Role of prophylactic azithromycin to reduce airway inflammation and mortality in a RSV mouse infection model

Pediatr Pulmonol. 2018 May;53(5):567-574. doi: 10.1002/ppul.23956. Epub 2018 Feb 6.


Background: Respiratory syncytial virus (RSV) infection is an important cause of morbidity and mortality in vulnerable populations. Macrolides have received considerable attention for their anti-inflammatory actions beyond their antibacterial effect. We hypothesize that prophylactic azithromycin will be effective in reducing the severity of RSV infection in a mouse model.

Methods: Four groups of BALB/c mice were studied for 8 days: Control (C), RSV-infected (R), early prophylaxis with daily azithromycin from days 1 to 8, (E), and late prophylaxis with daily azithromycin from days 4 to 8 (L). Mice were infected with RSV on day 4, except for the control group. All groups were followed for a total of 8 days when bronchoalveolar lavage cell count and cytokines levels were measured. Mouse weight, histopathology, and mortality data were obtained.

Results: Prophylactic azithromycin significantly attenuated post-viral weight loss between group R and both groups E and L (P = 0.0236, 0.0179, respectively). IL-6, IL-5, and Interferon-Gamma were significantly lower in group L (P = 0.0294, 0.0131, and 0.0056, respectively) compared with group R. The total cell count was significantly lower for group L as compared with group R (P < 0.05). Mortality was only observed in group R (8%). Lung histology in the prophylactic groups showed diminished inflammatory infiltrates and cellularity when compared with group R.

Conclusion: Prophylactic azithromycin effectively reduced weight loss, airway inflammation, cytokine levels and mortality in RSV-infected mice. These results support the rationale for future clinical trials to evaluate the effects of prophylactic azithromycin for RSV infection.

Keywords: airway inflammation; azithromycin; elderly BALB/c mouse; interleukin-6; respiratory syncytial virus.

MeSH terms

  • Animals
  • Antibiotic Prophylaxis*
  • Azithromycin / pharmacology*
  • Bronchoalveolar Lavage Fluid
  • Disease Models, Animal
  • Inflammation / drug therapy*
  • Inflammation / pathology
  • Lung / drug effects
  • Lung / pathology*
  • Mice
  • Mice, Inbred BALB C
  • Respiratory Syncytial Virus Infections / drug therapy*
  • Respiratory Syncytial Virus Infections / pathology
  • Respiratory Syncytial Viruses / pathogenicity*


  • Azithromycin