Chemical structure of clarithromycin.
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Biaxin

Clarithromycin is a macrolide antibiotic used to treat pharyngitis, tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, pneumonia (especially atypical pneumonias associated with Chlamydia pneumoniae or TWAR), skin and skin structure infections, and, in HIV and AIDS patients to prevent, and to treat, disseminated Mycobacterium avium complex or MAC. more...

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In addition, it is sometimes used to treat Legionellosis.

Clarithromycin is available under several brandnames, for example Biaxin and Klacid.

History

Abbott Laboratories brought out clarithromycin in 1991.

Available forms

Clarithromycin is commonly administered in tablets (Biaxin®), extended-release tablets (Biaxin XL®), or oral suspension.

Mechanism of action

Clarithromycin prevents bacteria from growing, by interfering with their protein synthesis. Clarithromycin binds to the subunit 50S of the bacterial ribosome, and thus inhibits the translocation of peptides. Clarithromycin has similar antimicrobial spectrum as erythromycin, but is more effective against certain gram-negative bacteria, particularly Legionella pneumophilae. Besides this bacteriostatic effect, clarithromycin also has bactericidal effect on certain strains such as Haemophilus influenzae, Streptococcus pneumoniae and Neisseria gonorrhoeae.

Pharmacokinetics

Unlike erythromycin, clarithromycin is acid-stable and can therefore be taken orally without being protected from gastric acids. It is readily absorbed, and diffused into most tissues and phagocytes. Due to the high concentration in phagocytes, clarithromycin is actively transported to the site of infection. During active phagocytosis, large concentrations of clarithromycin is released. The concentration of clarithromycin in the tissues can be over 10 times higher than in plasma. Highest concentrations were found in liver and lung tissue.

Metabolism

Clarithromycin has a fairly rapid first-pass hepatic metabolism, i.e it is metabolised by the liver. However, this metabolite, 14-hydroxy clarithromycin is almost twice as active as clarithromycin. The half-life of clarithromycin is about 5 hours and 14-hydroxy clarithromycin's about 7 hours. Clarithromycin's and its metabolites' main routes of elimination are urinary and biliary excretion.

Side effects

Most common side-effects are gastrointestinal; diarrhea, nausea, abdominal pain and vomiting. Less common side-effects include headaches, rashes, alteration in senses of smell and taste.

Special Precautions

Allergic reactions can occur with clarithromycin use. People with a history of allergy, asthma, hay fever or hives seem to be more susceptible to these reactions. The reaction can be immediate and severe.

Allergic symptoms include wheezing, hives, itching, swelling, spasms in the throat and breathing tubes, joint and muscle pain, difficulty breathing, fever and skin rashes. Nausea and vomiting are not symptoms of an allergic reaction.

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Treating infections without antibiotics
From Townsend Letter for Doctors and Patients, 11/1/05 by Jacob Teitelbaum

Many people do not realize how many things they can do before resorting to using an antibiotic to clear an infection. If your patient is coming down with a respiratory infection such as a cold or the flu, I recommend that you try the following:

[ILLUSTRATION OMITTED]

* Give natural thymic hormone. This is available as a product called ProBoost from Klabin Marketing: 800-933-9440), and is a very effective immune stimulant. Dissolve the contents of one packet under your tongue three times a day and let it absorb there (any that is swallowed is destroyed). A study in CFS patients with markedly elevated Epstein-Barr antibody levels showed a dramatic drop in the antibody levels after six weeks of treatment with thymic hormone. Many physicians are finding that thymic hormone has been very helpful for CFS/FMS and other patients with acute or persistent viral, yeast, bowel, or other infections. I have found that using it for two or three days at the onset of an infection can shorten the length of the infection dramatically, and often stops it on the first day.

* Take 1,000 to 8,000 milligrams of vitamin C a day--enough to get diarrhea, then cut back to comfortable level.

* Suck on a zinc lozenge five to eight times a day. Make sure that the lozenges have at least 10 to 20 milligrams of zinc per lozenge. Less than this will not be effective. Zinc lozenges have been known to speed the time it takes to recover from a cold by about 40%. General Nutrition Centers sells a very good one.

* Drink plenty of water and hot caffeine-free tea (or hot water with lemon) and rest!

* Take Oscillococcinum, a homeopathic remedy available at most health food stores and some supermarkets, for flu-like symptoms such as chills, fever, achiness and/or malaise. It speeds healing and eases discomfort. It is best taken early in the infection--as soon as the patient has any Flu-like symptoms.

* For sinus infections, try nasal rinses. Dissolve 1/2 teaspoon of salt in a cup of lukewarm water. Inhale some of the solution about one inch up into your nose, one nostril at a time. Do this either by using a baby nose bulb or an eyedropper while lying down, or by sniffing the solution out of the palm of your hand while standing by a sink. Then gently blow your nose, being careful not to hurt your ears. Repeat the same process with the other nostril. Continue to repeat with each nostril until the nose is clear. Rinse your nasal passages at least twice a day until the infection improves. Each rinsing will wash away about 90% of the infection and make it much easier for your body to heal.

* 1,000 milligrams of olive leaf extract three times a day for three to seven days. Although probably not as effective as thymic hormone, olive leaf extract seems to be helpful against viral respiratory infections and, perhaps, yeast infections. It seems most helpful in fighting the common cold. In my experience, it has been very helpful for about half the people who try it--the cold is gone in twenty-four to thirty-six hours. If it causes nausea, cut the dose in half.

* Take acetaminophen (in Tylenol and many other over-the-counter pain relievers) for muscle aches and use Cepacol or Chloraseptic mouthwash as a gargle for a sore throat. Gargling with salt water, mixed as described above for the nasal rinse, also helps a sore throat. If you use acetaminophen frequently, you should also take 500 milligrams of supplemental N-acetylcysteine (NAC) each day so you don't deplete your glutathione levels.

* Try using a humidifier or vaporizer in your bedroom. You can also make a steam room by running a hot shower in your bathroom and then breathing in the steam. Or try using a steam inhaler, such as the one available from Bernhard Industries. This is also wonderful for chronic and acute sinusitis.

* Take at least 500 milligrams of vitamin C a day for prevention.

If, despite these measures, nasal and lung mucus is yellow after seven to fourteen days, or if you are feeling worse after three to four days, you may have to consider taking a course of antibiotics. If you do, you should take nystatin while on the antibiotic. Erythromycin antibiotics such as azithromycin (Zithromax) and clarithromycin (Biaxin) are usually preferable to penicillin antibiotics. Interestingly, my patients have sometimes found that all their CFIDS symptoms (not just the cold) improve while they are taking an erythromycin or tetracycline antibiotic. If that happens, I recommend a twelve-week course of 500 milligrams of Biaxin or 100 milligrams of doxycycline twice a day. If you feel better on the antibiotic (take thymic hormone, echinacea, and the antifungal nystatin in con-junction with it), keep repeating six-week courses until the symptoms stay gone. I would also check for Lyme disease using a blood or urine test. And for most of my patients who repeatedly get respiratory infections that take forever to go away, I consider an empiric trial of prescription hydrocortisone (Cortef) at a dosage of 7-1/2 milligrams in the morning and 5 milligrams at noon for two to three months.

As a preventive for respiratory infections, the flu vaccine is a double-edged sword for people with CFIDS/FMS. In some CFIDS/FMS patients, it can cause mild flulike symptoms for a few days. In rare cases, it can cause a severe flare-up of symptoms. Still, unless you are one of the 10% of CFIDS/FMS patients who feel worse after the flu shot or other vaccinations, I would get a flu shot. For most people, the benefit can significantly outweigh the risk. Interestingly, a recent Scandinavian study showed that having frequent vaccinations against Staphylococcus bacteria significantly improved symptoms in fibromyalgia patients. The researchers felt that it helped by stimulating the immune system.

Taking at least 500 milligrams of vitamin C a day is also a very good idea. And dress warmly. A cold breeze blowing across a patient's muscles can make fibromyalgia symptoms flare up.

Jacob Teitelbaum, MD is director of the Annapolis Research Center for Effective CFS/Fibromyalgia Therapies, which sees patients with CFS/FMS from all over the world (410-573-5389; www.EndFatigue.com) and author of the best selling book "From Fatigued to Fantastic!" and "Three Steps To Happiness! Healing Through Joy." His newest book "Pain Free 1-2-3!" has just been released. CD sets of his workshops on effective CFS/Fibromyalgia therapies and pain management for both prescribing and non-prescribing practitioners are available at www.vitality101.com. He accepts no money from any company whose products he recommends and 100% of his royalties for products he makes is donated to charity.

by Jacob Teitelbaum, MD

410-573-5389 * www.Vitality101.com.

COPYRIGHT 2005 The Townsend Letter Group
COPYRIGHT 2005 Gale Group

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