Pneumonia clarithromycin effect

In a multicenter, double-blind, randomized comparison of trovafloxacin 200 mg and clarithromycin 500 mg bd in 176 subjects with acute exacerbations of chronic bronchitis, the most common adverse effects of trovafloxacin were nausea (5%), dizziness (5%), vomiting (3%), and constipation (3%) (1). Because trovafloxacin is hepato-toxic, the list of appropriate indications has been limited to patients who have at least one of several specified infections, such as nosocomial pneumonia or complicated intra-abdominal infections that are serious and life- or limb-threatening in the physician s judgement. 

The macrolide antibiotics include erythromycin, clarithromycin, azithromycin, tylosin, tilmicosin and tiamulin. Clindamycin and lincomycin are related lincosamides. Susceptible bacteria include staphylococci, streptococci, Campylobacter jejunii, Clostridium spp., R. equi, Mycoplasma pneumoniae and Chlamydia spp. Drugs in this group are only effective against a few Gram-negative bacteria in cattle, namely some strains of Pasteurella and Haemophilus spp. Macrolides and lincosamides are associated with causing colitis in horses, so their use is usually restricted to p.o. erythromycin for the treatment of R. equi infections in foals. Subantimicrobial doses of erythromycin are administered i.v. to horses for gastrointestinal prokinetic action. 

Cockeran, R., 2012. Effects of clarithromycin at sub-minimum inhibitory concentrations on early ermB gene expression, metabolic activity and growth of an eim(B)-expressing macrolide-resistant strain of streptococcus pneumoniae. Open J. Respir. Dis. 02 (01), 1—8. Available from http //dx.doi.org/10.4236/ojrd.2012.21001. 

A post hoc analysis of two prospectively collected data sets on acute exacerbations of COPD and community-acquired pneumonia, investigated the effect of clarithromycin on CV events. There was an increased risk of CV events (HR 1.5) and acute coronary syndrome (HR 1.67) in those treated with clarithromycin for an acute exacerbation of COPD. There was an increased risk of CV events only (HR 1.68) in those treated for community-acquired pneumonia. There was also an increased risk of CV mortality (HR 1.52) in those treated for an acute exacerbation of COPD, but not for community-acquired pneumonia [113 ]. 

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