Clarithromycin infection

Mr. Park, a patient in a nursing home, has been receiving clarithromycin (Biaxin) for an upper respiratory infection for 9 days. The nurse assistant reports that he has been incontinent of feces for the past 2 days. Analyze whether this matter should be investigated. 

Systemic treatment of erythrosis finds its rationale in the association of rosacea with H. Pylori infection. The following scheme has heen suggested clarithromycin 250 mg twice daily + metronidazole 400 mg twice daily clarithrom-... 

Preexisting antimicrobial resistance is an increasing cause of treatment failure and is estimated to account for up to 70% of all treatment failures. Geography is the most important factor in HP resistance. Metronidazole-resistant strains are more prevalent in Asia (85%) than North America (30%).15 Primary resistance to amoxicillin and tetracycline remains low in both the United States and Europe. Clarithromycin resistance rates are estimated to be approximately 10% in the United States. Another confounding factor when evaluating potential antibiotic resistance is that culture and sensitivity studies are not routinely performed with HP infection. 

Furuta T, Shirai N, Takashima M et al. Effect of genotypic differences in CYP2C19 on cure rates for Helicobacter pylori infection by triple therapy with a proton pump inhibitor, amoxicillin, and clarithromycin. Clin Pharmacol Ther 2001 69[3] 158—168. 

The therapy prescribed is a 1-week triple therapy regimen consisting of amoxicillin, clarithromycin and omeprazole against Helicobacter pylori infection. 

In patients allergic to penicillin, macrolides are usually indicated in mild respiratory tract infections. Zithromax contains azithromycin, which is a macrolide that may be indicated for respiratory tract infections. As opposed to clarithromycin (another macrolide), azithromycin does not present any significant clinical interaction with phenytoin. Ciproxin contains ciprofloxacin. 

Cefalexin is a first-generation cephalosporin and therefore an alternative preparation would be Zinnat tablets, which contains cefuroxime, a second-generation cephalosporin. A penicillin such as Augmentin, which contains co-amoxiclav, can be an appropriate alternative since it provides a very similar spectrum of activity. Klaricid contains clarithromycin, which is a macrolide. Utinor contains norfloxacin, which is a quinolone that is effective in uncomplicated urinary-tract infections. Rocephin contains ceftriaxone, which is a third-generation cephalosporin that is available for parenteral administration only. 

First-line treatment in upper respiratory tract infections includes the use of penicillins, cephalosporins and mocrolides. Patients who are allergic to penicillins tend to be cross-sensitive to cephalosporins, so ore given mocrolides such as clarithromycin. 

The treatment of HP has become increasingly difficult due to the frequency of antibiotic resistance and recurrence after successful treatment. In Peru, the recurrence rate of the infection is as high as 73% even after successful eradication. In this instance, recurrence is not attributed to antibiotic resistance but to re-infection of patients. In the United States, resistant HP is also of concern. The Helicobacter pylori Antimicrobial Resistance Monitoring Program (HARP) is a multicenter US network that tracks HP patterns of resistance. In 2004, HARP reported that 34% of 347 HP isolates tested were resistant to one or more antibiotics commonly used to treat HP infections.In the US, most antibiotic resistance is associated with metronidazole and clarithromycin, both standard treatment options for HP. Thus, antibiotic resistance and high re-infection rates strongly argue for the development of new therapeutic modalities to prevent and treat HP infections worldwide. 

Clarithromycin is better absorbed and irritates the gastrointestinal tract less than erythromycin. It is presumed that its activity exceeds that of erythromycin by 2-4 times with respect to a number of streptococci and staphylococci, and to a few other microorganisms. It is used for treating bacterial bronchitis, pneumonia, skin and sexual infections. It is believed that clarithromycin is the most active macrolide for treating atypical mycobacteria. Synonyms of this drug are biaxin and others. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses Hiv infxns Action Antiretroviral nonnucleoside RTI Dose Adults. 600 mg/d PO qhs Feds. See package insert avoid high-fat meals Caution [D, ] CDC recommends HIV-infected mothers not breast-feed Contra Component sensitivity Disp Caps SE Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions T Effects W/ ritonavir T effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin X effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John s wort i effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin may alter effectiveness OF OCPs EMS Concurrent EtOH usage can t CNS d ression OD May cause muscle contractions and adverse CNS effects activated charcoal may be effective... 

The aminoglycoside (see Section II.c) streptomycin was the first antimycobacterial antibiotic. It has activity against extracellular mycobacteria with a high growth rate. The macrolide antibiotics azithromycin and clarithromycin (see Section Il.d.l) were approved for the treatment of disseminated mycobacterial infections due to Mycobacterium avium complex. 

A triple therapy regimen with combinations of clarithromycin or azithromycin plus ethambutol plus rifabutin is the current standard of care. However rifabutin may be omitted in HIV-infected patients on protease inhibitors because of significant interactions (Table 19). 

H. pylori infection PO 1 g twice a day in combination with clarithromycin and lansoprazole for 14 days. 

Duodenal ulcers associated with Helicobacter pybri infection PO 400 mg twice a day for 4 weeks in combination with clarithromycin 500 mg 2-3 times a day for the first 2 weeks. 

The study population consisted of CYP2C19-genotyped patients infected with H. pylori who had completed initial treatment with omeprazole 20 mg or lansoprazole 30 mg twice daily, and clarithromycin 200 mg and amoxicillin 500 mg three times a day for 1 week. Patients in whom the infection was not eradicated after initial treatment were retreated with lansoprazole 30 mg and amoxicillin 500 mg four times a day for 2 weeks. 

Noskin GA Tigecycline A new glycylcycline for treatment of serious infections. Clin Infect Dis 2005 41(Suppl 5) S303. Schlossberg D Azithromycin and clarithromycin. Med Clin North Am 1995 79 803. [PMID 7791424]... 

Zuckerman JM Macrolides and ketolides Azithromycin, clarithromycin, telithromycin. Infect Dis Clin North Am 2004 18 621. [PMID 15308279]... 

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

Mycobacterium avium complex HIV-infected patients with CD4 count < 75/14. Azithromycin, clarithromycin, or rifabutin Excellent... 

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]... 

Severe hypoglycemia occurred in two elderly men with type 2 diabetes mellitus and mild to moderate impaired renal function, who took clarithromycin 1000 mg/day for respiratory infections, in addition to a sulfonylurea (glibenclamide 5 mg/day in one case and glipizide 15 mg/day in the other) (168). Both developed severe hypoglycemia within 48 hours of starting clarithromycin. 

Treatment of H. pylori infection typically consists of a combination therapy, using several drugs simultaneously.42 For example, one common form of triple therapy consists of two antibacterials (amoxicillin and clarithromycin) and one of the PPIs described earlier in this chapter.17 36 Alternatively, various quadruple therapies have been used combining bismuth compound (described later in the section on Treatment of Diarrhea ) with a PPI and two antibacterials (e.g., tetracycline and metronidazole).5,36 These drug regimens are typically administered for 1 to 2 weeks and... 

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