Macrolide antibiotics, erythromycin, clarithromycin and azithromycin are commonly prescribed for
upper respiratory infection, and their use has recently been further linked to immunomodulatory
effects. With the widespread and expanded use of macrolides, special attention should be paid to
their potential adverse effects. We reported two cases of end-stage renal disease (ESRD) patients
who developed hallucinations such as vivid images of worms after taking clarithromycin. Similar to
previous case reports of clarithromycin neurotoxicity, the visual hallucination resolved upon cessation
of clarithromycin. Furthermore, we discussed the pharmacokinetic properties and other toxicities
of macrolide antibiotics in patients with chronic kidney disease and ESRD.