Clarithromycin use by GPs in developing countries needs even more caution
We studied the article by Wong et al.1 with great interest. The significant association with adverse cardiovascular outcomes with short term use of Clarithromycin for H. pylori treatment may present unique challenges in the context of developing countries due to their shortcomings in health infrastructure. The estimated burden of H. pylori in India is 60% to 80%.2 The majority of patients are exposed to use of clarithromycin for a short term either as a treatment regimen for community acquired pneumonia or as H. pylori treatment regimen. The significant risk of cardio-toxicity in form of arrythmias and myocardial infarction coupled with poor monitoring and record keeping in resource limited settings of developing countries may pose significant risk with use of clarithomycin in these settings.
Further, developing countries are continously facing the threat of an increasing burden of MDR tuberculosis. Clarithromycin is an important drug for the treatment of MDR tuberculosis. Excess exposure to clarithromycin in a tuberculosis prone population may lead to resistance, making the treatment of MDR tuberculosis even more difficult.
Thus, in developing countries it is even more important to come up with some safer alternative regimen for H. pylori infections to prevent cardio-vascular adverse events and decrease chances of clarithromycin resistance so that treatment of MDR TB does not suffer.
1. Wong Angel Y S, Root Adrian, Douglas Ian J, ChuiCeline S L, Chan Esther W, Ghebremichael-Weldeselassie Yonas et al. Cardiovascular outcomes associated with use of clarithromycin: population based study BMJ 2016; 352 :h6926
2. Thirumurthi S, Graham DY. Helicobacter pylori infection in India from a western perspective. The Indian Journal of Medical Research. 2012;136(4):549-562.
Competing interests: No competing interests