[Meta-analysis of clarithromycin compared with other antimicrobial drugs in the treatment of upper respiratory tract infections].
The goal of this meta-analysis was to evaluate the effectiveness of clarithromycin versus most commonly used treatments for upper respiratory infections. We performed a systematic review of comparative clinical trials found in the literature. Regarding effectiveness, no significant differences were found in comparisons between clarithromycin and amoxicillin-clavulanic acid for upper respiratory infections, nor for cephalosporins, amoxicillin or amoxicillin-clavulanic acid for otitis media, nor oral penicillin for classic streptococcal tonsillitis. Clarithromycin was more effective than betalactam antibiotics for sinusitis (OR: 1.27, 95% CI: 1.01-1.61 in intent-to-treat analysis). The effectiveness of clarithromycin was better than that for azithromycin, but only reached statistical significance in the per-protocol analysis. The global analysis including all 33 clinical trials showed a small benefit for clarithromycin reaching statistical significance in the fixed-effects model (OR: 1.12, 95% CI: 1.01-1.25). Regarding safety, the incidence of adverse events was significantly lower for clarithromycin compared to amoxicillin and amoxicillin-clavulanic acid. No differences were found when comparing adverse events due to cephalosporins, azithromycin and betalactam antibiotics, but the incidence of adverse events for clarithromycin was higher compared to that of oral penicillin for streptococcal tonsillitis treatment. Overall, all the compared drugs were well tolerated; discontinuations due to adverse events were very low: 2.2% for clarithromycin treatment and 2.5% for the other antibiotics. It was concluded that clarithromycin is an effective and safe treatment for upper respiratory infection, and its new formulation in a single daily dose may improve therapeutic compliance.
Abad-Santos
F
F
Servicio de Farmacologia Clinica, Hospital Universitario de La Princesa, Departamento de Farmacologia y Terapeutica, Instituto Teofilo Hernando, Universidad Autonoma de Madrid, Spain. fabad.hlpr@salud.madrid.org
Gálvez-Múgica
M A
MA
Espinosa de los Monteros
M J
MJ
Gallego-Sandín
S
S
Novalbos
J
J
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D012141:Respiratory Tract Infections / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D017291:Clarithromycin