Efficacy of an antibiotic, clarithromycin for endometriosis

Can we use antibiotic for treating endometriosis?

Key Points

Highlight:

• This article reports the activity of an antibiotic (clarithromycin) in the treatment of endometriosis.

Importance:

• Current standard treatments for endometriosis often influence fertility and ovulation, thus new treatments may be more useful clinically.

What's done here:

• This is a clinical trial conducted on endometriosis women to investigate the therapeutic efficacy of clarithromycin.
• The trial is double-blinded randomized and placebo-controlled in Dena Hospital, Shiraz, Iran from March 2016–2017.
• Women were randomly divided into clarithromycin (n = 120) and placebo group (n = 169) after surgery.
• Patients in the clarithromycin group received 500 mg of clarithromycin every day for 6 months.
• Serum levels of tumor necrosis factor-alpha (TNF α), interleukin-10 (IL-10), erythrocyte sedimentation rate (ESR) and C-reactive protein were measured at baseline, after 3 and 6 months
• Clinical symptoms were also monitored.

Data:

• Treatment resulted in reductions in the scores of dysmenorrhea, dyschezia, dyspareunia, and non-menstrual pain than the baseline values.
• Treatment resulted in reductions in the serum levels of CRP, TNF-α, and IL-10 compared with the baseline values.
• However, there was no significant reduction in the clinical symptoms and serum levels between the clarithromycin and placebo groups.

Limitation:

• Short follow-up period.
• Low sample size.
• A more robust statistical method is needed to analyze differences between the two groups due to the difference in the sample size

Lay Summary

Laparoscopic surgery is the standard treatment for advanced stages of endometriosis, followed by postoperative modalities including to progesterone, antiprogestogens, estrogen-progesterone combinations, danazol, and gonadotropin-releasing hormone agonists to reduce recurrence after surgery. However, these drugs interfere with ovulation and fertility.

The role of immune system in endometriosis progression and clinical symptoms has resulted in treatment using anti-inflammatory agents. Clarithromycin is a macrolide with an anti-inflammatory effect. It is used for different inflammatory diseases, such as asthma, cystic fibrosis, bronchiectasis, and sepsis. This study conducted by Alborzi et al. from the Department of Gynecology and Obstetrics, Shiraz University of Medical Sciences, Shiraz, Iran investigated the therapeutic efficacy of clarithromycin in patients with endometriosis. The study outcome was published in the Archives of Gynecology and Obstetrics.

The trial design was double-blinded, and patients were randomized into the placebo group (n=169) and clarithromycin group (n=120). The study was conducted during March 2016–2017 in Dena Hospital, Shiraz, Iran. Post-surgery, women received either placebo or 500 mg of clarithromycin every day for 6 months. The serum levels of tumor necrosis factor-alpha (TNF α), interleukin-10 (IL-10), erythrocyte sedimentation rate (ESR) and C-reactive protein were determined. In addition, the clinical symptoms were monitored at baseline and 3 and 6 months.

The data showed that clinical symptoms, dysmenorrhea, dyschezia, dyspareunia, and non-menstrual pain were reduced in both clarithromycin and placebo groups compared with the baseline values. Similar trends were shown in the serum levels of CRP, TNF-α, and IL-10. There was no significant difference between the clarithromycin and placebo groups, although the former showed greater reductions.

This study is limited by the relatively short follow-up period and a low sample size. A more powerful significant analysis is needed to compare the two groups since they were not the same size. Therefore, while clarithromycin may be appropriate, further studies with larger sample size and longer follow-up periods will be required to establish its benefit.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/30888478