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PubMed1994

[Clarithromycin in the treatment of oral infections].

The authors show the results of a clinical study to test the efficacy and the tolerance of clarithromycin when used in the treatment of odontological infections. Forty-one subjects were selected for the study. All the subjects were affected by odontological infections and needed antibiotic therapy. The results obtained are satisfactory and demonstrate the effectiveness of the use of clarithromycin in the treatment of odontological infections.

Adolescent↗
PubMed1994

[Antibacterial activity of clarithromycin and its hydroxylated derivative and two other macrolides against thirty strains of Streptococcus pneumoniae].

Macrolides are widely used in the treatment of respiratory infections. Here, the authors compared the activity of different 14-membered macrolides: erythromycin (Ery), roxithromycin (Rox), clarithromycin (Cla) and its 14-hydroxy metabolite 14-OH clarithromycin (14-OH) against 30 strains of Streptococcus pneumoniae isolated at the Dupuytren hospital (Limoges, France) from upper respiratory tract sputum, ophthalmic sputum, blood samples and CSF. Twenty strains were susceptible to macrolides and 10 were resistant. Three strains from the susceptible and 7 from the resistant were resistant to penicillin. Furthermore, for all the macrolides except Rox and 14-OH, susceptibility tests were performed by the disk diffusion method on Mueller-Hinton agar. MICs50 of Cla and Ery were 0.06 mg/l. They were two-fold increased for 14-OH (0.125 mg/l) and four-fold increased for Rox (0.25 mg/l). We noted that for 3 resistant strains, MICs of Cla were four-fold decreased than MICs of Ery. Ery, Cla and 14-OH had bactericidal activity against pneumococcus strains susceptible to these antibiotics at 4 and 8 times the MIC after 6 or 18 h. The difference between MIC and MBC was small (1 or 2 two-fold dilutions) for Ery, Rox and Cla. For 14-OH, this difference was within 2 to 4 two-fold dilutions. The bactericidal activity is similar to that of amoxicillin and cefotaxim. A microdilution chequeboard technique was used against 3 strains and the FIC index did not show synergistic effect of combining Cla and 14-OH. The activity of Cla and 14-OH against 5 strains was not modified in the presence of 50% fresh pooled human serum inactivated at 56 degrees C or not.

Anti-Bacterial Agents↗
PubMed1994

[Clarithromycin in pediatric age. Personal experience].

The authors report their experience on the use of oral suspension of Clarithromycin in respiratory infections in the pediatric age. Thirty-three patients affected by various infectious pathologies of the respiratory tract, treated with oral Clarithromycin at the dosage of 15 mg/kg/day, were studied. The therapeutic outcome was very encouraging, the drug well tolerated and without side effects.

Administration, Oral↗
PubMed1994

The new macrolides. Azithromycin and clarithromycin.

Clarithromycin and azithromycin are among the new generation of macrolides that have recently been approved for use. Compared with currently available antibiotics, these agents may be given less frequently and, in the case of azithromycin, for a shorter duration. In vitro data suggest an antimicrobial advantage of both clarithromycin and azithromycin against atypical mycobacterial and toxoplasmal species and possibly Haemophilus influenzae. The cost of both these agents is substantially higher than that of erythromycin and doxycycline, although the convenience of single-dose azithromycin is appealing compared with a 7-day course of doxycycline for chlamydial urethritis and cervicitis. These agents appear to offer advantages over erythromycin in the treatment of Mycobacterium avium-intracellulare. Additional data are needed to establish their role in other bacterial infections.

Azithromycin↗
PubMed1993

Clarithromycin and other antimicrobial agents in the treatment of disseminated Mycobacterium avium infections in patients with acquired immunodeficiency syndrome.

BACKGROUND: Disseminated infection with Mycobacterium avium is common with late-stage acquired immunodeficiency syndrome (AIDS), and no antimicrobial agent has been found to be clearly effective. METHODS: A multicenter open trial was conducted to assess the antimicrobial activity and clinical efficacy of clarithromycin--a new macrolide antibiotic--against disseminated M avium in 77 patients with late-stage AIDS. Blood cultures were taken at baseline and during treatment; side effects were also evaluated. RESULTS: Mycobacterium avium was eradicated from blood cultures in 11 (63%) of 16 evaluable patients receiving daily doses or 500 or 1000 mg, (n = 21) and in 45 of 46 (98%) of those receiving 1500 or 2000 mg (n = 56). Eradication after 2 months was influenced by continuity of drug treatment; 36 of 42 patients with no relapse had received continuous treatment vs six of 14 patients whose drug treatment had been stopped for 7 days or longer. After 2 to 7 months of treatment, acquired resistance associated with relapse was observed. Drug side effects were elevated liver enzyme levels (26%) and impaired hearing (4%). Concomitant AIDS drugs had no favorable effect on outcome and may have worsened liver toxicity. CONCLUSIONS: Clarithromycin has bacteriologic efficacy against M avium infection in late-stage AIDS, although drug resistance eventually develops. Further studies are needed to investigate safe, effective concomitant drugs.

AIDS-Related Opportunistic Infections↗
PubMed1995

Effect of Helicobacter pylori eradication on the healing and recurrence of peptic ulcer: combination therapy with low-dose omeprazole and clarithromycin.

AIM: To investigate the effect of eradication of Helicobacter pylori using combination therapy with low-dose omeprazole and clarithromycin on the healing and recurrence of peptide ulcers. PATIENTS AND METHODS: We studied 60 patients with active duodenal ulcers and 60 with gastric ulcers who were H. pylori-positive by the rapid urease test and a histological examination of antral biopsy specimens. The eradication method used was a combination of omeprazole (20 mg a day) and clarithromycin (400 mg twice a day). The patients were followed up for 24 months after the end of the treatment. H. pylori infection and the ulcer stage were investigated by endoscopy every 6 months. We assessed the relationship between H. pylori infection, ulcer healing to a white scar and ulcer recurrence after combination therapy. RESULTS: H. pylori was eradicated in 23 out of 120 patients (22%), with suppression in 101 out of 120 patients (84%). The rate of ulcer healing to a white scar 6 months after treatment was significantly higher and the ulcer recurrence rate within 2 years after treatment was significantly lower in patients with H. pylori suppression or eradication than in those continuously positive for the organism. CONCLUSIONS: These results suggest that not only the eradication but also the suppression of H. pylori may improve ulcer healing and reduce the rate of relapse.

Adult↗
PubMed1995

Duodenal ulcer healing after 7-day treatment: a pilot study with lansoprazole, amoxicillin and clarithromycin.

OBJECTIVE: To evaluate the efficacy and safety of a one-week triple therapy without bismuth and metronidazole in duodenal ulcer healing and symptom relief. PATIENTS AND METHODS: Forty-five patients with duodenal ulcers and Helicobacter pylori (H. pylori) infections were given a 7-day treatment with lansoprazole 30 mg bid, amoxicillin 1.000 mg bid, and clarithromycin 500 mg bid. Endoscopies with urease tests and histologic examinations were performed before initiation and four weeks after cessation of therapy. RESULTS: Using efficacy analysis, 41 of 42 duodenal ulcers (98%; 95% CI 0.87-1.00) were healed after one week of treatment. H. pylori was eradicated in 40 of 42 patients (95%; 95% CI 0.84-1.00). Two patients with healed ulcers showed a persistent infection, whereas H. pylori was eradicated in the one patient with persisting ulcer. Using intention-to-treat analysis, ulcer healing was achieved in 41 of 45 (91%; 95% CI 0.79-0.98) and H. pylori eradication in 40 of 45 patients (89%; 95% CI 0.76-0.96). After a mean of five days, 40 of 41 patients (98%; 95% CI 0.87-1.00) with ulcer healing became completely pain-free. CONCLUSIONS: One-week therapy with lansoprazole, amoxicillin and clarithromycin is highly effective in duodenal ulcer healing and symptom improvement. Prolonged acid suppression does not seem to be essential for duodenal ulcer treatment.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1996

[Possible potentiation of phenprocoumon by clarithromycin and roxithromycin].

Two patients, a women of 70 and a man of 75 years old, who were using phenprocoumon chronically, and were monitored by a regional thrombosis service, received a macrolide antibiotic, clarithromycin and roxithromycin respectively, for an airway infection. Both patients developed a serious increase in hypocoagulability, requiring administration of phytomenadione and temporary decreases in phenprocoumon dose. There were no bleeding complications. After the antibiotics were discontinued, the original dosage of phenprocoumon was needed again. It is suggested that in these patients the macrolide antibiotics may have potentiated the effect of phenprocoumon, perhaps as a result of inhibition of phenprocoumon transformation by liver enzymes. In patients receiving chronic treatment with phenprocoumon, coagulation parameters should be regularly checked if they are given a macrolide antibiotic such as clarithromycin, roxithromycin or erythromycin.

Aged↗
PubMed1997

Electron microscopic analysis of Mycobacterium avium complex isolates exposed to ciprofloxacin, rifabutin, ethambutol and clarithromycin.

SETTING: Mycobacterium avium complex (MAC) isolates grown in the presence of clarithromycin, ciprofloxacin, ethambutol or rifabutin were examined by electron microscopy for drug-induced ultrastructural changes. OBJECTIVE: To further the understanding of the activity of clarithromycin, ciprofloxacin, ethambutol and rifabutin against MAC. DESIGN: Four MAC isolates, 1 control and 3 patient, were cultured for 24 or 72 hours in liquid medium containing one of two concentrations of an antimicrobial agent prior to examination by electron microscopy. RESULTS: One or more of the following ultrastructural changes was observed after exposure to the antimicrobial agent: disorganized nucleoid and cytoplasm, condensation of nucleoid, vacuolization, enlargement of the periplasmic space with or without vesicles, intracytoplasmic lipid-like inclusions, and cell lysis. Changes were seen after as little as 24 hours of exposure to the antimicrobial agent and were more evident with the higher of the two concentrations of the drug. Changes were present regardless of the minimum inhibitory concentration (MIC) of the antimicrobial agent against the isolates tested, but were more pronounced if the MIC was less than the concentration of drug tested. CONCLUSION: Consistent ultrastructural changes were observed following exposure to a given antimicrobial agent. No drug-specific changes were identified.

Antitubercular Agents↗
PubMed1997

Pharmacokinetic and pharmacodynamic interaction study between midazolam and the macrolide antibiotics, erythromycin, clarithromycin, and the azalide azithromycin.

This report includes a recalculation of the pooled data of 2 pharmacokinetic and pharmacodynamic studies of the interaction between the hypnotic midazolam and the antibiotics erythromycin, clarithromycin (macrolides), and azithromycin (an azalide). Erythromycin and clarithromycin similarly and strikingly impaired the metabolism of midazolam and enhanced its pharmacodynamic activity; little or no effect was found with azithromycin. It was concluded that coadministration of midazolam and azithromycin involves less clinical risk than with the 2 macrolides.

Anti-Anxiety Agents↗
PubMed1997

One-week therapy with omeprazole, clarithromycin and metronidazole or ornidazole, followed by 3 weeks' treatment with omeprazole, eradicates Helicobacter pylori equally and heals duodenal ulcer.

OBJECTIVE: To estimate and compare the efficacy of 'triple' 1-week regimens--omeprazole, clarithromycin and a nitroimidazole (metronidazole or ornidazole)--followed by omeprazole, for an additional 3 weeks, on Helicobacter pylori eradication and duodenal ulcer (DU) healing, in a country with a high resistance rate of H. pylori to metronidazole. DESIGN: Open, prospective, two-centre study. METHODS: Patients older than 18 years with active duodenal ulcer (DU), diagnosed by endoscopy and found to be infected with H. pylori (modified Giemsa stain and CLO test, Delta West, Australia), were included in the study. Three triple-drug regimens, given for 7 days, were used. (1) omeprazole (Om) 20 mg once a day, plus clarithromycin (Cl) 250 mg twice daily, plus ornidazole (Or) 500 mg twice daily (O1COr); (2) Om 20 mg twice daily, plus Cl 250 mg twice daily, plus Or 500 mg twice daily (OCOr); and (3) Om 20 mg twice daily, plus Cl 250 mg twice daily, plus metronidazole (M) 500 mg twice daily (OCM). Two hundred and three consecutive H. pylori-positive patients were included in the study, randomly assigned as follows: 50 patients (group A1: 32 men, 18 women, age 23-77 years) on O1COr; 47 patients (group A2: 29 men, 18 women, age 27-77 years) on OCOr; and 106 (group B: 71 men, 35 women, age 18-83 years) on OCM. Ulcer healing and H. pylori eradication were assessed endoscopically, 8-9 weeks after the start of treatment. H. pylori was considered eradicated if both histology and rapid urease test (six biopsies, antrum-body) were negative. RESULTS: Eleven patients were lost to follow-up; 192 patients were analysed. Group A1: 48; group A2: 44; group B: 100. 'Per-protocol' analysis: H. pylori eradication, 90-93% (P = 0.901); ulcer healing, 90-98% (P = 0.300). 'Intention to treat' analysis: H. pylori eradication, 85-88% (P = 0.887); ulcer healing, 86-91% (P = 0.657). Compliance was excellent, no serious side effects were observed and no patients withdrew due to side effects. CONCLUSIONS: No differences were observed in the H. pylori eradication and the healing rate among the groups. It seems that twice daily omeprazole is no better than single daily dosage and that ornidazole is as effective as metronidazole. In addition, in the studied population which is believed to have a high prevalence of metronidazole resistance, all the regimens used were effective.

Adolescent↗
PubMed1997

[Mycobacterium chelonae cutaneous infection: efficacy of prolonged treatment by clarithromycin].

INTRODUCTION: Mycobacterium chelonae is an ubiquitous mycobacterium which is exceptionally pathogenic. It can cause localized skin infections which are difficult to treat because of multiple drug-resistance. CASE REPORT: A 87-year-old woman with bullous pemphigoid was treated with long-term prednisone and developed a skin infection due to M. Chelonae. Treatment with clarithromycin was successful, but relapse occurred 6 months after withdrawal of the antibiotic. DISCUSSION: Clarithromycin is effective in single drug regimen for M. Chelonae infection, but the duration of treatment should be long when immunosuppression cannot be avoided.

Aged↗
PubMed1998

Relevance of antibiotic sensitivities in predicting failure of omeprazole, clarithromycin, and tinidazole to eradicate Helicobacter pylori.

Omeprazole 20mg once (od) or twice daily (bd), clarithromycin 250mg bd, and tinidazole 500 mg bd for 7 days (OCT) is an effective regimen against Helicobacter pylori, but the effect of 5-nitroimidazole resistance is unclear. We aimed to evaluate this using the disc diffusion technique and E-test to assess 5-nitroimidazole resistance. H. pylori was cultured from antral biopsies of infected patients as determined by 13C-urea breath test (13C-UBT), histology, and/or rapid urease test. Patients were prescribed OCT, and H. pylori eradication was assessed by 13C-UBT at least 4 weeks after completion of therapy. Antibiotic sensitivities to metronidazole and clarithromycin were evaluated by the disc diffusion method and by minimum inhibitory concentration (MIC) using the E-test. One hundred and forty-one H. pylori-infected patients were enrolled into the study and the organism was successfully cultured in 119 patients (84%). The overall eradication rate was 125/141 (89%). OCT was successful in 62/69 (90%) patients harboring fully sensitive strains of H. pylori compared with 42/45 (93%) of patients with strains that were resistant to metronidazole alone (P = 0.74, Fisher's exact test). MIC was assessed in 22 samples. Using a cut-off point of > 32 microg/ml to define metronidazole resistance, eradication rates were higher against sensitive (9/12; 75%) compared with resistant (3/10; 30%) strains (P = 0.08, Fisher's exact test). 5-Nitroimidazole resistance assessed by the disc diffusion technique is not helpful in predicting OCT failure, but the E-test may be of value.

Adult↗
PubMed1998

In-vitro susceptibility of group A beta-haemolytic streptococci (GABHS) to penicillin, erythromycin, clarithromycin and azithromycin in Styria, Austria.

248 Strains of group A beta-haemolytic streptococci (GABHS) were tested against penicillin and the macrolide antibiotics, erythromycin, clarithromycin and azithromycin. 213 (85.9%) GABHS isolates were taken from throat swabs from patients with pharyngotonsillitis, 35 isolates (14.1%) were from other body sites or from invasive infections. The age of the patients ranged from 9 months to 89 years, 155 of the patients (62.5%) were below 10 years of age. The results of the E-test method and a disk diffusion assay were compared; to classify the phenotype of the erythromycin-resistant strains, a disk induction test was carried out. None of the 248 GABHS strains showed resistance to penicillin, whereas 53 GABHS isolates (21.4%) were resistant to the macrolide antibiotics included in the test. There were only minor discrepancies between the two testing methods. The MIC data obtained with the E-test method suggested that among the macrolides, erythromycin and clarithromycin had slightly higher antistreptococcal activity than azithromycin in vitro. 50 (94.3%) of the erythromycin-resistant GABHS showed the pattern of novel resistance (M phenotype), 2 (3.8%) strains showed inducible resistance (IR) and 1 (1.9%) strain exhibited consecutive resistance (CR).

Adolescent↗
PubMed2000

Prevalence of Helicobacter pylori resistance to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone in Brazil.

BACKGROUND: Helicobacter pylori infection is associated with a wide range of digestive diseases and is very prevalent in developing countries, although few data exist on the susceptibility of H. pylori to antimicrobials commonly used in eradication schedules in these countries. The aim of this study was to evaluate the resistance of H. pylori to metronidazole, clarithromycin, amoxicillin, tetracycline, and furazolidone in dyspeptic Brazilian patients. Material and Methods. Ninety consecutive H. pylori-positive patients were enrolled. Resistance was evaluated by an agar dilution test. RESULTS: Resistance to metronidazole was detected in 38 patients (42%); to amoxicillin in 26 individuals (29%); to clarithromycin in 6 patients (7%); to tetracycline in 6 patients (7%); and to furazolidone in 4 individuals (4%). Thirteen strains were resistant to two agents, and eight strains were resistant to three antimicrobials. CONCLUSIONS: These results confirm the need for culture and susceptibility testing to define H. pylori resistance patterns in particular geographical areas before the general use of an eradication schedule. They also suggest the possibility of resistance to such antimicrobials as amoxicillin or tetracycline in geographical areas with a high prevalence of H. pylori infection and still not fully evaluated for antimicrobial susceptibility.

Adolescent↗
PubMed1993

Susceptibility of Mycobacterium kansasii to ofloxacin, sparfloxacin, clarithromycin, azithromycin, and fusidic acid.

The MICs of ofloxacin, sparfloxacin, clarithromycin, azithromycin, and fusidic acid for clinical isolates of Mycobacterium kansasii were determined by the radiometric (BACTEC) method. All drugs except azithromycin elicited MICs for 90% of the strains tested that were lower than previously reported achievable maximum concentrations in serum. Ofloxacin, sparfloxacin, and clarithromycin had the largest maximum concentration in serum/MIC for 90% of strains ratio of the drugs tested.

4-Quinolones↗
PubMed1996

In vitro activities of rifabutin, azithromycin, ciprofloxacin, clarithromycin, clofazimine, ethambutol, and amikacin in combinations of two, three, and four drugs against Mycobacterium avium.

Multidrug therapy is recommended for treatment of Mycobacterium avium complex (MAC) bacteremia in patients with AIDS. Azithromycin, clarithromycin, rifabutin, ciprofloxacin, ethambutol, clofazimine, and amikacin have all been suggested for use in treating MAC bacteremia, but the most active combinations of these drugs have not been identified, nor has the minimum number of drugs needed for effective therapy been determined. To address the former, the in vitro bactericidal activities of all two-, three-, and four-drug combinations of these seven agents was determined by using 10 blood-derived strains of MAC isolated from patients with AIDS. The activities of the 132 drug combinations were compared by statistical analysis of survival means (analysis of variance) and further evaluated by determining the percentage of strains considered susceptible to each combination. When susceptibility was defined as a decrease in CFU of > or = 2 log10, no two- or three-drug combination and only two four-drug combinations were active against all 10 MAC strains. When a less stringent definition was applied (> or = 1 log10 decrease in CFU), 1 two-drug combinations, 9 three-drug combinations, and 31 four-drug combinations showed activity against all 10 strains. Eighteen selected drug combinations were also tested for intracellular activity in MAC-infected J774 cells. Combinations which contained amikacin as a component were considerably less active against intracellular MAC organisms than against organisms in broth. The opposite result was obtained for the combination of clarithromycin plus clofazimine.

AIDS-Related Opportunistic Infections↗
PubMed1998

The combination of omeprazole, amoxycillin, and clarithromycin eradicates Helicobacter pylori in 95% of patients---7 days of therapy is as good as 10 days.

More than half of the known Helicobacter pylori strains are resistant to metronidazole, according to previous Hong Kong studies. The response rates to treatment regimens that comprise metronidazole as one of the antimicrobial agents have usually been disappointing in cases involving metronidazole-resistant strains. The objective of this open cohort evaluation was to assess the efficacy of an alternative regimen that combines omeprazole with amoxycillin and clarithromycin in Helicobacter pylor-positive ulcer and non-ulcer patients in Hong Kong. Furthermore, we aimed to investigate if 7 days were as good as 10 days of therapy. We studied 186 Helicobacter pylor-positive subjects; 149 subjects received 7 days of combination therapy and 37 subjects received 10 days. Our results showed that the overall Helicobacter pylori eradication efficiency was identical (94.6%) for both treatments. The incidences of adverse effects were also very similar (16.8% versus 16.2%) and both treatments were well tolerated. Thus, we propose that omeprazole in combination with amoxycillin and clarithromycin should be considered as one of the first-line therapies for patients with Helicobacter pylor infection in Hong Kong.

Journal Article↗