Erythromycin-induced Suppression of Pulmonary Antibacterial Defenses: A Potential Mechanism of Superinfection in the Lung

Abstract

Erythromycin is a broad-spectrum antibiotic commonly used in patients with respiratory infections. Certain of these patients become colonized with new microorganisms and develop superinfections. Antibiotics have a number of effects other than simply killing or inhibiting the growth of bacteria and may have direct effects upon host cells, including phagocytes. In vitro and in vivo studies have demonstrated that erythromycin decreases polymorphonuclear leukocyte (PMN) directed migration. To test the hypothesis that erythromycin inhibits normal PMN migration into the alveoli in response to a bacterial challenge, mice were challenged by aerosol inhalation with Proteus mirabilis or Staphylococcus aureus and injected intravenously with erythromycin (50 or 100 mg/kg). Pulmonary bactericidal activity and total lavaged lung cell and differential counts were determined 4 h after bacterial challenge. In control mice, only 24 .+-. 2% of the initial inoculum of P. mirabilis was viable at 4 h. At a dose of 100 mg/kg, lung defenses after erythromycin were ablated, allowing the proliferation of P. mirabilis to 113 .+-. 5% of the initial inoculum. The number of PMN obtained by lavage after P. mirabilis challenge was also inhibited by erythromycin in a dose-dependent manner. In untreated animals, 5.0 .+-. 0.2 .times. 106 PMN were recovered as compared with 3.1 .+-. 0.4 .times. 106 and 1.1 .+-. 0.3 .times. 106 with increasing doses of erythromycin. Intrapulmonary bactericidal activity against S. aureus was not impaired by erythromycin. In separate in vitro studies, the chemotactic index of human PMN incubated with 10 .mu.g/ml of erythromycin was significantly depressed compared with that in untreated control cultures. In contrast, the bactericidal oxidative metabolism of these cells as measured by chemiluminescence and nitroblue tetrazollum reduction was not altered by erythromycin. This study demonstrated dose-related suppression of pulmonary antibacterial defenses by erythromycin administration and indicates that one possible mechanism of bacterial superinfection in antibiotic-treated infection may involve suppression of cellular host defenses produced by the antibiotics themselves. These observations underscore the necessity for selective and judicious antibiotic usage.