Treatment with protein synthesis inhibitors improves outcomes of secondary bacterial pneumonia after influenza

J Infect Dis. 2009 Feb 1;199(3):311-9. doi: 10.1086/596051.

Abstract

Pneumonia occurring as a secondary infection after influenza is a major cause of excess morbidity and mortality, despite the availability and use of antibiotics active against Streptococcus pneumoniae. We hypothesized that the use of a bacteriostatic protein synthesis inhibitor would improve outcomes by reducing the inflammatory response. BALB/cJ mice infected with influenza virus and superinfected with S. pneumoniae were treated with either the cell-wall-active antibiotic ampicillin or the protein synthesis inhibitor clindamycin or azithromycin. In the model, ampicillin therapy performed significantly worse (survival rate, 56%) than (1) clindamycin therapy used either alone (82%) or in combination with ampicillin (80%) and (2) azithromycin (92%). Improved survival appeared to be mediated by decreased inflammation manifested as lower levels of inflammatory cells and proinflammatory cytokines in the lungs and by observation of less-severe histopathologic findings. These data suggest that beta-lactam therapy may not be optimal as a first-line treatment for community-acquired pneumonia when it follows influenza.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Ampicillin / pharmacology
  • Ampicillin / therapeutic use
  • Animals
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Bronchoalveolar Lavage Fluid / cytology
  • Clindamycin / pharmacology
  • Clindamycin / therapeutic use*
  • Disease Models, Animal
  • Drug Screening Assays, Antitumor
  • Drug Therapy, Combination
  • Female
  • Inflammation / metabolism
  • Inflammation / prevention & control
  • Influenza A virus* / drug effects
  • Lung / metabolism
  • Lung / pathology
  • Mice
  • Mice, Inbred BALB C
  • N-Acetylmuramoyl-L-alanine Amidase / drug effects
  • Orthomyxoviridae Infections / complications*
  • Pneumonia, Pneumococcal / complications
  • Pneumonia, Pneumococcal / drug therapy*
  • Protein Synthesis Inhibitors / pharmacology
  • Protein Synthesis Inhibitors / therapeutic use*
  • Tumor Necrosis Factor-alpha / metabolism

Substances

  • Anti-Bacterial Agents
  • Protein Synthesis Inhibitors
  • Tumor Necrosis Factor-alpha
  • Clindamycin
  • Ampicillin
  • LytB protein, Streptococcus
  • N-Acetylmuramoyl-L-alanine Amidase