Clarithromycin for Safe and Cost-Effective Reduction of Cyclosporine Doses in Lung Allograft Recipients

Background. This study was done to analyze the economic effect of clarithromycin on the daily dosing of cyclosporine in lung transplantation. Methods. Nine consecutive patients (mean age ± SEM, 34.6 ± 5.2 years) had transplantation from June 1995 to June 1996. Median follow-up time was 649 days (range, 431 to 799 days). Preoperative diagnoses were cystic fibrosis (n = 4), idiopathic pulmonary fibrosis (n = 2), emphysema, bronchiectasis, and obliterative bronchiolitis. Median time from transplantation to addition of clarithromycin to a standard immunosuppressive regimen was 86 days (range, 14 to 181 days). Results. Baseline cyclosporine dose (9.9 ± 2.2 mg/kg/day) was reduced to 5.8 ± 1.0 mg/kg/day and 4.1 ± 0.8 mg/kg/day at 1 month and 1 year, respectively, after initiation of clarithromycin therapy. Estimated annual savings were $3,400 per patient. There was no increase in infection or rejection episodes. Conclusions. Clarithromycin safely reduced the dose and cost of cyclosporine in this series.