Suppression of Postoperative Systemic Inflammatory Response Syndrome with Clarithromycin following Lung Cancer Surgery

Abstract

We examined whether clarithromycin (CAM), a 14-membered macrolide, can control the postoperative systemic inflammatory response syndrome that occurs following lung cancer surgery. In the control group (n = 16), prophylactic antibiotics (flomoxef) were administered for 4–7 days following surgery. In the CAM group (n = 10), 400 mg/day of CAM were administered orally for 14 days prior to surgery and for 7 days following surgery, in addition to the postoperative administration of flomoxef. The incidence and duration of the systemic inflammatory response syndrome in the CAM group (30%, 0.3 days) were significantly lower than those in the control group (81%, 1.6 days). There were no significant differences between the control and CAM groups in both the amount and frequency of nonsteroidal anti-inflammatory drugs following surgery. In conclusion, our study suggests that CAM may suppress the postoperative systemic inflammatory response syndrome in lung cancer patients.

Repurposing Drugs in Oncology (ReDO)—clarithromycin as an anti-cancer agent

“…Both the incidence and duration of the postoperative systemic inflammatory response syndrome (SIRS) was significantly reduced in lung cancer patients receiving CAM compared to control [73]. Also the inflammatory response after mastectomy was modulated by CAM, as reflected by differences in temperature, heart rate, respiratory rate, and monocyte count between the treatment and control group.…”

“…Anti-inflammatory effects relevant to cancer have been suggested by the capacity of CAM to reduce acute inflammation after mastectomy or lung cancer surgery [73, 74]. …”

“…In addition to celecoxib which has been used in many cancer experiments and trials [9], other anti-inflammatory drugs have the potential to dramatically modify the inflammatory response leading amongst other things to modification of the sub-types of immune cells populating the environment of tumours [10]. A marker study validating this concept in a few patients might be an important prelude to justifying such a trial with survival endpoints. Drugs in the perioperative period : in addition to the use of CAM and anti-inflammatory drugs in patients with advanced disease, data indicate that both CAM [11, 12] and anti-inflammatory drugs [13] are able to affect the inflammatory and pro-angiogenic response induced by cancer surgery. A perioperative intervention combining these two might prove even more effective as has been shown experimentally by combining NSAID and beta blockers [14].…”

COPD—pharmakologische Basisbehandlung und Zukunft der antiinflammatorischen Therapie

“…Für die Therapie der Sepsis und der "acute lung injury" gibt es erste tierexperimentelle Daten der Inflammationsmodulation [151,152]. Die postoperative systemische Entzündungsantwort ("systemic inflammatory response syndrome" [SIRS]) wird beim Menschen durch die Gabe von Clarithromycin unterdrückt [153]. Schließlich ist die niedrigdosierte Gabe von Azithromycin in der Therapie des "bronchiolitis obliterans syndrome" (BOS) nach Lungentransplantation erfolgreich [154].…”

Síndrome de respuesta inflamatoria sistémica

“…La concentración de citoquinas circulantes se eleva antes que se produzca falla multiorgánica, lo que permite instaurar rápidamente la terapia adecuada evitando dicha complicación 6 , como se observó en nuestra paciente con el drástico descenso de la concentración de citoquinas proinflamatorias circulantes tres días después del diagnóstico. …”