Additive effect of continuous low-dose ofloxacin on erythromycin therapy for sinobronchial syndrome

Abstract

It has been established that long-term low-dose erythromycin therapy (EM therapy) is very effective for sinobronchial syndrome, a common condition in Japan characterized by chronic upper and lower airway inflammation. The effect does not result from its bacteriocidal activity and the detailed mechanisms are not known. It takes 3-6 months for EM therapy to improve the symptoms. This study was designed to evaluate the additive effect of continuous low dosage or intermittent usual dosage of ofloxacin (OFLX) on EM therapy in patients with sinobronchial syndrome. Patients with sinobronchial syndrome were randomly allocated to receive one of the following four regimens. Patients in Group A received both low-dose OFLX and EM therapy daily for 6 months. Patients in Group B received EM therapy and intermittent treatment of OFLX for 6 months. Patients in Group C underwent EM therapy for 6 months. Patients in Group D received neither OFLX nor EM therapy. All patients were given carbocystein for more than 2 months before starting each treatment and during the study period. In patients receiving OFLX and/or EM therapy, these antimicrobial agents were well-tolerated during the treatment period. Amount of sputum in the morning was significantly less in Group C than in Group D after 3-6 months, and decreased significantly in Group A as compared with Group B after 2 weeks, Group C after 2 weeks to 2 months, and Group D after 2 weeks to 6 months. Other symptoms such as number of expectorations, difficulty of expectoration and severity of cough also improved rapidly in Group A. These findings suggest that it is useful to add low-dose OFLX to EM therapy for sinobronchial syndrome, especially within 1-2 months from starting treatment, and it may be cost-effective as this combination therapy can shorten the treatment period of EM therapy.

Mycobacterium avium-intracellulare Pulmonary Infection in Patients Without Known Predisposing Lung Disease

“…In the left lung: S1 + 2, apical-posterior; S3, anterior (upper division of upper lobe); S4, superior; S5, inferior (lingula of upper lobe); S6, superior; S8, antero-medial basal; S9, lateral basal; S10, posterior basal (lower lobe). [10] and diffuse panbronchiolitis (DPB) [7,16]. SBS and DPB are common disorders in Japan and affect mainly women; the disorders are characterized by chronic inflammation of airways and manifestation of a nasobronchial mucociliary dysfunction.…”

Beraprost, a stable analog of prostacyclin, enhances cough reflex sensitivity to capsaicin in bronchitic patients

“…It has been shown that EM therapy is highly effective for treatment of chronic neutrophilic bronchitic disorders, including chronic bronchitis, sinobronchial syndrome, and diffuse panbronchiolitis [3,4,16]. Previous studies have also shown that EM therapy achieves significant improvement of pulmonary inflammation by reducing the intrapulmonary chemotactic gradient-the ability of the neutrophils to respond to chemotactic factors-ultimately reducing the migration of neutrophils to inflammatory sites, and resulting in the Data are shown as standard error of the mean for FVC, FEV 1 , and FEF (25-75).…”

“…improvement of outcomes, symptoms, and biomarkers of disease activity [3,4,16,24]. However, at least 8 weeks are required to improve the symptoms, including chronic productive cough [3,4,16].…”

“…In our patients, diagnosis of sinobronchial syndrome was based on the following criteria: (1) productive cough on most days for at least 3 months for 2 consecutive years; (2) chronic sinusitis diagnosed on the basis of symptoms (postnasal drip, nasal discharge, and nasal obstruction), physical examinations and plain roentgenogram as indicated by opacities or air-fluid levels of one or more paranasal sinuses; (3) no history suggesting to the attending physician that the patient had bronchial asthma; (4) no history of wheezing syndrome; and (5) no significant emphysema documented by computed tomographic scan of the chest.…”

“…Chronic neutrophilic airway inflammation is a prominent component of several diseases presenting with chronic productive cough, including chronic bronchitis, sinobronchial syndrome, diffuse panbronchiolitis, and bronchietasis [1][2][3][4]. Accumulating evidence indicates that various inflammatory mediators may play an important role in the pathophysiologic mechanisms of these disorders [2,5].…”