Clarithromycin: review of a new macrolide antibiotic with improved microbiologic spectrum and favorable pharmacokinetic and adverse effect profiles.
OBJECTIVE
To compare the new macrolide antibiotic clarithromycin with erythromycin in terms of in vitro activity, pharmacokinetics, pharmacodynamics, clinical efficacy, and toxicity.


METHODS
An English-language literature search employing MEDLINE (1987-91), Index Medicus (1987-91), Program and Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy (1990), Program and Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (1991), and bibliographic reviews of related textbooks and review articles.


METHODS
Eighty-five articles were selected. Clinical trials with clarithromycin have been limited, and emphasis was placed on trials reported in the Program and Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy and Program and Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy.


METHODS
Articles were assessed for study quality and specific information addressing the stated purpose. In articles reporting the results of clinical trials, emphasis was placed on comparative efficacy and toxicity.


RESULTS
A review of 24 human trials suggests that clarithromycin is equally effective as erythromycin, penicillin VK, ampicillin, or amoxicillin for treatment of a variety of upper and lower respiratory tract or skin infections. Clarithromycin also appears to be better tolerated than these agents, with a lower incidence of gastrointestinal adverse effects. Limited clinical studies in patients with Mycobacterium leprae or Mycobacterium avium-intracellulare complex (MAI) suggest that clarithromycin may prove to be efficacious and well tolerated in the treatment of these infections.


CONCLUSIONS
Clarithromycin is as effective in vivo as erythromycin, with less gastrointestinal irritation. Additionally, clarithromycin appears to expand the traditional spectrum of macrolide antibiotics, with promising activity against M. leprae and MAI.
Sturgill
M G
MG
Department of Pharmacy Practice and Administration, Rutgers College of Pharmacy, Piscataway, NJ 08855.
Rapp
R P
RP
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D017291:Clarithromycin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D002986:Clinical Trials as Topic; D004347:Drug Interactions; D004917:Erythromycin / Q000009:adverse effects / Q000493:pharmacokinetics / Q000494:pharmacology; D006801:Humans; D008264:Macrophages / Q000502:physiology; D015270:Mycobacterium avium-intracellulare Infection / Q000188:drug therapy; D012141:Respiratory Tract Infections / Q000188:drug therapy; D012874:Skin Diseases, Infectious / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D004917:Erythromycin; D017291:Clarithromycin