Clarithromycin: overview and its current clinical utility in the treatment of respiratory tract infections
DOI:
https://doi.org/10.18203/2320-6012.ijrms20240027Keywords:
Upper respiratory tract infection, Streptococcus A, ClarithromycinAbstract
Upper respiratory tract infection (URTI) is a common reason for medical consultation all over the world. Streptococcus A (Strep A) and other infections can cause sore throat as well as pharyngitis or tonsillitis. It may also result in post-infection sequelae, including acute post-streptococcal glomerulonephritis, acute rheumatic fever, and rheumatic heart disease. As a result, there is a need for an antibiotic that is effective, easy to administer, has a favorable sensitivity pattern, and preferably has some additional pharmacodynamic properties that complement the basic antibacterial profile. Clarithromycin is a macrolide antibacterial agent with broad-spectrum activity against respiratory pathogens. It is especially active against atypical Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella spp. It is well absorbed and stable at gastric pH. It is metabolized by the cytochrome P450 enzymes and forms 14-hydroxy clarithromycin, which is more active than the parent compound, especially against Hemophilus influenzae. It acts by preventing protein synthesis by binding to the 50S subunit of bacterial ribosomes. In dosages of 500 to 1000 mg/day for 5 to 14 days, clarithromycin is effective in the treatment of community-acquired upper and lower respiratory tract infections in hospital and community settings. It exerts significant anti-inflammatory, immunomodulatory, and post-antibiotic effects. It provides a viable option for the treatment of community-acquired respiratory tract infections, in both children and adults.
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Respiratory Tract Infections - Antibiotic Prescribing: Prescribing of Antibiotics for Self-Limiting Respiratory Tract Infections in Adults and Children in Primary Care. London: National Institute for Health and Clinical Excellence (NICE); 2008 Jul. (NICE Clinical Guidelines, No. 69.) 1, Summary. Available at: https://www.ncbi. nlm.nih.gov/books/NBK53636/. Accessed on 5 October 2023.
Esposito C, Garzarella EU, Bocchino B, D'Avino M, Caruso G, Buonomo AR, et al. A standardized polyphenol mixture extracted from poplar-type propolis for remission of symptoms of uncomplicated upper respiratory tract infection (URTI): A monocentric, randomized, double-blind, placebo-controlled clinical trial. Phytomedicine. 2021;80:153368.
Parthasarathy R, Kumar R, Gopal G, Amarchand R, Broor S, Choudekar A, et al. Incidence and clinical features of viral sore throat among children in rural Haryana, India. J Family Med Prim Care. 2020;9(10):5136-5141.
Miller KM, Carapetis JR, Van Beneden CA, Cadarette D, Daw JN, Moore HC, et al. The global burden of sore throat and group A Streptococcus pharyngitis: A systematic review and meta-analysis. E Clin Med. 2022;48:101458.
Alam K, Mazumder A, Sikdar S, et al. Streptomyces: The biofactory of secondary metabolites. Front Microbiol. 2022;13:968053.
Davidson RJ. In vitro activity and pharmacodynamic/pharmacokinetic parameters of clarithromycin and azithromycin: why they matter in the treatment of respiratory tract infections. Infect Drug Resist. 2019;12:585-96.
Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc. 1999;74(6):613-34.
Firth A, Prathapan P. Azithromycin: The First Broad-spectrum Therapeutic. Eur J Med Chem. 2020;207:112739.
Kirst HA. New macrolides: expanded horizons for an old class of antibiotics. J Antimicrob Chemother. 1991;28(6):787-90.
Kirst HA, Sides GD. New directions for macrolide antibiotics: structural modifications and in vitro activity. Antimicrob Agents Chemother. 1989;33(9):1413-8.
Kwiatkowska B, Maślińska M. Macrolide therapy in chronic inflammatory diseases. Mediators Inflamm. 2012;2012:636157.
Zhanel GG, Dueck M, Hoban DJ, et al. Review of macrolides and ketolides: focus on respiratory tract infections. Drugs. 2001;61(4):443-98.
Peters DH, Clissold SP. Clarithromycin. A review of its antimicrobial activity, pharmacokinetic properties and therapeutic potential. Drugs. 1992;44(1):117-64.
Sivapalasingam S, Steigbigel NH. Macrolides, clindamycin, and ketolides. In: Principles and Practice of Infectious Diseases, 6th ed, Mandell GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2005: 396.
Fraschini F, Scaglione F, Demartini G. Clarithromycin clinical pharmacokinetics. Clin Pharmacokinet. 1993;25(3):189-204.
Clarithromycin: Drug information. Available at: https://www.uptodate.com/contents/clarithromycin-drug-information?search=clarithromycin%20 adult&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1. Accessed on 4 October 2023.
Gotfried MH. Clarithromycin (Biaxin) extended-release tablet: a therapeutic review. Expert Rev Anti Infect Ther. 2003;1(1):9-20.
O'Doherty B, Muller O. Randomized, multicentre study of the efficacy and tolerance of azithromycin versus clarithromycin in the treatment of adults with mild to moderate community-acquired pneumonia. Azithromycin Study Group. Eur J Clin Microbiol Infect Dis. 1998;17(12):828.
Hoban DJ, Nauta J. Clinical And Bacteriological Impact Of Clarithromycin In Streptococcal Pharyngitis: Findings From A Meta-Analysis Of Clinical Trials. Drug Des Devel Ther. 2019;13:3551-3558.
Gouthami P, Jyothirmayee V, Bethala R, Jagillapuram A, Thakur S, Noorbasha N, et al. A randomised control study to compare the efficacy of cefuroxime, clarithromycin, and levofloxacin in the management of paediatric upper respiratory tract infection. Asian J Pharm Clin Res. 2021;14(10):103-10.
Venuta A, Laudizi L, Beverelli A. Azithromycin compared with clarithromycin for the treatment of streptococcal pharyngitis in children. J Int Med Res 1998;26:152-8.
Kearsley NL, Campbell A, Sanderson AAF. Comparison of clarithromycin suspension and amoxycillin syrup for the treatment of children with pharyngitis and/or tonsillitis. Br J Clin Pract 1997;51:133-7
Arguedas A, Loaiza C, Rodriguez F. Comparative trial of 3 days of azithromycin versus 10 days of clarithromycin in the treatment of children with acute otitis media with effusion. J Chemother 1997;9:44-50.
Aspin MM, Hoberman A, McCarty J, et al. Comparative study of the safety and efficacy of clarithromycin and amoxicillin clavulanate in the treatment of acute otitis media in children. J Pediatr 1994;125:136-41.
Adelglass J, Jones TM, Ruoff G. A multicenter, investigator- blinded, randomized comparison of oral levofloxacin and oral clarithromycin in the treatment of acute bacterial sinusitis. Pharmacother 1998;18:1255-63.
Genné D, Siegrist HH, Humair L. Clarithromycin versus amoxycillin-clavulanic acid in the treatment of communityacquired pneumonia. Eur J Clin Microbiol Infect Dis 1997;16:783-8.
Zarogoulidis P, Papanas N, Kioumis I, et al. Macrolides: from in vitro anti-inflammatory and immunomodulatory properties to clinical practice in respiratory diseases. Eur J Clin Pharmacol 2012;68:479-503.
Hrvacić B, Bosnjak B, Bosnar M, Ferencić Z, Glojnarić I, Haber VE. Clarithromycin suppresses airway hyperresponsiveness and inflammation in mouse models of asthma. Eur J Pharmacol. 2009;616(1-3):236-43.
Zhanel GG, Noreddin AM. Pharmacokinetics and pharmacodynamics of the new fluoroquinolones: focus on respiratory infections. Curr Opin Pharmacol. 2001;1(5):459-63.
Carbon C. Pharmacodynamics of macrolides, azalides, and streptogramins: effect on extracellular pathogens. Clin Infect Dis. 1998;27:28-32.
Available at: https://mic.eucast.org/search/diagram/ 6100?mode=weighted. Accessed on 27th September 2023.
Dhanda V, Chaudhary P, Toor D, Kumar R, Chakraborti A. Antimicrobial susceptibility pattern of β-haemolytic group A, C and G streptococci isolated from North India. J Med Microbiol. 2013;62(Pt 3):386-93.
Hardy DJ, Swanson RN, Rode RA, Marsh K, Shipkowitz NL, Clement JJ, et al. Enhancement of the in vitro and in vivo activities of clarithromycin against Haemophilus influenzae by 14-hydroxyclarithromycin, its major metabolite in humans. Antimicrob Agents Chemother. 1990;34(7):1407-13.
Gan VN, McCarty JM, Chu SY, Carr R. Penetration of clarithromycin into middle ear fluid of children with acute otitis media. Pediatr Infect Dis J. 1997;16(1):39-43.
Rodvold KA, Gotfried MH, Danziger LH, Servi RJ. Intrapulmonary steady-state concentrations of clarithromycin and azithromycin in healthy adult volunteers. Antimicrob Agents Chemother. 1997;41(6):1399–402.
Langtry HD, Brogden RN. Clarithromycin. A review of its efficacy in the treatment of respiratory tract infections in immunocompetent patients. Drugs 1997;53(6):973-1004.
Krüger K, Töpfner N, Berner R, Windfuhr J, Oltrogge JH; Guideline group. Clinical Practice Guideline: Sore Throat. Dtsch Arztebl Int. 2021;118(11):188-94.
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