Does Clarithromycin Cause Hearing Loss? A 12-Year Review of Clarithromycin Therapy for Nontuberculous Mycobacterial Lymphadenitis in Children

Heffernan, Colleen; McKeon, Mallory; Molony, Sasha; Kawai, Kosuke; Stiles, Derek J.; Lachenauer, Catherine S.; Kenna, Margaret A.; Watters, Karen

doi:10.1177/0003489418788112

“…It is acid stable, causes fewer gastrointestinal side effects, and has a longer half-life than erythromycin. It can be administered twice a day instead of four times a day (57). This increases the likelihood of patient compliance with clarithromycin compared with erythromycin.…”

Section: Clinical Studiesmentioning

confidence: 99%

“…Hearing loss developed between 25 and 63 days after initiation of treatment. HL was unilateral in two children and persisted in one child after treatment was discontinued (57). Based on their review of the literature and the addition of their three cases, the authors estimated that the risk of clarithromycin ototoxicity was 9% (16/184) in healthy adults and 22% (6/27) among HIV-positive individuals (57).…”

Section: Clinical Studiesmentioning

confidence: 99%

“…However, these authors did not include children under the age of 15 nor did they study patients >60 years of age. Macrolide ototoxicity has been observed in children (57,71) and published case reports suggest that the elderly and patients with HIV disease may be at higher risk of ototoxic reactions to all the commonly prescribed macrolide antibiotics, including azithromycin, clarithromycin, and erythromycin (44).…”

Section: Macrolides Clinical Studiesmentioning

confidence: 99%

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Ototoxicity of Non-aminoglycoside Antibiotics

Rybak

¹

,

Ramkumar

²

,

Mukherjea

³

2021

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It is well-known that aminoglycoside antibiotics can cause significant hearing loss and vestibular deficits that have been described in animal studies and in clinical reports. The purpose of this review is to summarize relevant preclinical and clinical publications that discuss the ototoxicity of non-aminoglycoside antibiotics. The major classes of antibiotics other than aminoglycosides that have been associated with hearing loss in animal studies and in patients are discussed in this report. These antibiotics include: capreomycin, a polypeptide antibiotic that has been used to treat patients with drug-resistant tuberculosis, particularly in developing nations; the macrolides, including erythromycin, azithromycin and clarithromycin; and vancomycin. These antibiotics have been associated with ototoxicity, particularly in neonates. It is critical to be aware of the ototoxic potential of these antibiotics since so much attention has been given to the ototoxicity of aminoglycoside antibiotics in the literature.

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“…However, clarithromycin has been associated with hearing loss, with one study citing a 7% hearing loss rate in their patients. This side effect did resolve in all but one patient; however, the authors state that the patient had a pre-existing condition that hindered their ability to attribute this hearing loss solely to clarithromycin [58]. A case study on an 81-year-old woman, who was being treated with clarithromycin for infective exacerbation of chronic pulmonary obstructive disease (COPD) showed another example of clarithromycin-related permanent hearing loss, despite evidence that clarithromycin is relatively well tolerated [59,60].…”

Section: Treatmentmentioning

confidence: 99%

Mycobacterium abscessus: Environmental Bacterium Turned Clinical Nightmare

Lopeman

¹

,

Harrison

²

,

Desai

³

et al. 2019

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Mycobacteria are a large family of over 100 species, most of which do not cause diseases in humans. The majority of the mycobacterial species are referred to as nontuberculous mycobacteria (NTM), meaning they are not the causative agent of tuberculous (TB) or leprosy, i.e., Mycobacterium tuberculous complex and Mycobacterium leprae, respectively. The latter group is undoubtedly the most infamous, with TB infecting an estimated 10 million people and causing over 1.2 million deaths in 2017 alone TB and leprosy also differ from NTM in that they are only transmitted from person to person and have no environmental reservoir, whereas NTM infections are commonly acquired from the environment. It took until the 1950′s for NTM to be recognised as a potential lung pathogen in people with underlying pulmonary disease and another three decades for NTM to be widely regarded by the medical community when Mycobacterium avium complex was identified as the most common group of opportunistic pathogens in AIDS patients. This review focuses on an emerging NTM called Mycobacterium abscessus (M. abs). M. abs is a rapidly growing NTM that is responsible for opportunistic pulmonary infections in patients with structural lung disorders such as cystic fibrosis and bronchiectasis, as well as a wide range of skin and soft tissue infections in humans. In this review, we discuss how we came to understand the pathogen, how it is currently treated and examine drug resistance mechanisms and novel treatments currently in development. We highlight the urgent need for new and effective treatments for M. abs infection as well as improved in vivo methods of efficacy testing.

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“…However, clarithromycin has been associated with hearing loss, with one study citing a 7% hearing loss rate in their patients. This side effect did resolve in all but one patient, but the authors state that the patient had a pre-existing condition that hindered their ability to attribute this hearing loss solely to clarithromycin (65) found all the isolates to have an MIC of ≤1 µg/mL with an average of 0.5 µg/mL, which is decidedly superior than that of the other orally available tetracycline antibiotics such as moxifloxacin and tetracycline (105).…”

Section: Abscessus Infection In Non-cf Populationsmentioning

confidence: 99%

<em>Mycobacterium abscessus: </em>Environmental Bacterium Turned Clinical Nightmare

Lopeman

¹

,

Harrison

²

,

Desai

³

et al. 2019

Preprint

View full text Add to dashboard Cite

Mycobacteria are a large family of over 100 species, most of which do not cause diseases in humans. The majority of the mycobacterial species are referred to as nontuberculous mycobacteria (NTM), meaning they are not the causative agent of tuberculous (TB) or leprosy, i.e. Mycobacterium tuberculous complex and Mycobacterium leprae, respectively. The latter group is undoubtedly the most infamous, with TB infecting an estimated 10 million people and causing over 1.2 million deaths in 2017 alone (1). TB and leprosy also differ from NTM in that they are only transmitted from person to person and have no environmental reservoir, whereas NTM infections are commonly acquired from the environment (2) (3). It took until the 1950's for NTM to be recognised as a potential lung pathogen in people with underlying pulmonary disease and another 3 decades for NTM to be widely recognised by the medical community when NTM, particularly Mycobacterium avium complex (MAC) was recognised as the most common group of opportunistic pathogens in AIDS patients (4). This review focusses on an emerging NTM called Mycobacterium abscessus (M. abs). M. abs is a rapidly growing (RGM) NTM that is responsible for opportunistic pulmonary infections in patients with structural lung disorders such as cystic fibrosis (CF) and bronchiectasis (5), as well as a wide range of skin and soft tissue infections (SSTIs) in humans (6) (7). M. abs is a weakly staining Gram-positive mycobacterium that is neverand is, like other NTM, most often seen in soil and aquatic environments (8). The bacillus-shaped bacterium is 1-6µm long and 0.2-0.5µm in diameter, with curved ends and the presence of cord factor, or trehalose 6-6'-dimycolate, a glycolipid found in the cell wall of virulent species of mycobacteria that results in "serpentine cord" cell morphology is sometimes observed (8) (9). On solid growth medium, M. abs can display either a rough (M. abs-R) or smooth (M. abs-S) morphotype, with the rough morphotype displaying a more virulent phenotype than its smooth variant (10). The rough morphotype is characterised by irregular parallel filaments that form ridges across the colony, whereas a smooth morphology is displays a wet, smooth colony with no filaments or ridges (79). This morphology is driven by cell wall glycopeptidolipid (GPL); a loss of GPL results in the reversion from rough to smooth morphotype (80) (81). Moreover, it has been shown using human tissue culture models of infection that M. abs-R is able to persist and multiply within the host macrophage whereas M. abs-S lacks this capacity, hence its role in virulence (82). Like all other mycobacteria, M. abs are aerobic, non-motile and acid-fast organisms with a characteristically thick, lipid-rich cell wall that is hydrophobic. Due to their unusually impermeable, thick cell wall, mycobacteria are notoriously resistant to many antibiotics, disinfectants and heavy metals (11). When the genome of M. abs became available in 2009, elucidation of the resistance mechanisms of M. abs became an area of focus for scientific research, as the considerable threat it poses to public health became more apparent (12) (13) (14). In this review we will discuss how we came to understand the pathogen, how it is currently treated, as well as a discussion of drug resistance mechanisms and novel treatments currently in development.

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Does Clarithromycin Cause Hearing Loss? A 12-Year Review of Clarithromycin Therapy for Nontuberculous Mycobacterial Lymphadenitis in Children

Cited by 12 publications

References 26 publications

Ototoxicity of Non-aminoglycoside Antibiotics

Ototoxicity of Non-aminoglycoside Antibiotics

Mycobacterium abscessus: Environmental Bacterium Turned Clinical Nightmare

<em>Mycobacterium abscessus: </em>Environmental Bacterium Turned Clinical Nightmare

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