82 Indian Journal of Pharmacology | February 2011 | Vol 43 | Issue 1 | 82-83
Vesiculobullous eruption of the right arm after intravenous
clarithromycin
Abdulkadir Kuçukbayrak, Engin Senel1, Zeynep Seckin Kücükbayrak2, Ersin Gunay3, Ezgi Simsek3
Drug Watch
Clinic of Infectious Diseases and Clinical Microbiology, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, 1Clinic of Dermatology,
Çankiri State Hospital, Çankiri,
2Department of Physiology, Duzce
University School of Medicine, Duzce, 3Clinic of Chest Diseases,
Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
Received: 05-06-2010 Revised: 31-07-2010 Accepted: 21-10-2010 Correspondence to: Dr. Engin Senel E-mail: enginsenel@enginsenel.com Introduction
Clarithromycin is a macrolide antibiotic. It is highly active against gram-positive bacteria and has a good activity against Haemophilus influenzae, Moraxella catarrhalis and atypical bacteria.[1]
In clinical studies, adverse drug reactions (ADRs) of clarithromycin are usually mild and transient. Only 1% of the adverse reactions are severe.[1] The most common
ADRs observed after intravenous clarithromycin treatment are phlebitis, pain and inflammation, which are mild and reversible.[2] We present a case of vesiculobullous eruption and
vein thrombosis caused by the intravenous administration of clarithromycin.
Case Report
A 73-year-old man presented to the emergency room with complaints of cough and purulent sputum. He had a history of cerebrovascular disease 1 year ago. His family history was unremarkable.
Physical examination revealed decreased lung sounds in
ABSTRACT
Clarithromycin is a macrolide antibiotic. In clinical trials, adverse drug reactions of clarithromycin are usually mild and transient. Only 1% of the adverse reactions are severe. Herein, we present a case with vesiculobullous skin reaction and vein thrombosis caused by administration of intravenous clarithromycin.
KEY WORDS: Adverse drug reaction, bullous reaction, clarithromycin, intravenous, venous thrombosis
the left hemithorax. Complete blood count, liver and kidney functional laboratory tests were in the normal range. The patient was hospitalized. Pulse intravenous clarithromycin (500 mg twice-daily) treatment was initiated due to lower respiratory tract infection. No concomitant or additional medication was given. In 12 h of the treatment, erythema and swelling developed on his right forearm where i.v. clarithromycin was given.
Dermatological examination revealed sharp erythema that spread from the middle of the forearm to the entire right dorsal hand, with multiple vesicles and bullae filled with serous material [Figure 1]. Arterial Doppler ultrasonography of the right arm was normal. Venous Doppler ultrasonography revealed venous thrombosis and edema in subcutaneous tissue on the right arm. Intravenous clarithromycin was stopped. Intravenous piperacillin–tazobactam treatment (3 x 4.5 g daily) was initiated for the lower tract infection and conservative local wound care treatment with analgesics and dressings was administrated. At the end of the first month of follow-up, the clinical findings improved [Figure 2].
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Website: www.ijp-online.com Quick Response Code: DOI: 10.4103/0253-7613.75679
83 Indian Journal of Pharmacology | February 2011 | Vol 43 | Issue 1 | 82-83 Discussion
Clarithromycin-associated adverse reactions are wide ranging, from mild urticaria and skin eruptions to rare conditions such as anaphylaxis, Stevens–Johnson syndrome and toxic epidermal necrolysis.[3] Vorbach et al. suggested that
clarithromycin has a better endothelial compatibility when it dilutes to a final concentration of 1 mg/ml. It was previously reported that the development of clarithromycin-induced phlebitis could be reduced by manufacturers with production of the diluted form (1 mg/ml) of clarithromycin.[4]
The Naranjo criteria is frequently used for determination of causality for suspected ADRs.[5] A causality assessment of this
ADR using the Naranjo criteria revealed that an adverse drug event due to clarithromycin was possible in this case (overall score, 4).
To conclude, intravenous pulse administration of clarithromycin should not be performed. Local ADRs depend
Figure 2: Residual scar 1 month after the presentation of the patient Figure 1: Edema, erythema and bullae on the right arm after pulse
intravenous clarithromycin application
on the infusion time and the drug concentration. We recommend that slow infusion and low concentrations can reduce the frequency and severity of the local ADRs. Although local adverse reactions may be serious, they can be improved with close observation and appropriate treatment.
References
1. Wood MJ. The tolerance and toxicity of clarithromycin. J Hosp Infect 1991;19:39-46. 2. Genne D, Siegrist HH, Humair L, Janin-Jaquat B, de Torrente A. Clarithromycin versus amoxicillin-clavulanic acid in the treatment of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 1997;16:783-8.
3. Ben-Shoshan M, Moore A, Primeau MN. Anaphylactic reaction to clarithromycin in a child. Allergy 2009;64:962-3.
4. Vorbach H, Weigel G, Robibaro B, Armbruster C, Schaumann R, Hlousek M, et al. Endothelial cell compatibility of clarithromycin for intravenous use. Clin Biochem 1998;31:653-6.
5. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30:239-45.
