Rapid Communication
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 21, 2008; 14(39): 6065-6071
Published online Oct 21, 2008. doi: 10.3748/wjg.14.6065
Drug utilization of clarithromycin for gastrointestinal disease treatment
Quan Zhou, Ling-Ling Zhu, Xiao-Feng Yan, Wen-Sheng Pan, Su Zeng
Quan Zhou, Xiao-Feng Yan, Department of Clinical Pharmacy, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310009, China
Ling-Ling Zhu, Geriatric Ward, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310009, China
Wen-Sheng Pan, Department of gastroenterology, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310009, China
Su Zeng, Department of Pharmaceutical Analysis & Drug Metabolism, College of Pharmaceutical Sciences, Zhejiang University, Zhejiang Province 310058, China
Author contributions: Zhou Q and Pan WS contributed equally to this work; Zhou Q and Yan XF put forward the viewpoint and designed this survey; Zhou Q, Zhu LL and Zeng S performed literature review and data analysis/interpretation; and Zhou Q and Pan WS wrote the paper.
Supported by Zhejiang Provincial Bureau of Education, No. 20070227; Zhejiang Medical Association, No. 2007ZYC18 and Association of Zhejiang Hospital Administration, No. 2007AZHA-KEB312
Correspondence to: Quan Zhou, Associate Professor, Department of Clinical Pharmacy, the 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Province 310009, China. zhouquan142602@zju.edu.cn
Telephone: +86-571-87784615 Fax: +86-571-87213864
Received: September 1, 2008
Revised: September 12, 2008
Accepted: September 29, 2008
Published online: October 21, 2008
Abstract

AIM: To evaluate the patterns of use of clarithromycin for gastrointestinal disease treatment and promote its rational use.

METHODS: Using a structured pro forma, we conducted a two-month survey of the electronic prescriptions containing immediate-release (IR) or sustained-release (SR) product of clarithromycin for outpatients with gastrointestinal diseases in a 2200-bed general hospital. Suitability of the prescription was audited retrospectively.

RESULTS: One hundred and sixty-four prescriptions of SR product and 110 prescriptions of IR product were prescribed for gastrointestinal disease treatment. Among prescriptions for anti-Helicobacter pylori (H pylori) therapy, triple therapy take the dominant position (91.8%), followed by quadruple therapy (4.3%) and dual therapy (3.9%). Amoxicillin was the most frequently co-prescribed antibiotic. Furazolidone and levofloxacin are used more widely than metronidazole or tinidazole. Clarithromycin SR was administered at inappropriate time points in all prescriptions. Fifty percent of all prescriptions of clarithromycin SR, and 6.4% of prescriptions of clarithromycin IR, were prescribed at inappropriate dosing intervals. Surprisingly, disconcordance between diagnoses and indications was observed in all prescriptions of clarithromycin SR which has not been approved for treating H pylori infection although off-label use for this purpose was reported in literature. On the contrary, only one prescription (0.9%) of clarithromycin IR was prescribed for unapproved indication (i.e. gastro-oesophageal reflux disease). 1.4% of prescriptions for chronic gastritis or peptic ulcer treatment were irrational in that clarithromycin was not co-prescribed with gastric acid inhibitors. Clinical significant CYP3A based drug interactions with clarithromycin were identified.

CONCLUSION: There is a great scope to improve the quality of clarithromycin prescribing in patients with gastrointestinal disease, especially with regard to administration schedule, concordance between indications and diagnoses and management of drug interactions.

Keywords: Clarithromycin, Drug utilization, Prescriptions, Helicobacter pylori, Gastrointestinal diseases, Drug administration schedule, drug interactions, Polypharmacy