Effect of Low Dose Azithromycin Towards The Long Period of Clinical Improvement, Level of IL-8 And Sputum Neutrophil of Pneumonia Patients
DOI:
https://doi.org/10.36497/jri.v38i1.138Keywords:
low-dose azithromycin, pneumonia, IL-8, sputum neutrophil, long period of clinical improvementAbstract
Backgrounds: Pneumonia is an acute inflammation of the lung parenchyma caused by microorganisms. Inflammation is an immune response that occurs when bacterial infection. The immune response that occurs will induce alveolar macrophages secrete IL-8 which mediates the movement of neutrophils into the alveolar to release reactive oxygen species (ROS) and protease. Low-dose azithromycin has anti-inflammatory effects that are used on a chronic inflammatory disease of the lung, so its use in pneumonia interesting to do. This study aimed to determine the effect of low-dose azithromycin towards the long period of clinical improvement, level of IL-8 and sputum neutrophil of pneumonia patients. Methode: This research is an experimental study with pretest and post-test design. Subjects were patients with pneumonia who were treated at the Hospital Dr. Moewardi Surakarta in July - August 2016. Samples were taken by consecutive sampling as many as 30 patients. treatment group (n = 15) received additional therapy of azithromycin 250 mg / day and the control group (n = 15) received additional placebo. Result: Supplementation of low-dose azithromycin was significantly reduced levels of IL-8 (reduction = -90.31 ± 89.30; P=0.002) and sputum neutrophil (reduction = -35.73 ± 25.25; P=0.0001) in pneumonia patients. There is a statistically significant difference (P=0.0001) of the long period of clinical improvement between treatment groups (3.87 + 0.64 days) and control (5,60+ 0.91 days). Conclusion: Supplementation 250 mg/day of azithromycin during hospitalization led to decreased levels of IL-8 serum, sputum neutrophil, and affect the long period of clinical improvement in pneumonia patients. (J Respir Indo 2018; 38(1): 39-47)Downloads
References
Perhimpunan Dokter Paru Indonesia. Pneumonia komunitas. Edisi II. Pedoman diagnosis dan penatalaksanaan di Indonesia. Balai Penerbit FKUI. Jakarta; 2014. p.1-52.
Holter JC, Muller F, Samdal HH, Marthinsen JB, Jenum PA, Ueland T, et al. Etiology of community-acquired pneumonia and diagnostic yields of microbiological methods: a 3-year prospective study in Norway. BMC Infect Dis. 2015;15:64.
Medzhitov R. Inflammation 2010: new adventures of an old flame. Cell. 2010;140:771-6.
Soedarsono. Pneumonia. In: Wibisono MJ, Hariadi S, Winariani, editors. Buku ajar ilmu penyakit paru. 2nd edition. Surabaya: Departemen ilmu penyakit paru FK UNAIR; 2010. p. 149-79.
Silhavy TJ, Kahne D, Walker S. The bacterial cell envelope. Cold Spring Harb Perspect Biol. 2010;2:a000414.
Van Amersfoort ES, Van berkel TJC, Kuiper J. Receptors, mediators, and mechanisms involved in bacterial sepsis and septic shock. Clinical Microbiol Rev. 2003;3:379-414.
Moldoveanu B, Otmishi P, Jani P, Walker J, Sarmiento X, Guardiola J, et al. Inflammatory mechanisms in the lung. J Inflamm Res. 2009;2:1-11.
Balamayooran G, Batra S, Fessler MB, Happel KI, Jeyaseelan S. Mechanism of neutrophil accumulation in the lungs against bacteria. Am J Respir Cell Mol Biol. 2010;43:5-16.
Samitas K, Gaga M, Chorianopoulos D. Immunological mechanisms in the lung. Pneumon. 2007;20:274-84.
Ramachandran G. Gram-positive and gram-negative bacterial toxins in sepsis. Virulence. 2014;5:213-8.
Guntur H. Sitokin yang berperan dalam SIRS dan sepsis. In: Diding, editor. SIRS, sepsis, dan syok septik (imunologi, diagnosis, penatalaksanaan). Sebelas Maret University Press. Surakarta; 2008. p.19-30.
Abbas AK. Cells and tissues of the immune system. In: Abbas AK, Lichtman AH, Pillai S, editors. Cellular and molecular immunology. 7th edition. Philadelphia: Saunders Elsevier; 2012a. p. 15-34.
Mizgerd JP. Molecular mechanisms of neutrophil recruitment elicited by bacteria in the lungs. Immunology. 2002;14:123-32.
Steel HC, Theron AJ, Cockeran R, Anderson R, Feldman C. Pathogen and host directed anti-inflammatory activities of macrolide antibiotics. Mediators of inflammation. 2015. [Cited 2015 Oktober 10th]. Available from: http://www.hindawi.com.
Kanoh S and Rubin BK. Mechanism of action and clinical application of macrolides as immunomodulatory medications. Clin Microbiol Rev. 2010;23:590-615.
Irfan M, Farooqi J, Hasan R. Community acquired pneumonia. Curr Opin Pulm Med. 2013;19:1-11.
Mizgerd JP. Acute lower respiratory tract infection. N Engl J Med. 2008;358, pp. 716-727.
Abbas AK. Innate immunity. In: Abbas AK, Lichtman AH, Pillai S, editors. Cellular and molecular immunology. 7th edition. Philadelphia: Saunders Elsevier; 2012b. p. 55-88.
Craig A, Mai J, Cai S, Jeyaseelan S. Neutrophil recruitment to the lungs during bacterial pneumonia. Infection and Immunity. 2009;77:568-75.
Chambers HF. Antimicrobial agents: Protein synthesis inhibitors and miscellaneous antibacterial agents. In: Hardman JG, Limbird LE, editors. Goodman & Gilman’s the pharmacological basis of therapeutics. 10th edition. McGraw-Hill; 2001. p.1239-65.
Stellari FF, Sala A, Donofrio G, Ruscitti F, Caruso P, Topini TM, et al. Azithromycin inhibits nuclear factor-κB activation during lung inflammation: an in vivo imaging study. Pharma Res Per. 2014;2:1-9.
Vrancic M, Banjanac M, Nujic K, Bosnar M, Murati T, Munic V, et al. Azithromycin distinctively modulates classical activation of human monocytes in vitro. Br J Pharmacol. 2011;165:1348-60.
Verleden GM, Vanaudenaerde BM, Dupont LJ, Van Raemdonck DE. Azithromycin reduces airway neutrophilia and interleukin-8 in patients with bronchiolitis obliterans syndrome. Am J Respir Crit Care Med. 2006;174:566-70.
Baratawidjaja KG and Rengganis I. Sel-sel sistem imun nonspesifik. In: Ambara, editor. Imunologi dasar. 10th ed. Jakarta: Badan penerbit FK UI; 2012. p.57-89.
Abbas AK. Cells and tissues of the immune system. In: Abbas AK, Lichtman AH, Pillai S, editors. Cellular and molecular immunology. 7th edition. Philadelphia: Saunders Elsevier; 2012c. p.15-34.
Bordon J, Aliberti S, Fernandez-Botran R, Uriarte SM, Rane MJ, Duvvuri P, et al. Understanding the roles of cytokines and neutrophil activity and neutrophil apoptosis in the protective versus deleterious inflammatory response in pneumonia. Int J Infect Dis. 2013;17:76-83.
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