Azithromycin Treatment Modulates Cytokine Production in Chlamydia trachomatis Infected Women

Abstract

Listen

Translate article

Chlamydial infection of the lower genital tract usually spreads to the upper genital tract and is then responsible for more serious consequences of chlamydial infection, such as infertility, ectopic pregnancy, pelvic pain and pelvic inflammatory disease [1]. Genital infection with Chlamydia trachomatis and the resulting cytokine environment largely determines the outcome of infection and disease [2–7]. Chlamydial infections are usually treated with Azithromycin or Doxycycline [8]. The immunomodulatory effects of macrolides have mainly been shown in vitro or in animal experiments. It has been reported that macrolide antibiotics can interfere with cytokine production in vitro [9–11]. Azithromycin has also been reported to inhibit the production of pro-inflammatory cytokines [12–17]. There is little evidence from the clinical arena that these immunomodulatory actions of antibiotics play a role in terms of outcome. Therefore, further studies to investigate the potential usefulness of azithromycin are necessary to elucidate its mechanism of action. The direct relevance of these findings for the treatment of infectious and inflammatory diseases will have to be tested in patients. The results of clinical trials have suggested that antibacterial activity of azithromycin is efficacious in the treatment of chlamydial cervical infection [18–20]. However, there are no human studies that have assessed antibacterial as well as anti-inflammatory effects of azithromycin treatment in different clinical conditions associated with the chlamydial infections. In a recent study on a Macaque model, azithromycin effectively prevented the progression of inflammation and fibrosis in both the lower and upper reproductive tract after repeated chlamydial infections suggesting that azithromycin may provide anti-inflammatory as well as antimicrobial properties and this combined activity may be particularly well-suited for the treatment of chlamydial infection [21]. Therefore, it might be possible that in immunopathological conditions like infertility and pelvic inflammatory disease, the anti-inflammatory property of azithromycin may act in the eradication of infection and disease. Hence, in the present study in order to examine the anti-inflammatory effects of azithromycin, we investigated the levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-13, interferon-γ (IFN-γ) and tumour necrosis factor-α (TNF-α) in women representing different clinical conditions, that is, Chlamydiapositive fertile and infertile women with genital tract infection of C. trachomatis before and after treatment with azithromycin.