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A radiometric respirometric technique (Bactec) which is highly standardized for Mycobacterium tuberculosis was used for antibiotic susceptibility testing of clinical isolates of M. marinum. Ciprofloxacin, clarithromycin, rifampicin and trimethoprim/sulfamethoxazole were effective at clinically relevant concentrations. Doxycycline, erythromycin and roxithromycin were ineffective. These in vitro results are discussed in relation to documented clinical experience.
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To review the pharmacology, chemistry, microbiology, in vitro susceptibility, mechanism of resistance, pharmacokinetics, pharmacodynamics, clinical efficacy, safety, drug interactions, dosage, and administration of cethromycin, a new ketolide antibiotic.
Seventy-three studies with 134 treatment arms were reviewed. Pooled eradication rates of dual, triple and quadruple therapies were 61.0, 86.5 and 93.4%, respectively. Proton pump inhibitor (PPI)-based combinations were more widely used and effective, with overall eradication rates of 90.7% in triple therapy and 93.4% in quadruple therapy. Bismuth combined with tetracycline and metronidazole also showed a high eradication rate of 92.0%.
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Mycobacteria were isolated and characterised from 49 cats with extensive infections of the subcutis and skin. Cats were generally between 3 and 10 years of age, and female cats were markedly over-represented. All isolates were rapid-growers and identified as either Mycobacteria smegmatis (40 strains) or M fortuitum (nine strains). On the basis of Etest for minimum inhibitory concentration and/or disc diffusion susceptibility testing, all strains of M smegmatis were susceptible to trimethoprim while all strains of M fortuitum were resistant. M smegmatis strains were typically susceptible to doxycycline, gentamicin and fluoroquinolones but not clarithromycin. All M fortuitum strains were susceptible to fluoroquinolones, and often also susceptible to gentamicin, doxycycline and clarithromycin. Generally, M smegmatis strains were more susceptible to antimicrobial agents than M fortuitum strains. Treatment of mycobacterial panniculitis involves long courses of antimicrobial agents, typically of 3-6 months, chosen on the basis of in vitro susceptibility testing and often combined with extensive surgical debridement and wound reconstruction. These therapies will result in effective cure of the disease. One or a combination of doxycycline, ciprofloxacin/enrofloxacin or clarithromycin are the drugs of choice for long-term oral therapy.
Randomized, double-blind, placebo-controlled study was the study design used. Patients of functional dyspepsia defined as per Rome 2 criteria were tested for H. pylori infection by rapid urease test and gastric biopsy. H. pylori-positive patients were randomly allocated to triple therapy (20 mg of omeprazole, 500 mg of clarithromycin, and 1000 mg of amoxicillin orally two times daily) and omeperazole plus identical placebo for 2 weeks. Symptoms were assessed with the weekly Likert scale.
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To describe an outbreak of mycobacterial keratitis after laser in situ keratomileusis (LASIK), including the microbiologic investigation, clinical findings, treatment response, and outcome.
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13 Canadian HIV clinics.
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The diagnosis of a facial nontuberculous mycobacteria infection was established using polymerase chain reaction.
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The macrolide antibacterial agent clarithromycin has been shown to cause QT interval prolongation on the electrocardiogram. In rabbit heart preparations clarithromycin (concentration dependently) lengthened the action potential duration and blocked the delayed rectifier current. The aim of the present study was to investigate the clarithromycin effects: (i) on the Ca2+ L-type and the main K+ repolarizing currents on human atrial myocytes, using whole-cell patch clamp recordings and (ii) on action potentials recorded from human atrial and ventricular myocardium using conventional microelectrodes. It has been found that (i) 10-30 microM clarithromycin reduced the sustained current Isus significantly and that a 100 microM concentration was needed to cause a significant reduction in the transient outward current Ito, whereas clarithomycin did not affect the calcium current and (ii) clarithromycin (10-100 microM) prolonged the action potential duration in atrial preparations but did not alter the different parameters of the ventricular action potential. It is concluded that clarithromycin exerts direct cardiac electrophysiological effects that may contribute to pro-arrythmic potential.
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A total of 50 patients, with a positive rapid urease test and endoscopically diagnosed active duodenal ulcer, were randomly assigned to one of two treatment groups after endoscopic examinations. Patients in the first group received lansoprazole 30 mg b.d., amoxycillin 1000mg b.d., clarithromycin 500 mg b.d.; patients in the second group received pantoprazole 40 mg b.d., amoxycillin 1000 mg b.d., clarithromycin 500 mg b.d for two weeks. Patients were scheduled for repeat endoscopic examination; repeat rapid urease test, and histological examination 4 weeks after the end of the therapy.
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H. pylori eradication is a safe and effective therapy for peptic stenosis. Endoscopic balloon dilation or surgery should be used only after failure of this conservative treatment.
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Clinical and economic data of 100 participants from a previously reported clinical trial conducted in Hong Kong were analyzed. Patients with a history of peptic ulcers were randomized to 1-week omeprazole 20 mg, amoxicillin 1 g and clarithromycin 500 mg twice daily (eradication group; n = 51) or 1-week omeprazole 20 mg twice daily (omeprazole group; n = 49) before initiation of diclofenac 100 mg daily for 6 months. The rates of PUD and healthcare utilization for routine follow-up as well as for management of symptomatic PUD of the 2 groups were retrieved from medical records.
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In the past, Mycobacterium avium complex (MAC) was considered a colonizing microbe in the immunocompetent host. Today it should be considered a potential pathogen. We present a case of MAC necrotizing pneumonia in a 27-year-old man who tested negatively for the human immunodeficiency virus, had no typical granulomas, and responded rapidly to antimicrobial therapy.
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One-hundred and fifty-four patients were recruited and randomized to omeprazole plus clarithromycin (n = 74) or to omeprazole plus placebo (n = 80). One month after treatment, H. pylori was eradicated in 57 of 69 (83%; 95% CI: 72-91%) patients receiving omeprazole plus clarithromycin, compared with 1 of 75 (1%; 95% CI: 0-7%) receiving omeprazole alone (P < 0.001). In patients receiving omeprazole plus clarithromycin the ulcer healed at 2 weeks in 83% (95% CI: 71-91%) and at 4 weeks in 100% (95% CI: 95-100%), compared with 77% (95% CI: 66-86%) and 97% (95% CI: 91-100%) in those given omeprazole plus placebo (N.S.). Ulcers recurred at 12 months in 6% (95% CI: 1-16%) of patients given omeprazole plus clarithromycin, compared with 76% (95% CI: 63-86%) of patients given omeprazole plus placebo (P < 0.001). The incidence of side-effects was similar in both treatment groups (38% with clarithromycin dual therapy and 29% with omeprazole plus placebo; P = 0.304). Ninety per cent of patients took at least 90% of their prescribed medication.
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Helicobacter pylori has been associated with several diseases including peptic ulcer disease and gastric cancer. Eradication of H pylori not only results in ulcer healing, but reduces recurrences essentially curing peptic ulcer disease. Eradicating H pylori can be difficult. There are several reasons for antimicrobial failure, and the resistance rates for several antibiotics are increasing. The most common drugs used to treat this infection include amoxicillin, clarithromycin, tetracycline, bismuth, and omeprazole and lansoprazole. Dual therapy using a proton pump inhibitor and a single antibiotic gives a suboptimal eradication rate. Triple therapy using at least two antibiotics and either bismuth or a proton pump inhibitor gives satisfactory eradication rates of 90%. However, these regimens are complicated and have significant side effects and compliance problems. The ideal regimen has yet to be developed. In the future, we will prevent infection with immunization. Several vaccines are being developed.
Different interpolymer complexes (IPCs) of chitosan (CS) and carboxymethylcellulose sodium salt (CMC) were used to elaborate mini-matrices containing clarithromycin (CAM). IPCs were characterized by FTIR, DSC and powder X-ray (XRD). Compression processes did not modify the physical state of CAM which was in its polymorph Form II. However, during tableting, polymer/polymer interactions occurred to form matrix systems that were confirmed by DSC. When mini-matrices were placed in acetate buffer (pH 4.2), the formation of a CAM solvate was determined by XRD, FTIR and DSC, showing the presence of incorporated crystallizing solvent molecules. Grazing incidence X-ray diffraction (GID) enabled us to profile transformations of CAM on surfaces of mini-matrices when it is in intimate contact with dissolution medium, and its conversion to a solvate form prior to its dissolution process. Besides, FTIR and DSC revealed polymer-polymer electrostatic interactions during dissolution process. Furthermore, swelling and eroding studies and in vitro drug release exhibited that when increasing the amount of CS within IPCs, swelling and erosion rates were greater and CAM release was faster. Zero-order kinetics from drug release profiles were related to linear erosion kinetics, and highlighted that erosion played an important role in drug release due to CAM poor solubility at this pH.
All articles pertaining to ranitidine bismuth citrate were considered for inclusion, with emphasis placed on randomized, double-blind trials. Priority was placed on data pertaining to regimens that are currently approved by the Food and Drug Administration for the treatment of duodenal ulcer in conjunction with HP.
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Two-week bismuth-containing quadruple therapy was more effective than the 1-week treatment, and should be considered for second-line treatment in Korea.
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The MIC ranges of the 6 antibiotics used against the Legionella isolates were as follows: 0.004-0.062 microg/mL (azithromycin), 0.002-0.5 microg/mL (ciprofloxacin), 0.004-0.5 microg/mL (clarithromycin), 0.12-4 microg/mL (clindamycin), 0.002-0.12 microg/mL (gatifloxacin), and 0.008-1 microg/mL (gemifloxacin).
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Helicobacter pylori (H. pylori) is a major human pathogen associated with significant morbidity and mortality. However, after decades of efforts, treatment of H. pylori remains a challenge for physicians, as there is no universally effective regimen. Due to the rising prevalence of antimicrobial resistance, mainly to clarithromycin, efficacy of standard triple therapies has declined to unacceptably low levels in most parts of the world. Novel regimens, specifically experimented to improve the therapeutic outcome against antibiotic-resistant H. pylori strains, are now recommended as first-line empirical treatment options providing high efficacy (reportedly > 90% in intention to treat analysis) even in high clarithromycin resistance settings. These include the bismuth quadruple, concomitant, sequential and hybrid therapies. Due to the rapid development of quinolone resistance, levofloxacin-based regimens should be reserved as second-line/rescue options. Adjunct use of probiotics has been proposed in order to boost eradication rates and decrease occurrence of treatment-related side effects. Molecular testing methods are currently available for the characterization of H. pylori therapeutic susceptibility, including genotypic detection of macrolide resistance and evaluation of the cytochrome P450 2C19 status known to affect the metabolism of proton pump inhibitors. In the future, use of these techniques may allow for culture-free, non-invasive tailoring of therapy for H. pylori infection.