Safety and tolerability of clarithromycin in the treatment of multidrug-resistant tuberculosis. Issue 3 (23rd March 2017)

• Record Type: Journal Article
• Authors: Van der Paardt, Anne-Fleur Louise; Akkerman, Onno W.; Gualano, Gina; Palmieri, Fabrizio; Davies Forsman, Lina; Aleksa, Alena; Tiberi, Simon; de Lange, Wiel C.M.; Bolhuis, Mathieu S.; Skrahina, Alena; van Soolingen, Dick; Kosterink, Jos G.W.; Migliori, Giovanni Battista; van der Werf, Tjip S.; Alffenaar, Jan-Willem C.
• Is Part Of: European respiratory journal. Volume 49:Issue 3(2017)
• Publication Date: 2017-03-23
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiration -- Periodicals; 616.2
• DOI: 10.1183/13993003.01612-2016
• Languages: English
• ISSNs: 0903-1936

Abstract

Multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) are an emerging global threat. An estimated 3.3% of newly diagnosed TB patients and 20% of previously treated patients worldwide have MDR-TB [1]. Moreover, 9.7% of MDR-TB cases are suffering from XDR-TB. Treatment of TB is becoming more difficult since the resistance pattern of Mycobacterium tuberculosis is expanding and treatment success rate is decreasing, with newly emerging drug-resistant strains [2]. Therefore, evaluation of antimicrobial drugs active against M. tuberculosis is necessary. Clarithromycin (CLR) is a macrolide antibiotic previously listed as a World Health Organization (WHO) group 5 drug, but not included in the new WHO classification because it has only modest bacteriostatic effects against M. tuberculosis [3]. However, the in vitro synergy of CLR in combination with linezolid, ethambutol and spectinomycin, and its immunomodulatory effects, hold promise [4–6]. Despite the introduction of newer drugs such as bedaquiline and delamanid, clarithromycin may have added value for the treatment of TB patients in cases of extensive resistance but proven susceptibility to clarithromycin. Unfortunately, real-life data on the use of clarithromycin to guide physicians in the treatment of MDR-TB is scarce. Clarithromycin had a good tolerability and safety profile as assessed in MDR-TB patients receiving prolonged treatment http://ow.ly/r8Jh306Ac0u