Azithromycin or claritromycin

[leerobert]

Hi everyone,

Looking for feedback on these two macrolides. Have you found one to work better than the other? Is one better over the other for herxing? When reading, my impression is Clarithromycin works faster, is that so? Any input you can offer would be great. Going to be talking with AP doctor tomorrow to see what the next plan is since tetracyclines are a no.

RA diagnosis 2015 - positive anti-CCP. Currently Clarithromycin 500 mg daily; Turmeric supplement; probiotic; fish oil; vitamin D3; MSM. Minocycline therapy from 2015-2017 until developing sensitivities. Gluten free and dairy free diet. Severe dairy intolerance. Tested positive for M. pneumoniae igG

[kater]

Hi I don’t have much to add–I have taken them both at times during treatment for scleroderma/lyme along with clindy and many other abx. I think they were both useful and I didn’t herx or have difficulty with either though I don’t really herx. You don’t say what your diagnosis is but I have heard of azithromycin being used for scleroderma more than clarithromycin. Sorry I can’t add something more helpful. Good luck!
kate

Systemic Scleroderma since 2010. Lyme and Myco P. AP and many other antibiotics and treatments since Nov. 2011. Presently mostly in remission other than fatigue.
Teva Minocycline 100mg a day. Dessicated tyroid, LDN 4.5, LDI, hawthorne, curcurmin, berberine,, caprylex, reishi mushroom, liver protect, zinc,, fish oils, magnesium, vit K2, d3, bcomp, E, C

[leerobert]

Hi Katie,

I updated signature line to show diagnosis. Thanks for your input. Good to hear that you tolerated both of them. What dose were you taking?

RA diagnosis 2015 - positive anti-CCP. Currently Clarithromycin 500 mg daily; Turmeric supplement; probiotic; fish oil; vitamin D3; MSM. Minocycline therapy from 2015-2017 until developing sensitivities. Gluten free and dairy free diet. Severe dairy intolerance. Tested positive for M. pneumoniae igG

[PhilC]

I would choose clarithromycin because research has shown that it’s easier for (at least some) bacteria to develop resistance to azithromycin. And if that happens, you lose all the macrolide antibiotics, not just azithromycin. However, clarithromycin has more drug interactions than azithromycin, so I might choose azithromycin if I were already taking a drug that interacts with clarithromycin and could not find a compatible substitute.

This is another reason I prefer clarithromycin over azithromycin:

“Compared with amoxicillin-clavulanate treatment, the use of azithromycin and moxifloxacin was associated with significant increases in the risks of ventricular arrhythmia and cardiovascular death. The adjusted ORs for ventricular arrhythmia were 4.32 (95% CI, 2.95-6.33) for azithromycin, 3.30 (95% CI, 2.07-5.25) for moxifloxacin, and 1.41 (95% CI, .91-2.18) for levofloxacin. For cardiovascular death, the adjusted ORs for azithromycin, moxifloxacin, and levofloxacin were 2.62 (95% CI, 1.69-4.06), 2.31 (95% CI, 1.39-3.84), and 1.77 (95% CI, 1.22-2.59), respectively. No association was noted between clarithromycin or ciprofloxacin and adverse cardiac outcomes.”

Source: Risks of cardiac arrhythmia and mortality among patients using new-generation macrolides, fluoroquinolones, and β-lactam/β-lactamase inhibitors: a Taiwanese nationwide study.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

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