The effectiveness of long-term chemotherapy using Erythromycin (EM) for chronic lower airway infection has been practically proved. However, there still exist some ineffective cases, or cases in which the clinical effect was scarcely seen. In the present study was administered Clarithromycin (CAM) to such cases and found that CAM was effective in alleviating symptoms in some of them. The results were presented along with clinical findings and other basic studies. The subjects were 4 cases in which EM was either ineffective or low in its clinical effect. The subjects consisted of 1 case of DPB and 3 cases of bronchiectasis. EM was clinically ineffective in 2 cases and slightly effective in the two others. The pathogen was Pseudomonas aeruginosa in all cases. The dosage of EM was 200-1200 mg/day. The period of administration ranged from 2 years to 6 years 9 months. CAM was given orally after meals at a dose of either 200 or 400 mg/day. Chemotherapy had continued for 3-8 months at the time of final observation (Feb. 1992). Clinical effectiveness was evaluated on the basis of sputum volume and PaO2 examination, as well as evaluation by the patients themselves. As a result, in all 4 cases, reduction in sputum volume and improvement of PaO2 were observed. All subjects evaluated CAM therapy as being more effective than EM therapy. Moreover, it was found that CAM inhibited both the elastase and leucocidin produced in one of the ineffective cases by P. aeruginosa, whereas EM didnt.(ABSTRACT TRUNCATED AT 250 WORDS)