Garey K W, Rubinstein I, Gotfried M H, Khan I J, Varma S, Danziger L H
University of Illinois at Chicago, 60612-7323, USA.
Chest. 2000 Dec;118(6):1826-7. doi: 10.1378/chest.118.6.1826.
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.
长期使用泼尼松会引发严重的副作用，如骨质疏松，在老年人中尤为明显。大环内酯类抗生素具有与其抗菌特性不同的抗炎作用。因此，本病例报告的目的是描述每日两次服用500毫克克拉霉素进行长期治疗，对三名依赖泼尼松的老年哮喘患者减少泼尼松用量的效果。三名年龄在63至69岁的患者（一名女性和两名男性），在过去至少12个月中每天接受5至10毫克泼尼松治疗，给予他们每日两次500毫克克拉霉素。定期对他们进行随访，观察每日泼尼松剂量、肺功能测定、生活质量和不良事件的变化。每次门诊就诊时泼尼松剂量逐步减少。在开始使用克拉霉素治疗的3至6个月内以及整个12个月的随访期间，三名患者中有两名停止了泼尼松治疗，而第三名患者的肺功能测定读数增加，生活质量也越来越好。在此期间肺功能测试稳定或有所改善，未报告不良事件，包括感染率增加。一名患者在停用克拉霉素治疗后复发，但此后对重新开始治疗有反应。长期口服克拉霉素可能在减少依赖泼尼松的老年哮喘患者的泼尼松用量方面发挥作用。
