Community-Acquired InfectionsAs with previous studies, this retrospective study also showed no difference in failure rates between azithromycin and clarithromycin, although clarithromycin therapy cost twice as much as azithromycin canadian therapy. We could attribute no difference in failure rates to the small number of prescriptions assessed; 465 azithromycin prescriptions and 168 clarith-romycin prescriptions were evaluated.

Unfortunately, because of the limited amount of information extractable from a managed care database, we were unable to determine the cause of treatment failure. Failure rates could be attributed to any of the following:

  • antibiotic resistance.
  • lack of sufficient duration of treatment.
  • inappropriate drug selection.
  • nonadherence to regimens as a result of ADEs.

Another limitation of this study was the definition of therapeutic failure as 21 days, which was an arbitrary number. No published studies have defined the number of days to assess a failure rate. Prescriptions are usually intended to be taken for seven to 14 days, and we therefore estimated how long a patient might be able to tolerate an infection before receiving a new antibiotic prescription. Twenty-eight days might have been a long time for this, whereas 14 days might not be sufficient to detect a failure rate.

A major limitation of this study was the fact that the indications for all of the antibiotics were unknown. Some patients might have been prescribed an antibiotic for a viral or a parasitic infection.

Even though this study had many limitations, we noted a marked difference in costs between the two drugs. It is possible that this difference might be attributable to the duration of clarithromycin generic therapy, even though the average wholesale price (AWP) for a unit of clarithromycin is less expensive than the AWP for a unit.


The cost of health care, including prescription medications, has steadily increased over the years in the U.S. As health care professionals, we should aim to minimize costs while offering optimal therapy to our patients. Some possible strategies for reducing the costs of excessive antibiotic prescriptions might include:

  • prescribing antimicrobials only for suspected bacterial infections.
  • providing prescriptions only after an office visit.
  • taking a specimen culture after unsuccessful therapy with two antimicrobial agents.

This approach can help to reduce health care costs while minimizing antibiotic resistance.