Clarithromycin disease

III. Eradication of Helicobacter pylori C. This microorganism plays an important role in the pathogenesis of chronic gastritis and peptic ulcer disease. The combination of antibacterial drugs and omeprazole has proven effective. In case of intolerance to amoxicillin (p. 270) or clarithromycin (p. 276), metronidazole (p. 274) can be used as a substitute. Colloidal bismuth compounds are also effective however, the problem of heavy-metal exposure compromises their long-term use. 

Pregnancy (ergotamine s powerful uterine stimulant actions may cause fetal harm) hypersensitivity to ergot alkaloids peripheral vascular disease (eg, thromboangiitis obliterans, leutic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease) hepatic or renal impairment severe pruritus coronary artery disease hypertension sepsis. The use of potent CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is contraindicated. 

There is increasing evidence that eradication of Helicobacter pylori with combination therapy of two antibiotics (often amoxicillin with clarithromycin) with a proton pump inhibitor (e.g. pantoprazol) during one week will heal and prevent peptic ulcer disease. 

L D. Doxycycline is the preferred parenteral tetracycline for the primary state of Lyme disease in adults and children older than 8 years of age. Penicillin V (A) would be ineffective. Erythromycin (B) and clarithromycin (C) also are not effective against Borrelia burgdorferi, the gram-negative anaerobe organism responsible for Lyme disease. 

M marinum Granulomatous cutaneous disease Amikacin, clarithromycin, ethambutol, doxycycline, minocycline, rifampin, trimethoprim-sulfamethoxazole... 

M avium complex Pulmonary disease in patients with chronic lung disease disseminated infection in AIDS Amikacin, azithromycin, clarithromycin, ciprofloxacin, ethambutol, rifabutin... 

Finally, it is universally accepted at present that Helicobacter pylori infection has a definitive ethiological role in peptic ulcer disease, and that erradication therapy is warranted in these clinical scenarios. The majority of therapeutic trials have included the application of triple therapy with proton pump inhibitors or ranitidine bismuth citrate, clarithromycin and either amoxycillin or metronidazol and is to date the treatment of choice. However, recent studies have reported antibiotic resistance which can be one reason for failure of treatment of Helicobacter pylori infection [101-103], and new treatment strategies are therefore Wellcome. Flavonoids, in addition to their gastroprotective activity previously commented, have been also shown to inhibit Helicobacter pylori growth in vitro. In this way, Beil et al. [50]... 

Bacillus Legionella pneumophila Common Disease(s) Legionnaires disease Primary Agent(s) Erythromycin rifampin or a fluoroquinolone Alternative Agent(s) Azithromycin or clarithromycin doxycycline trimethoprim-sulfamethoxazole... 

Spirochetes Borrelia burgdorferi Lyme disease Amoxicillin doxycycline ceftriaxone cefuroxime Azithromycin cefotaxime clarithromycin penicillin (high dose)... 

Gomez-Gil E, Garcia F, Pintor L, Martinez JA, Mensa J, de Pablo J. Clarithromycin-induced acute psychoses in peptic ulcer disease. Eur J Clin Microbiol Infect Dis 1999 18(1) 70—1. 

Jamrozik K, Anderson CA, Stewart-Wynne EG (1994). The role of lifestyle factors in the etiology of stroke. A population-based case-control study in Perth Western Australia. Stroke 25 51-59 Jespersen CM, Als-Nielsen B, Damgaard M etal. (2006). Randomized placebo controlled multicentre trial to assess short term clarithromycin for patients with stable coronary heart disease CLARICOR trial. British Medical Journal 332 22-27 Jorgensen HS, Nakayama H, Raaschou HO etal. (1994). Stroke in patients with diabetes. The Copenhagen Stroke Study. Stroke 25 1977-1984... 

Clarithromycin 500 mg orally twice daily, plus ethambutol 15 mg/kg/day orally (Al), and For advanced disease, rifabutin 300 mj day (dose may need adjustment with ART) (Mf... 

BUSULFAN MACROLIDES - CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN t plasma concentrations of busulfan and t risk of toxicity of busulfan such as veno-ocdusive disease and pulmonary fibrosis Busulfan clearance may be 1 by 25%, and the AUC of busulfan may t by 1500 p,mol/L Monitor clinically for veno-ocdusive disease and pulmonary toxicity in transplant patients. Monitor busulfan blood levels as AUC below 1500 p,mol/L per minute tends to prevent toxicity... 

CICLOSPORIN MACROLIDES -CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN t plasma concentrations of ciclosporin, with risk of nephrotoxicity, myelosuppression, neurotoxicity, excessive immunosuppression, with risk of infection and post-transplant lymphoproliferative disease Inhibition of CYP3A4-mediated metabolism of ciclosporin these inhibitors vary in potency. Clarithromycin and telithromycin are classified as potent inhibitors Avoid co-administration with clarithromycin and telithromycin. Consider alternative antibiotics but need to monitor plasma ciclosporin levels to prevent toxicity... 

CLARITHROMYCIN, ERYTHROMYCIN IRINOTECAN t plasma concentrations of SN-38 (>AUC by 100%) and T toxicity of irinotecan, e.g. diarrhoea, acute cholinergic syndrome, interstitial pulmonary disease Due to inhibition of the metabolism of irinotecan by CYP3A4 isoenzymes by macrolides Peripheral blood counts should be checked before each course of treatment. Monitor lung function. Recommendation is to 4 dose of irinotecan by 25%... 

Other agents with in vitro activity include rifampin, vamcomycin, penicillin, ampicillin, chloramphenicol, imipenem, clindamycin, and clarithromycin. Because of concerns for beta-lactamases in Bacillus anthracis, penicillin and ampicillin should not be used alone. Consultation with an infectious disease specialist is advised... 

Most cases of Legionella pneumonia show improvement within 12-48 hours of starting antibiotic therapy. The antibiotic of choice has been erythromycin, sometimes paired with a second antibiotic, rifampin. Tetracycline, alone or with rifampin, is also used to treat Legionnaires disease, but has had more mixed success in comparison to erythromycin. Other antibiotics that have been used successfully to combat Legionella include doxycycline, clarithromycin, fluorinated quinolones, and trim ethoprim/sulfamethoxazole. 

Disease that is segmental or lobar in its distribution is usually caused by Streptococcus pneumoniae (pneumococcus). Haemophilus influenzae is a rare cause in this group, although it more often leads to exacerbations of chronic bronchitis and does cause pneumonia in patients infected with HIV. Benzyl-penicillin i.v. or amoxicillin p.o. are the treatments of choice if pneumococcal pneumonia is very likely alternatively, use erythromycin/clarithromycin in a penicillin-allergic patient. Seriously ill patients are best given benzylpenicillin (to cover the pneumococcus) plus ciprofloxacin (to cover Haemophilus and atypical pathogens). Where penicillin-resistant pneumococci are prevalent, i.v. cefotaxime is a reasonable best guess choice. 

Clarithromycin (0.75-2 g/day), minocycline (200 mg/ day), and clofazimine (100 mg/day) for 15 months were investigated as treatment of MAC lung disease in 30 HIVnegative patients. Eight patients did not complete the study owing to deviations from protocol or adverse effects. Persistently negative cultures were found in 14 of the other patients. There were three cases of hepatic disturbances and three of ototoxicity, which required a reduction in clarithromycin dosage after a short interruption of treatment (10). 

Fox JC, Szyjkowski RS, Sanderson SO, Levine RA. Progressive cholestatic liver disease associated with clarithromycin treatment. J Clin Pharmacol 2002 42(6) 676-80. 

Masia M, Gutierrez F, Jimeno A, Navarro A, Borras J, Matarredona J, Martin-Hidalgo A. Fulminant hepatitis and fatal toxic epidermal necrolysis (Lyell disease) coincident with clarithromycin administration in an alcoholic patient receiving distrlfiram therapy. Arch Intern Med 2002 I62(4) 474-6. 

In a similar study in 221 patients with peptic ulcer disease associated with H. pylori, rabeprazole has been compared with omeprazole and lansoprazole (combining them with amoxicillin plus clarithromycin for 1 week) (6). Rabeprazole was as effective as omeprazole and lansoprazole in eradicating H. pylori (84-88% each). There were no differences in reported adverse events. Common adverse effects were soft stools, glossitis, taste disturbances, and skin rashes. 

A beneficial effect of low doses of clarithromycin on sputum rheology has been reported in patients with chronic pulmonary diseases, such as chronic bronchitis... 

Laine L, Suchower L, Frantz J, Connors A, NeU G. Twice-daily, 10-day triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori eradication in duodenal ulcer disease results of three multicenter, double-blind, United States trials. Am J Gastroenterol 1998 93(11) 2106-12. 

A 53-year-old woman had periods of dizziness and episodes of fainting when she stood np 24 hours after having been given clarithromycin for an acute exacerbation of chronic obstmctive pnlmonary disease and verapamil for atrial fibrillation (32). One day later she developed severe hypotension and bradycardia (32). Since her symptoms matched those of severe verapamil overdosage, the drug was withdrawn and her condition improved within two days. 

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