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Clinical Investigations: Miscellaneous |

Oral Absorption of Clarithromycin in Acute Illness and During Convalescence in Patients With Community-Acquired Pneumonia*

Elliot Offman, BScPhm; Frances Varin, PhD; Tom Nolan, MD; Charlie D. Bayliff, PharmD; Anne Marie Bombassaro, PharmD; Dave G. McCormack, MD, FCCP
Author and Funding Information

*From the London Health Sciences Centre, London, Ontario, Canada.

Correspondence to: Dave G. McCormack, MD, FCCP, London Health Sciences Centre, 375 South St, London, Ontario, Canada N6A 4G5; e-mail: David.McCormack@LHSC.ON.CA



Chest. 2000;117(4):1090-1093. doi:10.1378/chest.117.4.1090
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Study objective: To compare the extent of oral clarithromycin absorption in patients during an illness and in health.

Design: Sequential two-phase prospective study including an acutely ill pneumonia phase (PP) and a subsequent convalescent phase (CP).

Study population: Patients≥ 18 years old with radiographically confirmed community-acquired pneumonia (CAP) who were admitted to the hospital.

Methods: During both study phases, patients received one single 500-mg dose of oral clarithromycin. Serial blood samples were drawn over a 24-h period in order to characterize the plasma concentration-time curves. Area under the curve from zero to 24 h (AUC0–24), maximum plasma concentration (Cmax), and time to maximum concentration (Tmax) were determined for both clarithromycin and its metabolite, 14-hydroxyclarithromycin, and compared between the two phases.

Results: Twelve patients completed both phases of the study. For clarithromycin, there was a significant increase AUC0–24 (47.37 ± 8.51μ g/h/mL vs 36.22 ± 6.09 μg/h/mL) in favor of the PP. There were no significant differences detected with respect to Cmax (4.32 ± 0.63 μg/mL vs 3.57 ± 0.46 μg/mL), or Tmax (3.50 ± 0.50 h vs 2.83 ± 0.59 h) between PP and CP. For 14-hydroxyclarithromycin, the AUC0–24 and Cmax were significantly higher (5.84 ± 1.08 μg/h/mL vs 8.84 ± 1.92μ g/h/mL; 0.42 ± 0.08 μg/mL vs 0.76 ± 0.23 μg/mL) in the CP as compared to the PP. Tmax remained unchanged.

Conclusion: The extent of absorption of oral clarithromycin was not diminished during an acute illness with CAP.

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