Mycobacterium fortuitum-induced persistent parotitis: successful therapy with clarithromycin and ciprofloxacin

BACKGROUND: Parotitis caused by nontuberculous mycobacteria, a very rare disease entity, has never been reported to be caused by Mycobacterium fortuitum (M. fortuitum) in the literature. METHODS AND RESULTS: An 8-year-old girl was seen with painful swelling of the right parotid gland despite antibiotic treatment of more than 1 month. Elevated serum amylase activity and diffuse contrast-enhanced CT of the parotid gland confirmed the diagnosis of parotitis. Histopathological study of specimens taken from the right parotid tail mass showed granulomatous inflammation with acid-fast positive bacilli; culture later confirmed M. fortuitum. After administration of clarithromycin and ciprofloxacin for 9 consecutive months, the parotitis and parotid tail mass were completely resolved at follow-up examination. CONCLUSION: To our knowledge, this is the first case report of parotitis caused by M. fortuitum and its successful medical treatment.     

不同厂家克拉霉素胶囊的质量考察

目的对市售5个厂家生产的克拉霉素胶囊进行质量考察。方法对克拉霉素胶囊的性状、溶出度、标示含量3个项目分别进行质量考察。结果考察项目在各个厂家之间存在一些差异,但均在中国药典规定的合格范围内。结论5个厂家生产的克拉霉素质量均可靠。     

Effects of claritromycin on inflammatory parameters and clinical conditions in children with bronchiectasis

Background: The effects of the macrolides cannot be ascribed to their antibacterial action alone. Their immunoregulatory and anti‐inflammatory functions are significant too. They are frequently used in the treatment of diffuse panbronchiolitis and cystic fibrosis (CF). Aim: To evaluate the effects of a macrolide antibiotic [clarithromycin (CAM)] on the process of inflammation [by measuring IL‐8, TNF‐α, IL‐10 levels and cell profiles in bronchoalveolar lavage (BAL) fluid], pulmonary function and sputum production in children with steady‐state bronchiectasis, secondary to causes other than CF or primary immunodeficiencies. Methods: Seventeen patients randomized to the treatment group received CAM and supportive therapies for 3 months and 17 patients in the control group were given supportive therapies only. Results: Compared with the control group, the treatment group showed a significant decrease in IL‐8 levels, total cell count, neutrophil ratios in BAL fluid and daily sputum production at the end of the third month. There was also a significant increase in the treatment group's BAL fluid macrophage ratios. The differences in pulmonary function test parameters were not significant. Conclusion: Use of CAM in children with steady‐state bronchiectasis results in laboratory improvement by reducing the inflammatory processes in the lungs. No corresponding clinical improvement could be shown but although this is possible with long‐term use, trial validation is necessary.     

Telithromycin versus clarithromycin for the treatment of community-acquired respiratory tract infections: a meta-analysis of randomized controlled trials

Background The emergence of bacterial resistance to commonly used antibiotics,such as macrolides,is complicating the management of respiratory tract infections (RTIs).Telithromycin,a ketolide antimicro...     

低剂量克拉霉素联合激素治疗慢性鼻-鼻窦炎疗效分析

目的研究分析低剂量克拉霉素联合激素治疗慢性鼻-鼻窦炎（CRS）的临床效果。方法随机选取2011—2012年在我院就诊的慢性CRS患者82例,将其随机分为观察组（41例）和对照组（41例）。对照组进行常规治疗,观察组在此基础上加用小剂量克拉霉素缓释片。对比两组治疗前后鼻部症状、鼻内镜检查、CT检查。结果两组总体临床效果均较治疗前有改善,差异均有统计学意义（P〈0．05）。且观察组疗效好于对照组,差异具有统计学意义（P〈0．05）。结论低剂量克拉霉素联合激素治疗慢性鼻-鼻窦炎效果显著,对CRS症状缓解率高,临床普谝反映良好．值得推广。     

长期低剂量克拉霉素联合布地奈德治疗慢性鼻窦炎临床研究

目的观察长期低剂量克拉霉素联合布地奈德喷雾剂治疗慢性鼻窦炎的疗效。方法将84例患者随机分为观察组44例和对照组40例,观察组采用长期低剂量克拉霉素联合布地奈德喷雾剂治疗,对照组单用布地奈德喷雾剂治疗,治疗前后采用视觉模拟量表(VAS)、鼻窦CT评分和糖精传输时间(ST)进行疗效评价。结果两组治疗1个月后的VAS评分、鼻窦CT评分和ST均明显降低(P<0.01),但组间无明显差异(P>0.05);两组治疗3个月后的VAS评分、鼻窦CT评分和ST均明显降低(P<0.01),且观察组降低更明显(P<0.01),且在整个服药期间未发现任何患者有严重的不良反应。结论长期低剂量克拉霉素联合布地奈德喷雾剂治疗慢性鼻窦炎安全有效。     

荷移分光光度法测定克拉霉素

目的 :建立测定制剂中克拉霉素含量的方法 .方法 :利用克拉霉素与茜素在水 醇介质中发生电荷转移反应 ,形成电荷转移络合物 ,采用可见分光光度法测定 .结果 :荷移反应生成的荷移络合物在 5 4 6nm处有最大吸收 ,络合物的组成比是 1∶1,稳定常数是 3.4× 10 4,表观摩尔吸光系数 7.31× 10 3 L/(mol·cm) ,药物浓度在 1～ 10 0mg/L范围内服从比耳定律 ,方法平均回收率在 98.0 %以上 ,克拉霉素浓度为 5 0mg/L时 ,相对标准偏差 (RSD)为 1.30 % (n =6 ) .结论 :方法稳定、准确、灵敏、快速 ,对样品的测定结果令人满意 .     

广东云浮地区幽门螺旋杆菌临床分离菌株耐药状况分析及其应对策略

目的：分析广东云浮地区幽门螺杆菌（Hp）临床分离菌株对常规治疗药物的耐药情况,观察补救疗法的疗效,为临床治疗幽门螺杆菌感染提供理论依据,探究根治幽门螺杆菌感染的应对策略。方法：选自2013年6月-2016年6月我院确诊为Hp感染的当地患者420例。本研究对420例Hp阳性患者进行Hp分离及阳性培养,共成功分离357组,在体外行药敏试验,探究幽门螺杆菌对甲硝唑、克拉霉素、阿莫西林、及左氧氟沙星等一种或多种常用抗生素的敏感性。将所有Hp阳性患者按不同治疗方案平均且随机分为3组,记为Ⅰ组、Ⅱ组、Ⅲ组,应用三联疗法规范治疗后,按照统计学方法计算Hp根除率,若Hp未根除,则给予四联疗法,记为Ⅳ组,经积极规范治疗后,计算Hp根除率。结果：初治3个组（Ⅰ、Ⅱ、Ⅲ组）Hp根除率中的Ⅰ组、Ⅱ组间根除率差异无统计学意义（P>0.05）,Ⅰ组、Ⅲ组间差异较大（P<0.05）;Ⅳ组Hp根除率明显高于初治3个组,第Ⅳ组与Ⅰ、Ⅱ、Ⅲ组根除率差异有统计学意义（P<0.05）;对所有Hp阳性患者进行Hp分离及阳性培养,根据统计分析,Hp对甲硝唑耐药率明显高于对左氧氟沙星、阿莫西林和克拉霉素的耐药率,具有统计学意义（P<0.05）;Hp对克拉霉素耐药率明显高于对左氧氟沙星和阿莫西林的耐药率,具有统计学意义（P<0.05）。结论：研究显示Hp对甲硝唑和克拉霉素的耐药性较高,为临床治疗幽门螺杆菌感染提供了一定的理论依据。     

Interaction between midazolam and clarithromycin in the elderly

AIM

To assess the relative contribution of intestinal and hepatic CYP3A inhibition to the interaction between the prototypic CYP3A substrate midazolam and clarithromycin in the elderly.

METHODS

On day 1, 16 volunteers (eight male, eight female) aged 65–75 years weighing 59–112 kg received simultaneous doses of midazolam intravenously (i.v.) (0.05 mg kg⁻¹ over 30 min) and orally (p.o.) (3.5 mg of a stable isotope, ¹⁵N₃-midazolam). Starting on day 2, clarithromycin 500 mg was administered orally twice daily for 7 days. On day eight, i.v. and p.o. doses of midazolam were administered 2 h after the final clarithromycin dose. Serum and urine samples were assayed for midazolam, ¹⁵N₃-midazolam and metabolites by gas chromatography/mass spectometry.

RESULTS

Men and women exhibited similar i.v. (30.4 vs. 36.0 l h⁻¹) and p.o. (119 vs. 124 l h⁻¹) clearances of midazolam. Midazolam hepatic availability was significantly (P = 0.006) greater in men [0.79, 95% confidence interval (CI) 0.75, 0.84] than in women (0.66, 95% CI 0.59, 0.73), but midazolam intestinal availability (0.39 vs. 0.55) was not different. Following clarithromycin dosing, a significant decrease in systemic (33.2 l h⁻¹ to 11.5 l h⁻¹) and oral (121 l h⁻¹ to 17.4 l h⁻¹) midazolam clearance occurred. Oral, hepatic and intestinal availability was significantly increased after clarithromycin dosing from 0.34 to 0.72, 0.73 to 0.91 and 0.47 to 0.79, respectively. Clarithromycin administration led to an increase in the AUC of midazolam by 3.2-fold following i.v. dosing and 8.0-fold following p.o. dosing. Similar effects were observed for males and females.

CONCLUSIONS

Intestinal and hepatic CYP3A inhibition by clarithromycin significantly reduces the clearance of midazolam in the elderly.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Clarithromycin is a mechanism-based inhibitor of CYP3A that has been shown to inhibit midazolam hydroxylation in young, healthy subjects.
• Elderly persons exhibit altered metabolism of a variety of drugs, including clarithromycin.
• However, the consequences of increased exposure to an inhibitor drug on CYP3A activity have not been addressed.

WHAT THIS STUDY ADDS

• This study utilized intravenous and oral midazolam as in vivo probes to examine the effect of clarithromycin on intestinal and hepatic CYP3A activity.
• Although clarithromycin concentrations are greater in elderly individuals than in young, healthy volunteers, intestinal and hepatic CYP3A enzymes are inhibited to a similar extent as in the young.