regularly for changes in daily prednisone dose, spirometry, quality of life, and adverse events. The prednisone dose was tapered in a stepwise fashion at each clinic visit. Within 3 to 6 months of initiation of treatment with clarithromycin, and throughout the 12-month follow-up, two of three patients discontinued prednisone therapy, while the third patient displayed increased spirometry readings and noted an increasingly better quality of life. Pulmonary function tests were stable or improved over this time period, with no reported adverse events, including increased rate of infections. One patient relapsed upon discontinuation of clarithromycin therapy but has since responded to re-initiation of treatment. Long-term oral clarithromycin may have a role in reducing prednisone requirements in elderly patients with prednisone-dependent asthma.

Key Words: anti-inflammatory • clarithromycin • macrolides • prednisone-dependent asthma

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