Clarithromycin (6-O-methyl erythromycin) is a macrolide antibiotic used to treat pharyngitis,

tonsillitis, acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis,

pneumonia (especially atypical pneumonias associated with Chlamydophila pneumoniae), skin
and skin structure infections. In addition, it is sometimes used to treat legionellosis, Helicobacter
pylori, and lyme disease. Recently there has been research towards whether Clarithromycin can
be used to effectively treat idiopathic hypersomnia.[1]
Clarithromycin is available under several brand names, for example Bioclar, Truclar, Crixan,
Claritt, Clarac, Biaxin, Klaricid, Klacid, Klaram, Klabax, Claripen, Clarem, Claridar,
Fromilid, Clacid, Clacee, Vikrol, Infex, Clariwin, Resclar, Ranbaxy and
Clarihexal,Clarinova 250mg & 500mg.

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History
Clarithromycin was invented by researchers at the Japanese drug company Taisho
Pharmaceutical in the 1970s. The product emerged through efforts to develop a version of the
antibiotic erythromycin that did not experience acid instability in the digestive tract, causing side
effects, such as nausea and stomach ache. Taisho filed for patent protection for the drug around
1980 and subsequently introduced a branded version of its drug, called Clarith, to the Japanese
market in 1991. In 1985, Taisho partnered with the American company Abbott Laboratories for
the international rights, and Abbott also gained FDA approval for Biaxin in October 1991. The
drug went generic in Europe in 2004 and in the US in mid-2005.
Its antibacterial spectrum is the same as erythromycin, but it is also active against
Mycobacterium avium complex MAV, M. leprae and atypical mycobacteria.

Mechanism of action
Clarithromycin prevents bacteria from growing by interfering with their protein synthesis. It
binds to the subunit 50S of the bacterial ribosome and thus inhibits the translation of peptides.
Clarithromycin has similar antimicrobial spectrum as erythromycin, but is more effective against
certain Gram-negative bacteria, particularly Legionella pneumophila. 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, so can 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 are
released; its concentration in the tissues can be over 10 times higher than in plasma. Highest
concentrations were found in liver, lung tissue and stool.

Metabolism
Clarithromycin has a fairly rapid first-pass hepatic metabolism. However, 14-hydroxy
clarithromycin, a metabolite, is almost twice as active and has a half-life of seven hours
compared to clarithromycin's five hours. Clarithromycin and its metabolites mainly are
eliminated by urinary and biliary excretion. Of all the drugs in its class, clarithromycin has the
best bioavailability at 50%, which makes it amenable to oral administration.

Side effects
Its most common side effects are gastrointestinal: diarrhea, Drowsiness, nausea, abdominal pain
and vomiting, facial swelling. Less common side effects include extreme irritability, headaches,

hallucinations (auditory and visual), dizziness/motion sickness, rashes, alteration in senses of

smell and taste, including a metallic taste that lasts the entire time one takes it. Dry mouth, panic
and / or anxiety attacks and nightmares have also been reported, albeit less frequently. In more
serious cases, it has been known to cause jaundice, cirrhosis, and kidney problems, including
renal failure. Uneven heartbeats, chest pain, and shortness of breath have also been reported
while taking this drug.
Clarithromycin causes positive results on urine drug screens for cocaine.
Adverse effects of clarithromycin in the central nervous system include dizziness, ototoxicity and
headaches, but delirium and mania are also uncommon side effects. According to one study, its
use has led to adverse effects on the nervous system in up to 3% of patients, including dizziness,
anxiety, insomnia, bad dreams, confusion, disorientation and hallucination.[2] It can very rarely
cause organic psychosis.[3]
When taken along with some statins used to reduce blood serum cholesterol levels, muscle pain
may occur.
A risk of oral candidiasis, due to the elimination of the yeast's natural bacterial competitors by
the antibiotic is also incurred.
Clarithromycin has been shown to induce miscarriage in several animals and a recent study
found an increased risk of miscarriage in women exposed to Clarithromycin in early pregnancy.[4]

Resistance
Many Gram-positive microbes quickly develop resistance to clarithromycin after standard
courses of treatment, most frequently via acquisition of the erm(B) gene, which confers highlevel resistance to all macrolides.[5]

Contraindications
Clarithromycin should be used with caution if the patient has liver or kidney disease, certain
heart problems or takes drugs that might cause certain heart problems (e.g., QT prolongation or
bradycardia), or an electrolyte imbalance (e.g., low potassium or sodium levels). Many other
drugs can interact with clarithromycin, so doctors should be informed of any other drugs taken
concomitantly.
Clarithromycin is almost never used in HIV patients due to significant interaction with HIV
drugs. It is not to be used in pregnant patients. It can also cause serotonin syndrome symptoms
when taken in conjunction with buspirone (Buspar).
Clarithromycin almost doubles the level of carbamazepine in serum by reducing its clearance,
inducing toxic symptoms of carbamazepine, including diplopia and nausea, as well as
hyponatremia (reduced level of sodium in serum). Research in many cases has shown a sharp
increase in serum level of carbamazepine in patients who were given clarithromycin. Therefore,
epileptic patients taking carbamazepine should avoid taking clarithromycin.

Drugs using clarithromycin

In Pakistan it is available under the brand name Claritek, and is manufactured and marketed by
Getz Pharmaceuticals. Its use is approved for upper and lower RTI, H. pylori, and, skin and soft
tissue infections. In Bangladesh, it is available as Claricin, produced by the Acme Laboratories
Ltd. In the United States, generic clarithromycin is available from Andrx, Genpharm, Ivax,
Ranbaxy Laboratories, Roxane, Sandoz, Teva and Wockhardt. It is also used as part of a
combination therapy to treat Helicobacter pylori. In the Middle East, it is available as Claridar,
produced by Dar Al Dawa. In India, Acnesol-CL gel, containing 1% clarithromycin, marketed by
Systopic, is used to treat acne vulgaris.

Potential increased mortality

In the CLARICOR Trial, the use of short-term clarithromycin treatment correlated with an
increased incidence of deaths classified as sudden cardiac deaths in stable coronary heart disease
patients not using statins.[6] Clarithromycin can potentially cause long QT syndrome, especially
in individuals with predispositions or taking medications that pose similar side effects, such as
atypical antipsychotics. Some case reports suspect it of causing liver disease.[7]

Tinidazole is an anti-parasitic drug used against protozoan infections. It is widely known

throughout Europe and the developing world as a treatment for a variety of amoebic and parasitic
infections. It was developed in 1972.
Tinidazole is marketed by Mission Pharmacal under the brand name Tindamax, by Pfizer under
the names Fasigyn and Simplotan, and in some Asian countries as Sporinex.
Contents
Pharmacology

It is chemically similar to metronidazolea drug with some unpleasant side effects that is used
in the United States as first-line therapy for amoebae. Tinidazole has similar side effects but has a
shorter treatment course.
Uses

A large body of clinical data exists to support use of tinidazole for infections from amoebae,
giardia and trichomonas, just like metronidazole. Tinidazole may be a therapeutic alternative in
the setting of metronidazole tolerance.
Tinidazole may also be used to treat a variety of other bacterial infections (e.g., as part of
combination therapy for Helicobacter pylori eradication protocols).
Side effects

The most common side effects reported with tinidazole are upset stomach, bitter taste, diarrhea
and itchiness. Other side effects which occur are headache, physical fatigue, and dizziness.
Anecdotally, people who have taken both metronidazole and tinidazole report toxicity is much
the same except the side effects don't last as long with the latter.
Drinking alcohol while taking tinidazole causes an unpleasant disulfiram-like reaction, which
includes nausea, vomiting, headache, increased blood pressure, flushing and shortness of breath.
Half-life

Elimination half-life is 13.2 1.4 hours. Plasma half-life is 12 to 14 hours.