Days Of Clarithromycin Research Articles

Eradication of Helicobacter Pylori Infection Using Triple Drug Therapy: A Hospital Based Observational Study in Sikkim

Introduction: Helicobacter pylori infection is the important cause of various gastrointestinal. Variable resistance to treatment has been reported. This study was conducted to assess eradication rate of h pylori infection using the standard clarithromycin triple therapy. Method: This retrospective observational study was conducted in Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences. 100 consecutive patients in a period of one year from 2016-2017 who were found positive for H pylori infection by rapid urease test (RUT) or histology or both were included in the study.Assessment of the eradication of H pylori was carried out after 8 weeks of treatment using 14 days of clarithromycin containing standard triple regimen. Results: Out of 100 patients,63 were males and 37 were females. Mean age of the patients was 38 years. Overall eradication rate was found to 63% after 8 weeks of treatment. Patients with gastric ulcer disease had worst eradication rate and it was statistically significant.[p=0.0143, OR 4.29(1.33-13.79)] .Out of these patients, eradication rate for H pylori was higher in duodenal ulcer patients than gastric ulcer patients. [p=0.0069, OR 6.5(1.6751-25.7798)].We found eradication rate of 63% in our study similar to these studies.7-10 days of triple therapy containing clarithromycin is reported to have around 90% eradication rate. (6) Of late, 7-10 days triple therapies have shown unacceptably low cure rates. We found eradication rate of 63% in our study similar to these studies. Discussion: Triple therapy, a recommended first-line treatment of H. pylori infection is found to be one of the most effective eradication in Asia and Africa. Seven days administration of a PPI, amoxicillin or metronidazole and clarithromycin is well-tolerated and improves patient’s compliance. 7-10 days of triple therapy containing clarithromycin is reported to have around 90% eradication rate.

Surviving COVID-19 Pneumonia At Home: COVID Case #1906

Surviving COVID-19 Pneumonia At Home: COVID Case #1906

Abstract CT153: Pharmacokinetic drug interactions between abemaciclib and CYP3A inducers and inhibitors

Abstract Abemaciclib is a selective and potent small-molecule inhibitor of cyclin-dependent kinases 4 and 6 (CDK4 and CDK6) being investigated for treatment of refractory hormone-receptor positive (HR+) advanced or metastatic breast cancer. In vitro, CYP3A is responsible for >99% of the CYP-mediated microsomal metabolism of abemaciclib and its active metabolites. Three clinical studies evaluated the disposition and metabolism and drug interaction potential of abemaciclib in the presence of a strong CYP3A-inducer, rifampin, or a strong CYP3A-inhibitor, clarithromycin. Abemaciclib disposition and metabolism were determined following a single oral 150 mg dose of [14C]-abemaciclib in healthy subjects (N = 6). In the rifampin interaction study, abemaciclib was administered as a single oral 200 mg dose in healthy subjects (N = 24) on 2 occasions: alone on Day 1 of Period 1 and in combination with 600 mg rifampin on Day 7 of Period 2, after 6 days of rifampin once daily (QD) dosing; rifampin continued QD for 7 days after abemaciclib. In the clarithromycin interaction study, abemaciclib was administered as a single oral 50 mg dose in patients with advanced cancer (N = 26) on 2 occasions: alone in Period 1 and on Day 5 of clarithromycin dosing (500 mg BID) in Period 2 followed by an additional 7 days of clarithromycin. Abemaciclib was extensively metabolized, with less than 10% of parent drug recovered unchanged in feces. Parent drug and 3 active metabolites; (LSN2839567 [M2], LSN3106729 [M18], and LSN3106726 [M20]) were detected in plasma. The mean t1/2 in healthy subjects was 29.0, 104.0, 55.9, and 43.1 hours for abemaciclib, M2, M18, and M20, respectively. Coadministration with rifampin compared to abemaciclib alone decreased abemaciclib AUC(0-?) and Cmax by 95% and 92%, respectively, and decreased AUC(0-?) and Cmax of total active species (abemaciclib + M2 + M18+ M20) by 77% and 45%, respectively. Coadministration with clarithromycin compared to abemaciclib alone increased abemaciclib AUC(0-?) and Cmax by 237% and 30%, respectively; and increased the total active species AUC(0-?) by 119% and decreased Cmax by 7%. The mean abemaciclib t1/2 was prolonged from 28.8 to 63.6 hours. No clinically significant safety concerns were observed following single doses of abemaciclib in healthy subjects or in patients with advanced cancer based on vital signs, clinical laboratory evaluations, and electrocardiogram data. The human absorption, distribution, metabolism and excretion study indicated that abemaciclib was cleared primarily by hepatic metabolism, and the clinical drug-drug interaction studies with strong CYP3A inducer and inhibitor substantiated the major role of CYP3A in the metabolism of abemaciclib. Due to significant changes in abemaciclib and active-metabolite exposure in the presence of strong CYP3A inducers and inhibitors, concomitant use with abemaciclib should be avoided, or abemaciclib dose may require adjustment. Citation Format: Palaniappan Kulanthaivel, Daruka Mahadevan, P. Kellie Turner, Jane Royalty, Wee Teck Ng, Ping Yi, Jessica Rehmel, Kenneth Cassidy, Jill Chappell. Pharmacokinetic drug interactions between abemaciclib and CYP3A inducers and inhibitors. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr CT153.

Reductions in Use of Colchicine after FDA Enforcement of Market Exclusivity in a Commercially Insured Population.

A brand-name version of colchicine (Colcrys) was introduced after its manufacturer conducted a clinical trial in acute gout patients, leading to higher prices for this drug. We analyzed the impact of the new single-source colchicine product on prescribing and patient health spending as well as incidence rates of potentially dangerous concomitant use of clarithromycin and cyclosporine after formal FDA approval. We conducted a retrospective cohort study of UnitedHealth-affiliated enrollees newly diagnosed with gout or FMF. Among gout and FMF patients separately, we assessed linear trends in colchicine prescriptions, prescription drug costs, and total health care costs from 2009 to September 2010 (market exclusivity announced) compared to January 2011 (market exclusivity enforced) through 2012. Next, we estimated trends in co-prescription within 15days of clarithromycin, azithromycin (indicated on the Colcrys label for use in place of clarithromycin), and cyclosporine. Among gout patients, before Colcrys' market exclusivity, the odds of receiving colchicine within 30days of gout diagnosis increased 1.4%/month (OR: 1.014, 95% CI: 1.011-1.018). Following FDA action, the odds decreased by 0.5%/month (OR: 0.995, 95 % CI: 0.992-0.999) (p < 0.001). Similarly, among FMF patients, odds of initiating colchicine changed from an increase of 2.8%/month to a decrease by 7.6%/month (p = 0.01). Patients receiving colchicine experienced increases in average monthly prescription drug costs ($418 vs. $651, p < 0.001) and health care costs ($3,406 vs. $3,534, p < 0.001). Incidence rates of colchicine/clarithromycin co-prescription before and after FDA action did not change, while co-prescription of colchicine/cyclosporine increased after introduction of Colcrys [-0.75 monthly change in patients (95 % CI: -1.07, -0.43) vs. 0.13 (95 % CI: -0.16, 0.42), p < 0.001]. The FDA's actions were associated with a reduction in colchicine initiation and an increase in patient spending. By contrast, we did not observe any association with improvements in avoidance of potentially dangerous co-prescriptions.

Antibiotic Treatment of Pertussis

Short courses of antibiotic therapy are recommended for treatment of pertussis. We report 2 young unvaccinated infants with persistently positive Bordetella pertussis by polymerase chain reaction from nasopharyngeal swabs despite 7 days of clarithromycin (15 mg/kg/d) therapy. In 1 patient, quantitative polymerase chain reaction was 7.02 (log GEq/mL) at the onset of treatment, 6.26 at the end of treatment and remained positive with 2.64 and 2.69 during and after a second 7-day course, respectively. The generally believed assumption that contagiousness of pertussis is terminated after 5 days of antibiotic treatment should be challenged, at least in young infants.

Severe Hypoglycemia from Helicobacter Pylori Triple‐Drug Therapy and Insulin Detemir Drug Interaction

Two drugs commonly used in triple-drug therapy for treatment of a Helicobacter pylori infection, clarithromycin and omeprazole, have rarely been associated with hypoglycemia when given alone. No documented interactions between H.pylori treatment with clarithromycin, amoxicillin, and omeprazole and insulin detemir have been previously reported. This case report describes an 82-year-old man with drug-controlled type 2 diabetes who experienced severe hypoglycemia during treatment for a H.pylori infection in an outpatient setting. His diabetes treatment included 32 units of insulin detemir once/day at bedtime and insulin aspart, determined by carbohydrate intake, 3times/day with meals. After 5days of clarithromycin 500mg twice/day, amoxicillin 500mg twice/day, and omeprazole 20mg twice/day for treatment of the H.pylori infection, the patient experienced hypoglycemia and self-discontinued clarithromycin. Insulin detemir was decreased to 15 units and hypoglycemia reoccurred. Insulin detemir was further decreased to 10 units without further symptoms of hypoglycemia for the remainder of the H.pylori treatment. Once treatment was completed, the patient was instructed to resume taking 32 units of insulin detemir once/day. His blood glucose concentration returned to a baseline value, and he denied experiencing further hypoglycemic episodes. Health care practitioners should be aware of this possible drug interaction and anticipate that insulin detemir dosage adjustments may be required during treatment of H.pylori infection to avoid significant adverse events.

Inhibition of Human Intestinal Wall Metabolism by Macrolide Antibiotics: Effect of Clarithromycin on Cytochrome P450 3A4/5 Activity and Expression*

Clarithromycin increases both hepatic and intestinal availability of the selective cytochrome P450 (CYP) 3A probe midazolam. This study was designed to identify determinants of variability in the extent of intestinal wall CYP3A inhibition by clarithromycin, such as CYP3A5 genotype, and the mechanism of inhibition. Ten healthy volunteers received 500 mg oral clarithromycin twice a day for 7 days. Before and after administration of clarithromycin, small-bowel mucosal biopsy specimens were obtained endoscopically. Intestinal CYP3A activity was determined from the rate of 1'-hydroxymidazolam and 4-hydroxymidazolam formation by incubation of small-bowel homogenate with midazolam (25 micromol/L) and NADPH for 5 minutes. Intestinal CYP3A4 and CYP3A5 messenger ribonucleic acid was quantified by real-time reverse transcriptase-polymerase chain reaction. Intestinal CYP3A4 and CYP3A5 protein concentrations were determined by immunoblotting. Serum and homogenate concentrations of midazolam, clarithromycin, and metabolites were determined by liquid chromatography-mass spectrometry. CYP3A5 genotype was determined by real-time polymerase chain reaction. The formation of 1'-hydroxymidazolam (1.36 +/- 0.46 pmol . min(-1) . mg(-1) at baseline versus 0.35 +/- 0.16 pmol . min(-1) . mg(-1) after administration) and 4-hydroxymidazolam (0.39 +/- 0.12 pmol . min(-1) . mg(-1) at baseline versus 0.12 +/- 0.05 pmol . min(-1) . mg(-1) after administration) was significantly (P < .001) reduced after clarithromycin administration. Clarithromycin administration did not result in a significant change in intestinal CYP3A4 and CYP3A5 messenger ribonucleic acid and protein expression. All subjects had detectable serum clarithromycin concentrations after 7 days of clarithromycin (3.71 +/- 2.43 micromol/L). The mean concentration of clarithromycin in the intestinal biopsy homogenate was 1.2 +/- 0.7 nmol/L (range, 0.42-2.39 nmol/L). Compared with CYP3A5 nonexpressers, subjects with at least 1 CYP3A5*1 allele (CYP3A5 expressers) had greater inhibition of intestinal CYP3A activity after treatment with clarithromycin. There was a strong linear relationship between the decrease in intestinal CYP3A activity and baseline catalytic activity (R(2) = 0.9). Baseline intestinal activity of CYP3A4 was a key determinant of variability of the inhibitory effect of clarithromycin among individuals. CYP3A5*1 alleles were associated with greater baseline intestinal CYP3A activity and, therefore, greater extent of inhibition. The primary in vivo mechanism was not rapidly reversible competitive or irreversible inhibition but was likely formation of metabolic intermediate complexes.

Acute Colchicine Intoxication During Clarithromycin Administration

To report a case of colchicine intoxication occurring with institution of clarithromycin. A 76-year-old man with familial Mediterranean fever (FMF) had received colchicine 1.5 mg daily for 6 years. The patient underwent 7 days of clarithromycin, amoxicillin, and omeprazole treatment for Helicobacter pylori-associated gastritis. Fever, abdominal pain, and diarrhea occurred 3 days after treatment initiation. On day 8, dehydration, pancytopenia, metabolic acidosis, and increased lipase level necessitated hospitalization. Alopecia was observed 2 weeks later. The patient recovered fully after the colchicine dosage was reduced to 0.5 mg/day and rehydration was performed. The previous dosage was then reinstituted without adverse reaction. An objective causality assessment revealed that the adverse event was probable. Continuous colchicine administration is used in treatment of microcrystalline arthritis, Behcet's disease, and FMF. Colchicine is primarily eliminated through biliary excretion. Renal elimination and cytochrome P450 metabolism play a less significant role. Colchicine is also a substrate of P-glycoprotein, a transporter involved in cellular efflux and elimination of numerous drugs. Three cases of intoxication have been reported when colchicine was combined with erythromycin, josamycin, or clarithromycin. Macrolides are inhibitors of P-glycoprotein and cytochrome P450-dependent enzymes and may decrease colchicine's biliary excretion through P-glycoprotein inhibition. Coadministration of colchicine and macrolides may impair colchicine elimination, resulting in excess drug exposure and toxicity. To this end, colchicine should be used with extreme caution in patients receiving P-glycoprotein inhibitors, particularly if they are elderly and/or renally compromised.

Comparison of 5 days of extended-release clarithromycin versus 10 days of penicillin V for the treatment of streptococcal pharyngitis/tonsillitis: results of a multicenter, double-blind, randomized study in adolescent and adult patients

SUMMARYObjective: This study compared a short-course of clarithromycin with a standard course of penicillin V in patients with tonsillopharyngitis caused by Streptococcus pyogenes.Research design and methods: A total of 539 patients, aged 12–75 years, were randomized to receive either clarithromycin extended-release (ER) 500 mg once daily for 5 days or penicillin V 500 mg three times daily for 10 days in this multicenter, double-blind, parallel-group trial. Eligibility required a positive antigen test for group A beta-hemolytic streptococcus (GABHS) followed by confirmatory culture.Main outcome measures: Bacteriological and clinical assessments were conducted at each study visit (visit 1: study day 1; visit 2: study day 3; visit 3: study days 8–12; visit 4: study days 13–20; and visit 5: study days 40–50).Results: At the test-of-cure visit (visit 3 for clarithromycin ER patients and visit 4 for penicillin V patients) in per-protocol patients, 5 days of clarithromycin ER was comparable to 10 days of penicillin V in eradicating S. pyogenes (89% (157/177) vs 90% (139/154) respectively; 95% CI for difference (−8.2, 5.1)). Bacterial eradication was sustained in both treatment groups at the follow-up visit (88% (135/153) vs 91% (112/123) respectively; 95% CI for difference (−10.0, 4.4)). Clinical cure was achieved in > 94% of patients in each treatment group. The most commonly reported study drug-related adverse events (< 3% in either treatment group) were abdominal pain, diarrhea, dyspepsia and nausea.Conclusion: Clarithromycin ER 500 mg once daily for 5 days is equally effective as penicillin V 500 mg three times daily for 10 days in the treatment of adolescent and adult patients with streptococcal tonsillopharyngitis.

Five days of cefprozil versus 10 days of clarithromycin in the treatment of an acute exacerbation of chronic bronchitis

Shorter than traditional 7- to 14-day treatment regimens have demonstrated efficacy in treatment of an acute exacerbation of chronic bronchitis (AECB). Perform a clinical efficacy study comparing 5 days of cefprozil therapy to 10 days of clarithromycin in treating an AECB. A multicenter, randomized, double-blind study comparing efficacy and safety of cefprozil, 500 mg twice daily, for 5 days with clarithromycin, 500 mg twice daily, for 10 days in treatment of 295 subjects with AECB. Concomitantly, among all treated subjects, 39% (115 of 295) had a history of chronic obstructive pulmonary disease/emphysema; 21% (62 of 295) had a history of asthma/reactive airway disease; and 31% (90 of 295) had environmental allergies. There were no statistically significant differences among clinically evaluable subjects' cure rates; 82% (109 of 133) treated with cefprozil versus 85% (105 of 123) treated with clarithromycin were cured at test-of-cure visit (95% confidence interval, -12.0 to 5.1%). Clinical cure rates at end of study were 80% and 81%, respectively (95% confidence interval, -10.8 to 7.9%). Before treatment, 99% (85 of 86) of Gram-positive organisms isolated were susceptible to cefprozil and 78% (67 of 86) were susceptible to clarithromycin. A total of 84% (96 of 114) of Gram-negative organisms were susceptible to cefprozil and 63% (72 of 114) were susceptible to clarithromycin. Of clinically evaluable Streptococcus pneumoniae-infected subjects, 100% (11 of 11) of cefprozil subjects and 93% (14 of 15) of clarithromycin subjects experienced clinical cure. The most frequently reported adverse effects were nausea, 5% (7 of 150), and diarrhea, 9% (14 of 150), for cefprozil. For clarithromycin, the adverse effects were nausea, 8% (11 of 145); diarrhea, 12% (18 of 145); taste perversion, 8% (11 of 145); and dry mouth, 5% (7 of 145). Five days of cefprozil is as effective as 10 days of clarithromycin for treatment of an AECB.

Macrolide Therapy of Group A Streptococcal Pharyngitis: 10 Days of Macrolide Therapy (Clarithromycin) Is More Effective in Streptococcal Eradication than 5 Days (Azithromycin)

We compared recommended doses of 2 oral macrolide antibiotics (10 days of clarithromycin, 5 days of azithromycin) for eradicating group A streptococci from the throats of individuals aged > or = 12 years with symptomatic pharyngitis and a positive throat culture. Patients received either clarithromycin (250 mg b.i.d. for 10 days [n=260]) or azythromycin (500 mg on day 1, followed by 250 mg q.d. for 4 days [n=265]). Follow-up throat cultures were obtained both at 13--19 days and at 28--38 days. We evaluated 392 patients (median age, 26 years; clarithromycin, 194 patients; azyithromycin, 198 patients). Ten days of clarithromycin therapy was more effective than 5 days of azithromycin therapy in eradicating the organism (91% [176/194] vs. 82% [162/198]; P=.012). More than 97% of all streptococcal isolates were macrolide-sensitive. Whether these bacteriologic eradication rates were the result of the 2 macrolides compared or were due to differences in duration of therapy could not be determined, but the statistically significant difference in eradication of group A streptococci does raise additional questions about shortened courses of macrolide therapy for this common infection.

Comparison of 5-day, short-course gatifloxacin therapy with 7-day gatifloxacin therapy and 10-day clarithromycin therapy for acute exacerbation of chronic bronchitis

Background: The ideal duration of antibiotic therapy for acute exacerbation of chronic bronchitis (AECB) remains controversial. Objective: This study compared short-course, 5-day gatifloxacin treatment with standard 10-day clarithromycin treatment in patients with AECB; 7-day gatifloxacin therapy was a secondary comparator. Methods: This was a multicenter, prospective, randomized, double-blind study in which adult outpatients with AECB were randomized to 1 of 3 treatment groups: 5 days of gatifloxacin, 7 days of gatifloxacin, or 10 days of clarithromycin. Clinical cure and microbiologic eradication rates were determined 7 to 14 days after the completion of antibiotic treatment. Results: A total of 527 patients with AECB were enrolled and treated with study drug (174, gatifloxacin 5-day; 175, gatifloxacin 7-day; 178, clarithromycin 10-day). Most patients (82%) had type 1 (severe) exacerbations, and a bacterial pathogen was isolated from pretreatment sputum samples in 59% of patients. The overall clinical cure rates among clinically evaluable patients were comparable between groups: 89% (135/151 patients) in the gatifloxacin 5-day group; 88% (136/154) in the gatifloxacin 7-day group; and 89% (145/163) in the clarithromycin 10-day group. The 95% CIs for the differences in response rates were −6.1 to 7.0 for gatifloxacin 5-day versus clarithromycin, −8.9 to 5.0 for gatifloxacin 7-day versus clarithromycin, and −5.5 to 8.0 for gatifloxacin 5-day versus 7-day. These observations did not appear to be affected by use of corticosteroids or smoking status, type of exacerbation, or duration of current episode. The microbiologic eradication rate among microbiologically evaluable pathogens was > 90% in all treatment groups. No clinically meaningful differences were noted in the incidence of drug-related adverse events. Conclusion: Short-course, 5-day gatifloxacin therapy in patients with AECB resulted in clinical cure and microbiologic eradication rates comparable to those of standard 7- and 10-day therapies.

In vitro and in vivo influence of adjunct clarithromycin on the treatment of mucoid Pseudomonas aeruginosa.

Recent in vitro and in vivo data have substantiated the beneficial effects of macrolides/ azalides for use against Pseudomonas aeruginosa. While macrolides/azalides are not very potent in vitro antimicrobial agents against this pathogen, they appear to have an adjunctive role by either altering the course of infection owing to their inhibition of biofilm production or modulation of the host anti-inflammatory response, or both. To determine the in vitro and in vivo effects of clarithromycin as adjunctive therapy with ceftazidime against a mucoidproducing strain of P. aeruginosa, we performed a standard time-kill experiment and a pneumonia model in mice, respectively. Time-kill studies were performed over a 24 h period with varying concentrations of clarithromycin and ceftazidime alone or in combination. Synergic activity was noted with the use of 0.5 x MIC of ceftazidime combined with either 0.5 or 2 x MIC of clarithromycin. Neutropenic mice were infected with 10(8) cfu of mucoid P. aeruginosa intranasally to produce pneumonia and subsequently treated with oral clarithromycin (100 mg/kg) and/or sc ceftazidime (1500 mg/kg) as monotherapy or in combination. The addition of 5 days of clarithromycin to the ceftazidime regimen significantly improved survival as compared with the beta-lactam alone (48% versus 32%, P = 0.04). While a statistically significant difference was not detected with the addition of 3 days of clarithromycin therapy, a trend towards improved survival was noted with this regimen (38% versus 32%). These data demonstrate the adjunctive potential of clarithromycin when administered in combination with an antipseudomonal agent for the treatment of mucoid-producing Pseudomonas in acute respiratory infection.

Pantoprazole plus azithromycin and metronidazole for cure of helicobacter pylori infection

AIM: Azithromycin is a new macrolide antibiotic with a potential of a three days short-term treatment in several indications. For eradication of helicobacter pylori (H. pylori) the drug is not yet established. Therefore the present study aimed to determine whether azithromycin 250 mg bid for the three initial days of therapy can replace clarithromycin in a 7 days triple therapy regimen consisting of pantoprazole, azithromycin and metronidazole. Methods: 72 out-patients (44 males, 28 females; median age 54 years) with an active duodenal ulcer were recruited for this open study. 63 patients were H. pylori positive. Patients were treated for seven days with pantoprazole 40 mg bid and metronidazole 500 mg bid. Additionally the patients received azithromycin 250 mg bid during the first three days. H. pylori status was ascertained on entry using rapid urease test and 13C-UBT. H. pylori cure was assessed 4 weeks after therapy with laC-UBT. Results: 58 patients were evaluable for successful eradication. Two patients were lost to follow-up, three discontinued the study prematurely due to adverse events. H. pylori infection was successfully cured in 43/58 of patients, equivalent to 74% (95% C1 61-85%). The mean intensitiy of gastrointestinal symptoms (ulcer pain, feeling of sickness, nausea and acid eructation) decreased during the study. 15 patients (21%) reported adverse events. The most frequent adverse events were diarrhoea, vomiting and nausea. None of the adverse events leading to premature withdrawal of three patients were likely or definitely related to pantoprazole with the exception of headache in one patient (likely related to pantoprazole and the antibiotics). No serious adverse events occured. Condnsiom A three days treatment with azithromycin in combination with seven days of pantoprazole and metronidazole is less effective than standard triple therapy including clarithromycin. Duration of azithromycin treatment should be increased to 6 or 7 days since the same combination with seven days of clarithromycin instead of azithromycin has been shown to be highly effective (eradication rate 96%, Frevel et al., Gastroenterology 112, Suppl. 1997, A119b). This study was supported by a grant from Byk Gulden, Konstanz, Germany

Comparative Trial of 3 Days of Azithromycin Versus 10 Days of Clarithromycin in the Treatment of Children with Acute Otitis Media with Effusion

The authors compared the efficacy, safety and tolerance of azithromycin and clarithromycin in pediatric patients with acute otitis media. A randomized, open clinical trial was performed comparing azithromycin and clarithromycin in children aged 6 months to 12 years of age with acute otitis media with effusion. Patients were allocated to azithromycin at 10 mg/kg once daily for 3 days or to clarithromycin at 15 mg/kg day divided into two equal doses for 10 days. Clinical examinations and tympanometric evaluations were performed at baseline, day 3-5, day 10-14, day 28-30 and day 50-60. Tympanocentesis fluid cultures were collected at enrollment and urine and blood samples were obtained at baseline and day 10-14. Of 100 patients enrolled, 97 were considered evaluable.The most common middle ear pathogens were Streptococcus pneumoniae (60%), Haemophilus influenzae (15%) and Staphylococcus aureus (13%). Fifty patients (100 %) treated with azithromycin and 45 (95.7%) patients treated with clarithromycin had a satisfactory clinical response. Rates of persistence of middle ear effusion and possible drug related side effects were comparable. Based on the efficacy and safety results, azithromycin for 3 days and clarithromycin for 10 days are considered to represent an attractive alternative for the treatment of children with acute otitis media.

Efficacy of ten days of clarithromycin, amoxicillin and omeprazole in eradicating Helicobacter pylori infection

Because of clinical importance of H. pylori infection, a diagnostic test is needed that is safe, inexpensive, accurate, rapid and readily available. The most popular and reliable diagnostic methods of H. pylori infection would be the histological and bacteriological identification. However, these methods are invasive and need time-consuming and tedious works. Recently, a variety of methods based on the H. pylori urease have developed. These methods include urea breath test, CLO test and phenol red dye spraying endoscopy, however, these urease reactions are not H. pylori specific. In the present study, we developed a rapid and sensitive method using a monoclonal antibody against H. pylori urease and a pH-sensitive field effect transistor (pH-FET), and evaluated the specifici!y and the sensitivity of the diagnostic method. Methods: The system is composed of a capillary-tube type solid-phase and a pH-measuring cell. The solid-phase, with the inner diameter 0.55ram and coated with a monoclonal antibody against H.pylori urease, is used to selectively capture the urease in endoscopically collected gastric mucus. Gastric mucus samples (10 l.tl) Were endoscopically taken from antrum and body using a washing tube connected with the solid-phase. The urease activity on the inner surface of the solid-phase is measured by coupling it with pH-FET in a pH measuring cell containing the urea solution (155 mM urea, 154 mM NaC1, and 10 mM NH4C1). Twenty seven volunteers were examined H. pylori infection by this urease probe method. Two biopsy specimens were taken for culture and CLO test at the same time. CLO test was carried out the standard manual and color change was checked after 2 hours. Results: The urease probe method detected 16 IU/L crude urease within 20 minutes, while CLO test indicated positive results above 2000 IU/L urease after 2 hours. The absolute detection limit was estimated around 10 cells of.H. pylori. The urease reaction of the present method was 11. pylori specific and the jack bean urease did not react with the system. In contrast, CLO test detected the jack bean urease. The clinical sensitivity and specificity were calculated using culture as a reference. In the present system, the sensitivity was 100 %, and the specificity was 94.7 %. In CLO test, the sensitivity was 94.1%, the specificity was 89.5 %. Conclusions: These results suggest that the urease probe method is superior to CLO test in its detectability by two order of magnitude, and that the system is a non invasive, accurate, rapid, and is useful for the clinical diagnosis of H. pylori infection. EFFICACY OF TEN DAYS OF CLARITHROMYCIN, AMOXICILLIN AND OMEPRAZOLE IN ERADICATING HELICOBACTER PYLORI INFECTION P. Moayyedi, D.S. Tompkins and A.T.R. Axon. General Infirmary at Leeds, Leeds, U.K.