ํด๋๋ฆฌํธ๋ก๋ง์ด์
ํด๋๋ฆฌํธ๋ก๋ง์ด์ ์ ์๋ฆฌํธ๋ก๋ง์ด์ ๊ณผ ๋ฐ์ ํ ๊ด๋ จ์ด ์๋ ๋ฐํฉ์ฑ **๋งํฌ๋ก๋ผ์ด๋๊ณ ํญ์์ **์ ๋๋ค. ๋ฝํค ๊ณ ๋ฆฌ์ 6๋ฒ ์์น๊ฐ ๋ฉํธํ๋์ด ๊ตฌ์กฐ์ ์ผ๋ก ๋ณํ๋์์ผ๋ฉฐ, ์ด๋ก ์ธํด ๋ชจํํฉ๋ฌผ์ ๋นํด ์์ฐ์ ๋ํ ์์ ์ฑ์ด ํฅ์๋๊ณ ๊ฒฝ๊ตฌ ์์ฒด์ด์ฉ๋ฅ ์ด ๋์ผ๋ฉฐ ํญ๊ท ์คํํธ๋ผ์ด ๋ ๋์ด์ก์ต๋๋ค. **์ฃผ์ ์์ ํน์ง:** * **ํญ๊ท ์คํํธ๋ผ:** ์๋ฆฌํธ๋ก๋ง์ด์ ๊ณผ ์ ์ฌํ์ง๋ง **๋น์ ํ ํญ์ฐ๊ท **(์: *Mycobacterium avium* complex), *ํฌ๋ฆฌ์ฝ๋ฐํฐ* ์ข ๋ฐ *Rhodococcus equi*์ ๋งค์ฐ ํจ๊ณผ์ ์ ๋๋ค. * **์์์ ์ ์ฉ์ฑ:** ์๋๋ฌผ์์๋ ์ฃผ๋ก ๋น์ ํ ํญ์ฐ๊ท ๊ฐ์ผ(๊ณ ์์ด ๋๋ณ ๋๋ ๊ฐ ๋๋ณ์ ์ก์์ข ๋ฑ) ๋ฐ *ํฌ๋ฆฌ์ฝ๋ฐํฐ* ์ ๊ท ์๋ฒ์ ์ฌ์ฉ๋ฉ๋๋ค. ๋ง์ํ์์๋ ๋ง์์ง์ *Rhodococcus equi* ํ๋ ด ์น๋ฃ์ ํต์ฌ์ ์ธ ์ฝ๋ฌผ์ ๋๋ค. * **๋ด์ฝ์ฑ:** ์ผ๋ฐ์ ์ผ๋ก ์๋ฆฌํธ๋ก๋ง์ด์ ๋ณด๋ค ๋ด์ฝ์ฑ์ด ์ข์ผ๋ฉฐ, ์์ฅ๊ด ์ด๋ ์ด์ง(๋ชจํธ๋ฆฐ ์์ฉ์ฒด ์์ฉ) ํจ๊ณผ๊ฐ ์ ์ด ์์ฅ๊ด ๋ถ์์ฉ์ด ๋ํฉ๋๋ค. > **์์ ํ:** ํด๋๋ฆฌํธ๋ก๋ง์ด์ ์ ์ฌ์ดํ ํฌ๋กฌ P450 3A(CYP3A) ํจ์๊ณ์ ๊ฐ๋ ฅํ ์ต์ ์ ์ ๋๋ค. ์ด ๊ฒฝ๋ก๋ฅผ ํตํด ๋์ฌ๋๋ ๋ค๋ฅธ ์ฝ๋ฌผ๊ณผ ๋ณ์ฉํ ๊ฒฝ์ฐ ๋ ์ฑ์ ํผํ๊ธฐ ์ํด ์ฃผ์ ๊น์ ๊ฒํ ๊ฐ ํ์ํฉ๋๋ค.
์์ฉ ๊ธฐ์ : Clarithromycin is typically **bacteriostatic**, though it can be bactericidal at high concentrations against highly susceptible organisms. * **Mechanism:** It penetrates the bacterial cell wall and reversibly binds to the **P site of the 50S ribosomal subunit**. * **Pathway:** Binding โ Inhibition of RNA-dependent protein synthesis (blocks transpeptidation and translocation) โ Suppression of bacterial growth. * **Post-Antibiotic Effect (PAE):** Macrolides generally exhibit a prolonged PAE against Gram-positive pathogens, allowing for sustained efficacy even when plasma levels drop below the MIC.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Treatment of feline leprosy ยท 62.5 mg per cat q12h ยท PO ยท q12h ยท Used in a regimen of 2 or 3 drugs including clofazimine and/or rifampin.
- Treatment of Nocardia (N. nova) infections ยท 62.5-125 mg (total dose per cat) PO twice daily ยท PO ยท q12h ยท Combination therapy with amoxicillin and/or doxycycline.
- Treatment of H. pylori infections ยท 7.5 mg/kg PO twice daily ยท PO ยท q12h ยท 14 days ยท Combination therapy with metronidazole and amoxicillin.
- Treatment of M. tuberculosis-bovis variant infections ยท 5-10 mg/kg PO q12h ยท PO ยท q12h ยท At least 2 months, then maintenance for 4 months ยท Used with rifampin and enrofloxacin.
- Susceptible infections ยท 7.5 mg/kg PO q12h ยท PO ยท q12h
- Treatment of Helicobacter mustelae infections ยท 12.5 mg/kg PO q12h ยท PO ยท q12h ยท 14 days ยท With ranitidine bismuth citrate. Same regimen given q8h is also published.
- Treatment of Helicobacter mustelae infections ยท 12.5-50 mg/kg q8-24h ยท PO ยท q8-24h ยท With omeprazole at 0.7 mg/kg PO once daily.
- Treatment of Rhodococcus equi infection in foals ยท 7.5 mg/kg PO q12h ยท PO ยท q12h
- Treatment of Rhodococcus equi infection in foals ยท 7.5 mg/kg PO q12h ยท PO ยท q12h ยท In combination with rifampin at 5 mg/kg PO q12h or 10 mg/kg PO q24h.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Known hypersensitivity to clarithromycin or other macrolide antibiotics (e.g., erythromycin, azithromycin)
- Concurrent use with cisapride (due to risk of fatal cardiac arrhythmias)
์ด์๋ฐ์
- Gastrointestinal disturbances (nausea, vomiting, anorexia, diarrhea)
- Pinnal or generalized erythema (specifically noted in cats)
- Transient, mild BUN elevation
- Prolonged QT interval / torsades de pointes (rare)
- Hepatotoxicity (rare)
- Thrombocytopenia (rare)
- Pseudomembranous colitis secondary to Clostridium difficile (reported in humans)
์ฝ๋ฌผ ์ํธ์์ฉ
- Cisapride ยท Clarithromycin inhibits cisapride metabolism; concurrent use is contraindicated due to risk of severe cardiac arrhythmias.
- Fluconazole ยท May increase clarithromycin serum levels.
- Digoxin ยท Clarithromycin may increase serum levels of digoxin.
- Omeprazole ยท Concurrent use can increase the plasma levels of both drugs.
- Warfarin ยท May potentiate the effects of oral anticoagulant drugs.
- Zidovudine ยท Clarithromycin may decrease serum concentrations of zidovudine.
- CYP3A Substrates (Alfentanil, Bromocriptine, Buspirone, Carbamazepine, Methylprednisolone, Midazolam, Alprazolam, Triazolam, Rifabutin, Tacrolimus, Theophylline) ยท Clarithromycin inhibits CYP3A, potentially increasing plasma concentrations and toxicity of these drugs. Therapeutic monitoring or dose reduction may be required.
- Disopyramide ยท Increased levels and risk of prolonged QT interval.
- Quinidine ยท Increased levels and risk of prolonged QT interval.
๋ชจ๋ํฐ๋ง
- Clinical efficacy (resolution of infection)
- Gastrointestinal adverse effects
- Signs of erythema (especially in cats)
- Potential drug interactions if on concurrent medications
๊ณผ์ฉ๋
Overdoses of clarithromycin are generally not life-threatening and primarily result in **gastrointestinal distress** (vomiting, diarrhea, cramping). * **Treatment:** For recent, large ingestions, administration of activated charcoal with a cathartic may help remove unabsorbed drug. * **Note:** Forced diuresis, peritoneal dialysis, or hemodialysis are **not effective** in enhancing the elimination of clarithromycin from the body.
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