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Acne, rosacea and similar disorders
Published in Ronald Marks, Richard Motley, Common Skin Diseases, 2019
The acute episodes of inflammation can be calmed with systemic tetracycline, erythromycin or metronidazole, using the full antibacterial dosage until the condition improves and then a dose sufficient to maintain improvement. Initial improvement usually occurs within the first 3–4 weeks of treatment. It would be typical for a patient to start tetracycline 250 mg 6-hourly for 3 weeks and then receive the drug three times daily for a further 3 or 4 weeks. At that time, reduction to twice-daily dosage would be made and maintained until stopping (perhaps at 10–12 weeks) did not result in the appearance of further papules. Minocycline or doxycycline 50 mg once or twice per day is more convenient. Erythromycin is also effective and the same dose regimen applies as for tetracycline. Clarithromycin has also been reported to be effective. Metronidazole is not often given because of its side effect profile. It has a disulfiram-like effect, causing alcohol intolerance. Other side effects include nausea and blood dyscrasias.
Clarithromycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Clarithromycin has been shown to have efficacies similar to those of other antibiotics in the treatment of community-acquired pneumonia. This includes other macrolides such as azithomycin (Sopena et al., 2004), telithromycin (Mathers Dunbar et al., 2004; Niederman et al., 2004; Tellier et al., 2004), roxithromycin (Tatsis et al., 1998), beta-lactams (Genné et al., 1997; Langtry and Brogden, 1997; Bonvehi et al., 2003), gatifloxacin (Dean et al., 1999; Lode et al., 2004; Dean et al., 2006), trovafloxacin (Sokol et al., 2002), and moxifloxacin (Hoeffken et al., 2001). Most of the clinical trials have been conducted with nonhospitalized patients. A study of dual therapy with clarithromycin and cefuroxime versus clarithromycin alone for treatment of community-acquired pneumonia in outpatient settings did not show the dual therapy as having any additional benefits (Rovira et al., 1999). Clarithromycin has greater side effects, particularly gastrointestinal side effects, compared with azithromycin, and hence azithromycin is often preferred (Sopena et al., 2004; Tamm et al., 2007).
Non-Tuberculous Mycobacteria
Published in Peter D O Davies, Stephen B Gordon, Geraint Davies, Clinical Tuberculosis, 2014
The last NTM species covered in the BTS trials is M. malmoense [63,64], a species for which other data on treatment and outcome are scarce, partly because this species is mostly restricted to northwestern Europe [10,15]. Outcome of treatment for M. malmoense disease is usually more favourable than for MAC or M. xenopi pulmonary disease [15]. The BTS trials revealed that the relapse/failure rate was equal for the rifampicin–ethambutol (12%; n = 52 patients), isoniazid–rifampicin–ethambutol (9%; n = 54) and rifampicin–ethambutol–clarithromycin (5%; n = 86) regimens. The addition of clarithromycin did lead to an increase in reported side effects [63,64]. These data are similar to the 17% failure/relapse rate reported in a recent case series of 30 patients treated for M. malmoense with various regimens. In this small cohort, too, the outcome did not differ between patients receiving rifampicin and ethambutol or rifampicin–ethambutol–clarithromycin [73].
ALSUntangled #66: antimycobacterial antibiotics.
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2023
Ellen S. Pierce, Paul Barkhaus, Morgan Beauchamp, Mark Bromberg, Gregory T. Carter, Jill Goslinga, David Greeley, Sky Kihuwa-Mani, Gleb Levitsky, Isaac Lund, Christopher McDermott, Gary Pattee, Kaitlyn Pierce, Meraida Polak, Dylan Ratner, Paul Wicks, Richard Bedlack
Rifabutin can cause leukopenia, neutropenia, thrombocytopenia, and hepatitis requiring laboratory monitoring (57). Rifabutin at the high dose of 600 mg/day, especially in combination with a macrolide antibiotic such as clarithromycin, can result in reversible anterior uveitis in a significant proportion of patients depending on their immune status (58,59). The treatment of drug-induced uveitis “occasionally” involves hospitalization (60). Clarithromycin can cause a metallic taste, 10% of patients may have nausea, diarrhea, abdominal pain, and/or headache (61), and there is an increased rate of sudden cardiac death compared to other antibiotics of 37/million clarithromycin doses (62). Clofazimine almost always causes brownish skin discoloration, and sometimes abdominal pain, but these side effects led to discontinuation of treatment in only 0.1% of patients (63). Nausea, vomiting, diarrhea, and abdominal pain are common side effects of metronidazole (64). Encephalopathy (65) and optic neuropathy (66) are rare side effects of metronidazole and are usually reversible with discontinuation of the drug. Based on these rare but potentially serious side effects, we assign a TOE “risks” grade of D (Table 1). Of additional interest, one case-control study suggests that any antibiotic use might increase the risk of developing ALS as well (67).
Evaluating the effect of oral clarithromycin on acute cutaneous leishmaniasis lesions compared with systemic glucantime
Published in Journal of Dermatological Treatment, 2022
Naghmeh Zabolinejad, Pouran Layegh, Zahra Abbasi Shaye, Maryam Salehi, Somayeh Ghanizadeh
Considering the structural similarity of azithromycin and clarithromycin and the effects of clarithromycin on intracellular organisms, and the proven anti-leishmanial effects of azithromycin, it seems that this drug can be presented as an anti-leishmanial compound. The effects of liposomal and non-liposomal forms of the drug were assessed in a research by Sazgarnia et al. in vitro, reporting that both types of clarithromycin could eliminate more than 50% of the organisms in the culture medium. However, the liposomal forms were more effective (8). Treatment of CL based on antimonial compounds (cytotoxic injection and intralesional injection) can lead to several complications, and the high frequency of therapy by intralesional injection is another known problem, which causes incomplete treatment in some cases. This explains the need for research on the effects of other therapies, especially noninvasive treatments (3).
The safety of antimicrobials for the treatment of community-acquired pneumonia
Published in Expert Opinion on Drug Safety, 2020
Carla Bastida, Dolors Soy, Antoni Torres
Gastrointestinal symptoms, including abdominal pain, nausea, vomiting, and diarrhea, are the most frequently reported side effects, with a prevalence of 2%–5% among patients taking azithromycin, clarithromycin and erythromycin [7,8]. The mechanism underlying these reactions is believed to be a dose-related agonist effect on motilin receptors that stimulates the smooth muscle of the gastrointestinal tract [13]. Gastrointestinal adverse events did not significantly differ between macrolides (OR erythromycin 4.00, 95% 1.83 to 8.74 versus OR azithromycin 1.77, 95% CI 1.30 to 2.42); p= 0.06) [5]. Dysgeusia is another common adverse effect associated with clarithromycin use, but this is much less common with azithromycin [7].