title: Clarithromycin for safe and cost-effective reduction of cyclosporine doses in lung allograft recipients.
abstract: BACKGROUND
  This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation.
  
  
  METHODS
  Nine consecutive patients (mean age +/- SEM, 34.6 +/- 5.2 years) had transplantation from June 1995 to June 1996. Median follow-up time was 649 days (range, 431 to 799 days). Preoperative diagnoses were cystic fibrosis (n = 4), idiopathic pulmonary fibrosis (n = 2), emphysema, bronchiectasis, and obliterative bronchiolitis. Median time from transplantation to addition of clarithromycin to a standard immunosuppressive regimen was 86 days (range, 14 to 181 days).
  
  
  RESULTS
  Baseline cyclosporine dose (9.9 +/- 2.2 mg/kg/day) was reduced to 5.8 +/- 1.0 mg/kg/day and 4.1 +/- 0.8 mg/kg/day at 1 month and 1 year, respectively, after initiation of clarithromycin therapy. Estimated annual savings were $3,400 per patient. There was no increase in infection or rejection episodes.
  
  
  CONCLUSIONS
  Clarithromycin safely reduced the dose and cost of cyclosporine in this series.
authors.affiliation: Ochsner Multi-Organ Transplant Center, Department of Lung Transplantation, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA 70121, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Knower
authors.forename: K
authors.initials: K
authors.lastname: Labella-Walker
authors.forename: P M
authors.initials: PM
authors.lastname: McFadden
authors.forename: S P
authors.initials: SP
authors.lastname: Kantrow
authors.forename: V G
authors.initials: VG
authors.lastname: Valentine
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017291:Clarithromycin / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016572:Cyclosporine / Q000008:administration & dosage* / Q000097:blood / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000097:blood / Q000191:economics; D007668:Kidney / Q000187:drug effects; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D016555:Matched-Pair Analysis; D011183:Postoperative Complications; D011552:Pseudomonas Infections / Q000209:etiology; D014184:Transplantation, Homologous
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D017291:Clarithromycin