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Medical Forum / Diseases and Disorders / Sinusitis / September 2006Sensitivity to clarithromycin but not roxithromycin
Hi all Through a happy accident, I was prescribed clarithromycin for two weeks that had the welcome side effect of eliminating my sinusitis while I was on it (and increasing my energy levels to near normal). When the clarithromycin stopped, all the symptoms returned. I know the macrolides have anti-inflammatory effects and are also good at dealing with mycoplasma and chlamydia infections. I ordered a large quantity of roxithromycin (300mg once per day on an empty stomach), in the hope of eliminating an underlying infection, or at least giving the sinus inflammation a break. However, I haven't had much of an improvement on the roxithromycin. Are there some pathogens that are sensitive to clarithromycin but not roxithromycin? Any other suggestions? Thanks. Nick Nick When you take the macrolides for anti-inflammatory properties, they only work for some people, and you take them at low doses, so they don't cure or treat infections. If you get benefit from the roxithromycin, it would appear after 8-12 weeks of use, and it would be less post nasal drip, and a reduced tendency to infection. Here's the reference in Chest: http://www.chestjournal.org/cgi/content/full/125/2_suppl/52S Here's the statement about roxithromycin: After 12 weeks of therapy, 64% of patients had reduced viscosity of nasal secretions, 56% had reduced quantity of nasal secretions, 62% had reduced postnasal drip, and 51% had reduced nasal obstruction. Clinical benefit in patients with chronic sinusitis also was observed following long-term administration of roxithromycin, 150 mg daily.26 So, the study used half the dose you're using, and looked for subtle improvement. Again, macrolides don't work for everyone. Judy > Hi all > [quoted text clipped - 19 lines] > > Nick > Nick > > > So, the study used half the dose you're using, and looked for subtle > improvement. Again, macrolides don't work for everyone. But, as I said, the clarithromycin *did* seem to work . . . that's why I'm curious what the functional difference is between roxithromycin and clarithromycin. Clarithromycin is a little too pricey for long term use, at least where I am. Nick But they are different goals: the clarithromycin was for treating an acute infection, if you intended to use the roxithromycin for anti-inflammatory effects it's a long term treatment. I sounds like you used full dose roxithromycin and the acute infection didn't respond. Macrolides for anti-inflammatory use are used at very low doses with the goal of not treating infection, but decreasing inflammation. The goal is NOT to use them at antibacterial doses. Roxithromycin isn't available in the US, so I've never used it. I'm not familar with the differences, but in any drug class, there will be differences between the drugs: macrolides are a relatively small group: erythromycin, clarithromycin, azithromycin are the main ones used in the the US. The latter two have an expanded spectrum of action and azithromycin has a very long half life. They're all the same class, but have different half lives and cover different bugs (although clarithromycin and azithromycin cover about the same spectrum of organisms.) Judy > > Nick > > > [quoted text clipped - 9 lines] > > Nick > Macrolides for anti-inflammatory use are used at very low doses with > the goal of not treating infection, but decreasing inflammation. The > goal is NOT to use them at antibacterial doses. Are you suggesting some kind of inverse dose-response relationship for the anti-inflammatory properties of macrolides? - because that would be the first I've heard of it. I think the reason doses are kept low is purely to minimize side-effects. The reason for the higher dose is that it would have a better chance of killing c. pneum, m. pneum. and friends, if present (e.g. see http://www.asthmastory.com/). In fact, I've seen it suggested that the "anti-inflammatory" properties of macrolides stem from their ability to knock-out occult chlamydial and mycoplasmal infections! (I would be interested if there are any studies on macrolides as anti-inflammatories that ALSO kept a record of mycoplasma and chlamydia infections in the sample groups). Which still leaves me nowhere near understanding why (short-term) clarithromycin seems to work, and long-term roxithromycin doesn't . . . Nick Nick For anti-inflammatory doses, you try to find the lowest possible dose that will provide anti-inflammatory properties. It is lower than anti-infective doses. There are companies working on creating derivatives of macrolides and tetracyclines that have NO antibiotic properties, but only anti-inflammatory properties. I have read asthmastory, and communicated with the physician. It's an interesting theory, but not widely accepted. C. pneumonia infection does require prolonged treatment. So, you were essentially trying to treat the infection with two full dose macrolides and one worked the other didn't: perhaps you've become resistant to macrolides. If you read the Chest article, and the other articles on macrolides as anti-inflammatories, they are used at low doses, with no goal of curing infection--just preventing an inflammatory response that may predispose to infection. Judy > > Macrolides for anti-inflammatory use are used at very low doses with > > the goal of not treating infection, but decreasing inflammation. The [quoted text clipped - 18 lines] > > Nick > For anti-inflammatory doses, you try to find the lowest possible dose > that will provide anti-inflammatory properties. It is lower than > anti-infective doses. There are companies working on creating > derivatives of macrolides and tetracyclines that have NO antibiotic > properties, but only anti-inflammatory properties. I am aware of all of the above. I have read the CHEST article (and many other PubMed articles on the same topic). I was not sure if I had a low-level chronic infection (which would require a slightly higher dose) or if the anti-inflammatory properties would be the main benefit. I am young, my liver enzymes are good, and there was no problem with selecting the high dose for a trial period of two months. > I have read asthmastory, and communicated with the physician. It's an > interesting theory, but not widely accepted. It is becoming *extremely* widely accepted . . . see www.cpnhelp.org, for one example. > So, you were essentially trying to treat the infection with two full > dose macrolides and one worked the other didn't: perhaps you've become > resistant to macrolides. You mean the pathogen has become resistant, I presume? Another options is that there's a pathogen involved that is only partially susceptible to macrolides. A swab or IgG assay may be the next step. Pseodomonas, golden staph etc. could probably cause the same symptoms. > If you read the Chest article, and the other articles on macrolides > as anti-inflammatories, they are used at low doses, with no goal of > curing infection--just preventing an inflammatory response that may > predispose to infection. Fully aware of that, thanks. Nick > I ordered a large quantity of roxithromycin (300mg once per day on an > empty stomach), in the hope of eliminating an underlying infection, or > at least giving the sinus inflammation a break. However, I haven't had > much of an improvement on the roxithromycin. What do you mean by you "ordered a a large quantity of ....."? Were you prescribed it by your doctor? If so, you pick up the quantity prescribed, one isn't likely to say "I ordered a large quantity of.....". Did you order from an overseas Internet pharmacy? I hear a lot of those meds are fakes. You might not be taking what you think.
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