Clarithromycin in post COVID-19 organizing pneumonia
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Clarithromycin, COVID, Organizing pneumonia
An increasing number of patients are reporting with symptoms secondary to post COVID-19 pulmonary sequelae. Radiological findings in these patients include fibrotic lung disease, interstitial lung abnormalities, ground glass opacities, and organizing pneumonia (OP). Therapeutic options in these patients include steroids and anti-fibrotics. The majority of these patients have received steroid therapy for COVID-19 pneumonia, and may continue to receive it for post COVID-19 pulmonary sequelae, subjecting themselves to steroid related adverse effects. Cryptogenic organizing pneumonia (COP) responds well to steroid therapy. Alternatively, macrolide therapy has been successful in the treatment of both cryptogenic and secondary forms of OP. Compared to steroid therapy, macrolide therapy in COP is well tolerated and associated with fewer adverse events. We report two patients who were diagnosed with post COVID-19 OP and were treated with clarithromycin for three months. We believe that clarithromycin offers a potential therapeutic option in post COVID-19 organizing pneumonia.
2.Zhou Y, Wang L, Huang M, et al. A long-term retrospective study of patients with biopsy-proven cryptogenic organizing pneumonia. Chron Respir Dis. Jan-Dec 2019;16:1479973119853829.
3.Radzikowska E, Wiatr E, Langfort R, et al. Cryptogenic organizing pneumonia-Results of treatment with clarithromycin versus corticosteroids - Observational study. PLoS One. 2017 Sep 25;12(9):e0184739.
4.Ciftci F and Kumbasar ÖÖ. Seven patients with cryptogenic organizing pneumonia succesfully treated with clarithromycin. Sarcoidosis Vasc Diffuse Lung Dis. 2018; 35(2): 165–170.
5.Hani C, Trieu NH, Saab I, et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging. 2020 May; 101(5): 263–268.
6.Marchiori E, Penha D, Nobre LF, Hochhegger B, and Zanetti G. Differences and Similarities between the Double Halo Sign, the Chest CT Target Sign and the Reversed Halo Sign in Patients with COVID-19 Pneumonia. Korean J Radiol. 2021 Apr; 22(4): 672–676.
7.Kory P, Kanne JP. SARS-CoV-2 organising pneumonia: 'Has there been a widespread failure to identify and treat this prevalent condition in COVID-19?' BMJ Open Respir Res. 2020 Sep;7(1):e000724.
8.Johkoh T, Müller NL, Cartier Y, et al. Idiopathic interstitial pneumonias: diagnostic accuracy of thin-section CT in 129 patients. Radiology. 1999 May;211(2):555-60.
9.Godbert B, Clement-Duchêne C, Regent D, Martinet Y. Do all cryptogenic organizing pneumonias require lung biopsy and steroid treatment? Rev Mal Respir. 2010 May;27(5):509-14.
10.Stover DE, Mangino D. Macrolides: a treatment alternative for bronchiolitis obliterans organizing pneumonia? Chest. 2005 Nov;128(5):3611-7.
11.Radzikowska E, Roży A, Jagus P, et al. Clarithromycin Decreases IL-6 Concentration in Serum and BAL Fluid in Patients with Cryptogenic Organizing Pneumonia. Adv Clin Exp Med. Sep-Oct 2016;25(5):871-878.
12.Jung IY, Jeon YD, Ahn M, et al. A case of bronchiolitis obliterans organizing pneumonia in an HIV-infected Korean patient successfully treated with clarithromycin. BMC Infect Dis. 2015 Jul 23;15:280.
13.Vanaudenaerde BM, Meyts I, Vos R, et al. A dichotomy in bronchiolitis obliterans syndrome after lung transplantation revealed by azithromycin therapy. Eur Respir J. 2008 Oct;32(4):832-43.
14.Ohe M, Shida H, Horita T, et al. Successful treatment of three patients with organizing pneumonia associated with rheumatoid arthritis using clarithromycin and prednisolone. Drug Discov Ther. 2017;11(4):218-222.
15.Petitpierre N, Cottin V, Marchand-Adam S, et al. A 12-week combination of clarithromycin and prednisone compared to a 24-week prednisone alone treatment in cryptogenic and radiation-induced organizing pneumonia. Sarcoidosis Vasc Diffuse Lung Dis. 2018;35(3):230-238.
16.Echeverría-Esnal D, Martin-Ontiyuelo C, Navarrete-Rouco ME, et al. Azithromycin in the treatment of COVID-19: a review. Expert Rev Anti Infect Ther. 2021 Feb;19(2):147-163.
17.Cavalcanti AB, Zampieri FG, Rosa RG, et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. N Engl J Med. 2020 Nov 19;383(21):2041-2052.
18.Oldenburg CE, Pinsky BA, Brogdon J, et al. Effect of Oral Azithromycin vs Placebo on COVID-19 Symptoms in Outpatients With SARS-CoV-2 Infection: A Randomized Clinical Trial. JAMA. 2021 Aug 10;326(6):490-498.
19.Hinks TSC, Cureton L, Knight R, et al. Azithromycin versus standard care in patients with mild-to-moderate COVID-19 (ATOMIC2): an open-label, randomised trial. Lancet Respir Med. 2021 Oct;9(10):1130-1140.
20.Myall KJ, Mukherjee B, Castanheira AM, et al. Persistent Post-COVID-19 Interstitial Lung Disease. An Observational Study of Corticosteroid Treatment. Ann Am Thorac Soc. 2021 May;18(5):799-806.
21.Ogata H, Nakagawa T, Sakoda S, et al. Nintedanib treatment for pulmonary fibrosis after coronavirus disease 2019. Respirol Case Rep. 2021 Mar 30;9(5):e00744.