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PubMed2005

One-week dual therapy with ranitidine bismuth citrate and clarithromycin for the treatment of Helicobacter pylori infection in Brazilian patients with peptic ulcer.

AIM: To assess the efficacy and safety of ranitidine bismuth citrate plus clarithromycin given for 1 wk in Brazilian patients with peptic ulcer. METHODS: One hundred and twenty patients with peptic ulcer were randomized in two treatment groups: (1) 1-wk regimen consisting of ranitidine bismuth citrate 400 mg b.i.d. with clarithromycin 500 mg b.i.d. or (2) 2-wk regimen of the same treatment. Eradication of the infection was considered when both the histologic examination and the urease test were negative for the infection 3 mo after treatment. RESULTS: By intention to treat analysis, Helicobacter pylori (H pylori) was eradicated in 73% and 76% of patients, respectively treated for 1 or 2 wk (P>0.05). By per protocol analysis, the eradication rates were 80% and 83%, respectively, in patients treated for 1 or 2 wk (P>0.05). Nine patients (8.2%) reported minor side effects. CONCLUSION: One-week therapy with ranitidine bismuth citrate and clarithromycin is safe, well tolerated and effective for treatment of H pylori infection, and appears to be comparable to the 2-wk regimen in terms of efficacy.

Adult↗
PubMedDate not supplied

The role of azithromycin and clarithromycin in clinical practice.

BACKGROUND: Azithromycin and clarithromycin are the newest approved macrolide antibiotics. OBJECTIVE: To review the pharmacology, microbiology, and clinical utility of these agents. SUMMARY: These agents have distinct advantages over erythromycin, including an improved pharmacokinetic profile, less toxicity, and a wider spectrum of activity. They are approved for the treatment of respiratory tract infections and uncomplicated skin and skin-structure infections associated with specific organisms. Azithromycin is also indicated for the treatment of nongonococcal urethritis. In addition, these agents may be useful in the treatment of toxoplasmosis, mycobacterial disease, Lyme disease, and legionellosis. Clarithromycin and azithromycin have lower rates of gastrointestinal side effects than erythromycin. CONCLUSIONS: Although clarithromycin and azithromycin show promise in the treatment of some less common infections, they should be considered alternatives to conventional agents in the treatment of respiratory tract, skin, and skin-structure infections caused by the usual pathogens. The expense of these agents may be prohibitive for routine use.

Animals↗
PubMed1997

[Effect of erythromycin and clarithromycin on ion transport across dissected canine tracheal epithelium].

Since erythromycin was shown to be effective in the treatment of patients with diffuse panbronchiolitits, newly discovered effects of macrolide antibiotics have attracted much attention. It was reported that erythromycin inhibits Cl secretion across cultured canine tracheal epithelial cells. Erythromycin may decrease the movement of water toward the lumen, thus reducing sputum volume. We tested the hypothesis that erythromycin and clarithromycin have a similar effect on the dissected canine tracheal epithelium, by measuring the short circuit current using Ussing chambers. Addition of erythromycin or clarithromycin did not change the short circuit current within 20 minutes when applied on either the mucosal side or the submucosal side. No changes in the short circuit current were observed after pretreatment of the epithelium with amiloride, an Na channel blocker, or bumetanide, a Cl transport inhibitor, and subsequent addition of the macrolide antibiotics. These data indicate that neither erythromycin nor clarithromycin has any short term effect on ion transport in the dissected canine tracheal epithelium.

Animals↗
PubMed2005

[Oral clarithromycin as a treatment option in chronic post-operative endophthalmitis].

PURPOSE: To assess the outcome of medical treatment with oral clarithromycin in patients with chronic post-surgical endophthalmitis. METHODS: This prospective study was performed between January 1999 and September 2003. Patients with a diagnosis of chronic post-surgical endophthalmitis of bacterial etiology were included. All received 500 mg of oral clarithromycin twice a day for 14 days. The initial and final visual acuity, etiology, post-surgical time of presentation, treatment-delay time, and follow up were recorded. According to the treatment results, patients were distributed into 3 separate groups: 1) complete response, 2) partial response, 3) no response. Data from these groups were compared by means of the Student's t test and Fisher exact test, depending on which was considered most suitable. RESULTS: Fifteen cases of chronic endophthalmitis (11 of Propionibacterium acnes, 4 of Staphylococcus epidermidis) were diagnosed. A complete response was observed in 4 cases, partial response in 4 cases, and no response in 7 cases. Final visual acuity greater than 0.5 was significantly more likely in the complete response group when compared with the no response group (Fisher exact test = 0.0454, p=0.05), however, the same comparison between the complete response group and the partial response group was not significant. CONCLUSION: Medical treatment with oral clarithromycin could be useful in some patients with chronic post-surgical endophthalmitis.

Administration, Oral↗
PubMed1999

Clarithromycin pharmacokinetics in the desert tortoise (Gopherus agassizii).

Clarithromycin is a new, safe orally administered macrolide antibiotic active against Mycoplasma sp. in humans. Single-dose and multidose pharmacokinetic parameters were determined for clarithromycin in wild-caught desert tortoises (Gopherus agassizii) seropositive for M. agassizii. Clarithromycin blood levels were measured in three tortoises for up to 72 hr after a single oral dose of 7.5 mg/kg. In a second group of six tortoises, levels were measured after a dose of 15 mg/kg. Noncompartmental iterative two-stage Bayesian and nonparametric expectation maximization pharmacokinetic parameters were determined for each animal assuming first order rate constants. At 15 mg/kg, the maximum concentration was 1.37 microg/ml, the time to maximum concentration was 8.0 hr, and a plasma half-life of 11.69 hr was derived from the latter method. The absorption constant was 0.08/hr, the absorption half-life was 8.47 hr, and the weight-normalized volume of distribution was 5.30 L/kg. Predictions derived by the latter method suggested a dosage of 15 mg/kg p.o. every 24 hr to achieve maximal blood levels of > or =1 microg/ml for multiple dosing. However, results from a preliminary multidose study with three tortoises indicate that the drug is accumulated; therefore, the predicted dose may be closer to 15 mg/kg p.o. every 2-3 days to maintain blood levels of 2-7.5 microg/ml. (For n = 3, 2-point linear regression median estimates for the apparent elimination rate constant (K) and half-life are 0.0227/hr and 30.52 hr, respectively.) This multidose accumulation reflects a slower apparent elimination than that predicted in the eight single-dose tortoises (i.e., K = 0.0593/hr, t1/2 = 11.69 hr). This study highlights a potential pitfall of depending solely on single-dose studies and the potential value of oral administration in reptiles.

Administration, Oral↗
PubMed1999

Response to triple treatment with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori infections in continuous ambulatory peritoneal dialysis patients.

In this study, the response to triple treatment with omeprazole, amoxicillin, and clarithromycin was investigated in continuous ambulatory peritoneal dialysis (CAPD) patients with Helicobacter pylori (Hp) infections. The study enrolled 20 CAPD patients (11 male, 9 female) who had dyspeptic complaints. The mean age of the patients was 46 (range: 21-65). The study also enrolled, as a control group, 124 patients (66 male, 58 female) who had no systemic disease, but who had upper gastrointestinal endoscopy for dyspeptic complaints. The mean age of the patients in the control group was 47 years (range: 20-74 years). Upper gastrointestinal endoscopy, rapid urease test (CLO test), and direct histologic examination were carried out to detect Hp infection. Hp infection was detected in 10 cases (50%) in the CAPD group and in 53 cases (43%) in the control group. In both groups, patients with Hp infection received the triple treatment of omeprazole 20 mg twice daily for 30 days, amoxicillin 500 mg thrice daily for 15 days, and clarithromycin 500 mg thrice daily for 15 days. To assess response to treatment, upper gastrointestinal endoscopy, CLO test, and direct histologic examination were repeated 3 months after initiation of the treatment. Hp was eradicated in all of the 11 CAPD patients (100%), and in 42 of the control patients (92%). Our results suggest that the triple treatment with omeprazole, amoxicillin, and clarithromycin for Hp infection is as effective in CAPD patients as in the normal population.

Adult↗
PubMedDate not supplied

Six-day therapy with ranitidine bismuth citrate plus low-dose clarithromycin and tinidazole to cure Helicobacter pylori infection.

BACKGROUND/AIMS: Short-term ranitidine bismuth citrate-based triple regimens have been shown to be effective for the eradication of H. pylori. We investigated the efficacy of an eradicating therapy including ranitidine bismuth citrate, low-dose clarithromycin and tinidazole, administered for only 6 days. METHODOLOGY: Forty-five consecutive patients, who underwent gastroscopy for symptoms and were found to be H. pylori-positive, were recruited. They received ranitidine bismuth citrate 400 mg b.i.d. plus clarithromycin 250 mg b.i.d. plus tinidazole 500 mg b.i.d., given for 6 days. The medications given in twice daily doses were taken after meals with an interval of 12 h. The H. pylori status was evaluated by means of histology and rapid urease test on admission, and by 13C-urea breath test alone 8 weeks after treatment. RESULTS: All 45 enrolled patients completed the study. Thirty-nine of 45 patients returned H. pylori-negative (both per protocol and intention-to-treat analysis = 87%; 95% confidence interval = from 73-95%), while 6 of 45 were still H. pylori-positive (13%). Slight or mild side effects occurred in 5/45 patients (11%). CONCLUSIONS: Ranitidine bismuth citrate-based triple therapy, containing low-dose clarithromycin and tinidazole, given for only 6 days, yielded high eradication rates with modest side effects. Regimens based on ranitidine bismuth citrate plus two antibiotics at low dosages, administered for less than 7 days, constitute highly promising strategies for eradication of H. pylori.

Adult↗
PubMedDate not supplied

Clarithromycin targeting to lung: optimization of the size, morphology and release characteristics of albumin microspheres.

Micropheres are drug carrier system which ensures controlled release in the shape of solid sphere particles with variable diameter distributions from a few microns to a milimeter of size. The active substance is dispersed in molecular level or in forms of macroscopic particles. Clarithromycin was selected as the model active substance in our study. Clarithromycin microspheres were prepared and evaluated by an emulsion polymerization technique. Two matrix materials have been considered as the basis in preparing the selected model active substance. Natural human serum albumin and bovine serum albumin, which were frequently used in early microsphere studies and are being used in some studies as microshpere matrix material were used. Albumin microspheres containing clarithromycin were prepared by heat stabilization at different stirring rate. In the first part of our study, drug content, payload, particle size, surface morphology and release characteristics from microspheres prepared.

Animals↗
PubMed2000

[Pulmonary Mycobacterium gordonae infection treated with clarithromycin].

We reported a case of 51-year-old female immunocompetent patient with pulmonary Mycobacterium gordonae infection. The patient complained persistent cough and sputum and occasionally hemosputum. Chest radiograph and computed tomography (CT) of the lung showed bronchiectasis and small nodules in middle lobe. Bronchofiberscopy was performed twice, and bronchial washing specimen repeatedly revealed acid-fast bacilli. The organism was identified as Mycobacterium gordonae by biochemical tests and direct sequence method. She was treated with clarithromycin (400 mg/day) over 6 months and the chest CT findings showed improvement. The case was considered to be sensitive to clarithromycin in vitro drug susceptibility test. The case suggested that clarithromycin was a useful therapeutic agent to Mycobacterium gordonae infection.

Clarithromycin↗
PubMed1992

Comparison of the effects of midecamycin acetate and clarithromycin on gastrointestinal motility in man.

The gastrointestinal motor effects of the macrolide antibiotic, clarithromycin, were compared with those of midecamycin acetate. The method of investigation consisted of intraluminal pressure measurements in the gastric antrum and upper small intestine by means of a low compliance perfused catheter system. Six healthy volunteers participated in the single-blind, placebo-controlled study of both interdigestive and postprandial gastrointestinal motility. Clarithromycin was administered by mouth in a dose of 250 mg b.i.d.; midecamycin acetate was given in a dose of 600 mg b.i.d. The effect of midecamycin acetate on gastric antral and jejunal motility was not significantly different from that of placebo. This was true for both the interdigestive and the postprandial phases of gastrointestinal motility. Oral treatment with clarithromycin (250 mg, b.i.d.) resulted in a statistically significant increase in the postprandial number of antral contractions per hour as well as in the postprandial antral motility index, as compared to placebo.

Adult↗
PubMed2003

Low dose, one-week triple therapy (lanzoprazole, amoxycillin, clarithromycin) for eradication of Helicobacter pylori infection.

OBJECTIVE: To evaluate the efficacy and safety of low dose one week triple therapy with lansoprazole, amoxycillin and clarithromycin for the eradication of Helicobacter pylori (H. pylori). METHOD: A total of 103 patients with H. pylori infection who had gastritis, duodenal ulcer (DU) or gastric ulcer (GU) received 1 week's triple therapy of lansoprazole 30 g once daily (OD), amoxycillin 250 mg qid and clarithromycin 250 mg tid. The status of H. pylori infection was determined using the CLO test and histology (gram stain) of biopsy specimens during endoscopic examination. RESULT: After treatment with triple therapy H. pylori infection was eradicated in 98 of 103 patients (95.15%), dyspeptic symptoms and upper gastrointestinal hemorrhage improved in 99 of 103 patients (96.1%). No adverse effect was observed in all the patients was received treatment. CONCLUSION: Low dose one-week triple therapy with lansoprazole, amoxycillin and clarithromycin is effective for eradication of H. pylori infection.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Acute pancreatitis after a course of clarithromycin.

We present a case of acute pancreatitis after a course of clarithromycin. An 84-year-old woman died of suspected pneumonia and cardiac failure. Autopsy surprisingly revealed acute pancreatitis. Except for the use of clarithromycin no other cause for her acute pancreatitis was obvious. Pancreatitis induced by clarithromycin has been reported twice in the English literature so far. There are, however, a few reports on acute pancreatitis associated with other macrolide antibiotics, such as erythromycin and roxithromycin.

Acute Disease↗
PubMed2003

[Results of an open multicenter study of the efficiency of one-week anti-helicobacter therapy using omeprazole, clarithromycin, and amoxicillin in patients with duodenal peptic ulcer].

AIM: To study the efficiency of one-week antihelicobacter therapy using omeprazole, clarithromycin, and amoxycillin in patients with duodenal peptic ulcer during its recurrence. MATERIALS AND METHODS: 105 patients with recurrent peptic ulcer and a not less than 0.5-cm ulcer in the duodenal bulb was given triple therapy: omeprazole, 20 mg twice daily, amoxycillin, 1000 mg twice daily, and clarithromycin, 500 mg twice daily for 7 days. Then the patients were allowed to take antacids if they were required to abolish the symptoms of recurrent peptic ulcer. H. pylori was detected in the mucosal biopsy specimens taken from the anthral part and body of the stomach at gastroduodenascopy, by using the rapid urease test and histology. Gastroduodenoscopy was performed before and 4-6 weeks after the triple therapy. RESULTS: The major symptoms of recurrent peptic ulcer were eliminated in 90% of the patients by the end of a course of therapy, i.e. on its day 7. By the control time, the rate of ulcer cicatrization was 99.05% (104/105). The coincidence of results of the two tests has indicated that H. pylori eradication was 81.9% (86/105) 4-6 weeks after termination of treatment. Adverse reactions during therapy were observed in 20% of the patients; however, treatment had to be discontinued only in 2.9% of the patients. CONCLUSION: One-week triple therapy using omeprazole, clarithromycin, and amoxycillin in highly effective in treating duodenal peptic ulcer during its recurrence.

Adolescent↗
PubMed2004

[Use of clarithromycin in the treatment of atopic dermatitis complicated by staphylococcal infection].

Thirty patients (19 boys and 11 girls) with atopic dermatitis complicated by pyodermia were treated with clarithromycin tablets (Fromilid, KRKA, Slovenia) in a dose of 7.5 mg/kg body weight twice a day. The average treatment course was 7 days. The severity of atopic dermatitis was evaluated by the SCARAD Index. Thirty patients of the reference group were treated with intramuscular lincomycin in a dose of 10-20 mg/kg body weight twice a day for 7 days. The difference in the average SCORAD Index before and after the treatment with clarithromycin amounted to 19.95 vs 14.68 (p < 0.005) with the use of lincomycin. The tolerance of clarithromycin was good.

Adolescent↗
PubMed2004

[The effects of clarithromycin treatment on cardiac events in acute coronary syndrome patients].

OBJECTIVE: The assessment of short duration early clarithromycin treatment on major cardiac events in acute coronary syndrome patients. METHODS: One hundred and thirteen patients with acute coronary syndrome had been enrolled in the study in a prospective manner. Fifty-seven of 113 patients received peroral clarithromycin 1g/day for 14 days in addition to standard therapy. The remaining 56 patients were considered as control group. The treatment and control groups had similar major cardiac risk factors such as diabetes, hypertension, dyslipidemia and smoking habits. The occurrence of unstable angina pectoris, non-ST elevation myocardial infarction and ST elevation myocardial infarction was comparable in both groups. The use of thrombolytic therapy and glycoprotein IIb/IIIa receptor blockers administration was also similar in both groups. The patients were followed for major cardiac events for 6 months. RESULTS: During the follow-up, no difference was observed between groups in the occurrence of unstable angina pectoris, myocardial infarction, the need for revascularization with percutaneous coronary intervention or cardiac surgery and cardiac death. We observed a reduction of myocardial infarction and cardiac death occurrence and an increase in the necessity of percutaneous interventions in the treatment group even though this difference did not reach statistical significance. CONCLUSION: No benefit of short duration early clarithromycin therapy was observed in the occurrence of major cardiac events in acute coronary syndromes. Studies with longer treatment and follow-up period using different antibiotics are necessary to elucidate the possible effect of antibiotics on major cardiac events in patients with acute coronary syndrome.

Administration, Oral↗
PubMed2005

Clarithromycin destroys biofilms and enhances bactericidal agents in the treatment of Pseudomonas aeruginosa osteomyelitis.

In this study, the effect of clarithromycin on the destruction of bacterial biofilm in Pseudomonas aeruginosa osteomyelitis was investigated. Foreign body-related osteomyelitis caused by ceftazidime-sensitive Pseudomonas aeruginosa was produced in the tibias of 26 rats. After osteomyelitis was verified on Day 14, 10 rats had ceftazidime (1500 mg/kg/day) given subcutaneously, and 10 rats had ceftazidime given subcutaneously and clarithromycin (100 mg/kg/day, two 50-mg/kg doses every 12 hours) given orally; three rats formed the control group. After a treatment period of 20 days, the tibias and the foreign bodies were removed, cultured, and examined by electron microscopy. The number of microorganisms growing on the bone tissue in the group receiving combined treatment was significantly lower than in the other groups. The number of microorganisms growing on the foreign body in the group receiving only ceftazidime was significantly higher than that of the group receiving combined treatment. Electron microscope examination revealed that the biofilm layer was eradicated in the group that had combined therapy; however, biofilm formation was evident on the foreign body in the group receiving only ceftazidime. Clarithromycin enhanced the activity of concomitantly used bactericidal agents by destroying biofilm on the surface of the materials.

Animals↗
PubMed2005

Q Fever pneumonia: are clarithromycin and moxifloxacin alternative treatments only?

Medical records of 77 patients with Q fever pneumonia that was serologically confirmed by enzyme-linked immunosorbent assay were studied to compare the clinical efficacy of doxycycline, clarithromycin, and moxifloxacin. The mean times to defervescence were 2.4 days for those receiving doxycycline, 1.9 days for those receiving clarithromycin, and 2.2 days for those receiving moxifloxacin. There were no interruptions of the regimens in any groups because of side effects, and outcome was favorable in all patients with no complications or relapses during follow-up. This efficacy of clarithromycin and moxifloxacin, together with their safety profiles, suggest that these alternative agents in the treatment of Q fever pneumonia could also be used as the first-line therapy.

Adolescent↗
PubMed2004

[Organizing pneumonia--own experiences with clarithromycin treatment].

Organising pneumonia (OP) is a rare syndrome that has been associated with a variety of underlying disorders, including infections, collagen vascular diseases, toxic fumes, cancer, drugs and radiotherapy. Cryptogenic form is also observed. Steroids are usually effective in the treatment of OP, but other treatment regimens have been used as well. We present 5 women with OP, age ranged 57-76 years (mean - 67 years). Two of them were smokers and three were non-smokers. One patient was treated because of hyperthyreosis, one of COPD, and four had a hypertension. Four of them were diagnosed by the open lung biopsy and one by transbronchial lung biopsy. Dyspnoea (100%), cough (100%), fever (80%), weight loss (40%), chest pain (20%), were the most frequently noticed symptoms. All patients had bilateral consolidations with areas of ground glass attenuations at chest x-ray and HRCT. Migratory pattern of them was observed in four patients. Significant elevation of antibodies titers against Chlamydia pneumoniae was revealed in two patients. In all patients clarithromycin in a dose 0.5 g b.d. was administrated. Complete clinical and radiological remission was obtained after 3 months of clarithromycin therapy in 3 patients (one had Chlamydia antibodies). Two patients had not obtained significant improvement during the first two weeks of therapy so prednisolone in a dose 0.5 mg/kg/d was introduced. Also complete remission was noticed in these patients. The observation period ranged from 8 months to 4 years (mean - 34 months). Our study confirms that OP can be treated by the use of clarithromycin. It may be the alternative treatment, particularly for patients in whom probability of adverse reactions in the course of steroid treatment is high.

Aged↗