Clarithromycin for safe and cost-effective reduction of cyclosporine doses in lung allograft recipients.
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.
Knower
M T
MT
Ochsner Multi-Organ Transplant Center, Department of Lung Transplantation, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, LA 70121, USA.
Labella-Walker
K
K
McFadden
P M
PM
Kantrow
S P
SP
Valentine
V G
VG
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
D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D017291:Clarithromycin