Erythromycin has been the most commonly used drug for the treatment of legionnaires' disease; however, failures have occurred and adverse effects are common. Doxycycline intravenously is preferred and is less expensive. The newer macrolides/azalides, clarithromycin and azithromycin, have excellent in vitro activity against Legionella and fewer adverse effects than erythromycin. The fluoroquinolones, particularly levofloxacin, are the most active anti-Legionella antibiotics available. Other agents with activity against Legionella pneumophila include minocycline, rifampin, and trimethoprim-sulfamethoxazole. The preferred therapy of legionellosis in immunocompromised patients are quinolone/macrolide combinations, eg, levofloxacin plus azithromycin.
A total of 77 patients with H. pylori-positive duodenal ulcer were included in a prospective, controlled, double-blind study. All patients received a 7-day treatment with omeprazole 20 mg b.d., clarithromycin 500 mg b.d. and amoxicillin 1000 mg b.d. Patients in the omeprazole group underwent an additional 14-day therapy with omeprazole 20 mg; patients in placebo group received placebo. Endoscopy was performed upon inclusion in the study and after 3 and 8 weeks.
To test whether one week's triple therapy with omeprazole and two antibiotics is enough to induce healing of a peptic (gastric and/or duodenal) ulcer.
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The aim of the current study was to investigate the effect of 14-membered ring macrolide clarithromycin (CAM) on migration induced by human plasma fibronectin (HFn) or on contraction of human fetal lung fibroblasts (HFL-1).
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Time-kill curves using simulated peak and trough serum concentrations, and postantibiotic effect (PAE) were determined for clarithromycin and 14-hydroxyclarithromycin alone and in combination against four strains of Legionella pneumophila. Both compounds were bactericidal at both peak and trough concentrations. The combination at trough concentrations demonstrated lower killing activity than the parent drug in three of the four strains. PAE ranges were 7.28-17.3 h for clarithromycin, 6.78-14.77 h for the metabolite, and 5.15-13.23 h for the combination.
The eradication rate was 69.7% (23/33) by both intention-to-treat and per-protocol analyses (95% confidence interval=61-79%). Seven (21.2%) patients experienced mild side-effects, such as soft stools and taste disturbance. No patient stopped the medication on account of adverse effects.
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This study failed to show any difference in H. pylori eradication rate between patients with NUD and PUD. There is no convincing evidence that the eradication rate may be affected by different PPI.
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Patients with active duodenal ulcer or diagnosed within the past 5 yr and with infection documented by (13)C-urea breath test plus histology or culture were randomly assigned to 10-day course of OBMT using a single-triple capsule containing bismuth biskalcitrate 140 mg, metronidazole 125 mg, and tetracycline 125 mg given as three capsules q.i.d. with omeprazole 20 mg b.i.d., or a 10-day course of OAC, omeprazole 20 mg plus amoxicillin 1 g plus clarithromycin 500 mg, all b.i.d. Eradication was confirmed by two negative urea breath tests at >1 month and >2 months after therapy.
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A retrospective analysis was conducted on 1497 consecutive dyspeptic patients with proven H. pylori infection and enrolled from 1996 to 2006. Patients received a standard triple therapy with proton pump inhibitor (PPI) plus amoxicillin 1 g and clarithromycin 500 mg for 7 days (all twice daily) plus PPI every day for further 4 weeks in case of active peptic ulcer or severe gastritis detected at endoscopy. One month after conclusion of therapy, endoscopy was performed in those patients for whom the examinations were clinically relevant. The remaining patients were checked by ¹³C-urea breath test.