Clarithromycin

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General

  • Type: macrolide
  • Dosage Forms: 250, 500, 500ER; 125, 250/5ml
  • Common Trade Names: Biaxin, Biaxin XL

Adult Dosing

  • infections, bacterial
    • 250-500mg PO q12h x 7-14d
    • Alt: 1000mg ER PO QD x 7-14d
  • chronic bronchitis, actue bacterial exacerbation
    • 1000mg ER PO q24 x 7d (with food, do not cut/crush/chew)
    • Alt: 250-500mg PO q12h x 7-14d
  • pharyngitis/tonsillitis, streptococcal
    • 250mg PO q12h x 10d
  • MAC primary prophylaxis
    • 500mg PO q12h
  • MAC secondary prophylaxis, HIV
    • 500mg q12h (use with ethambutol)
  • MAC treatment, disseminated
    • 500mg PO q12h (use with ethambutol)
  • H. pylori infection
    • triple treatment: 500mg PO q12hr x 7-14d
    • dual treatment: 500mg PO q8h x 14d (give with Omeprazole 40mg QD x 14d)
  • endocarditis prophylaxis, dental
    • 500mg PO x1 (30-60min before procedure)

Pediatric Dosing

  • infections, bacteria
    • > 6 months: 15mg/kg/day PO divided q12h, max 1000mg/day
  • otitis media, acute
    • 2mo-5yrs: 15mg/kg/day PO divided q12h x 10d
    • 6-12yrs: 15mg/kg/day PO divided q12 x 5-10d
  • pharyngitis/tonsillitis, streptococcal
    • >6mo: 15mg/kg/day PO divided q12h x 7-10d
  • MAC primary prophylaxis, HIV patients
    • 20mo-12yrs: 15mg/kg/day PO divided q12h; max 500mg/dose
    • >13yrs: 500mg PO q12h
  • MAC secondary prophylaxis, HIV patients
    • 20mo-12yrs: 15mg/kg/day PO divided q12h; max 500mg/dose (use with ethambutol)
    • >13yrs: 500mg PO q12h (use with ethambutol)
  • MAC treatments
    • 20mo-12yrs: 15-30mg/kg/day PO divided q12h; max 500mg/dose (use with ethambutol)
    • >13yrs: 500mg PO q12h (use with ethambutol)
  • endocarditis prophylaxis, dental
    • 15mg/kg PO x1; max 500mg (30-60min before procedure)
  • H. pylori infection
    • 20mg/kg/day PO divided BID x 7-14d; max 1000mg/day

Special Populations

  • Pregnancy: C (risk cannot be ruled out)
  • Lactation: safety unknown
  • Renal Dosing
    • Adult
      • all uses with out ritonavir or atazanavir
        • GFR < 30: decrease dose 50% or give IR form q24h or ER form q48h
        • HD/PD: no supplement
      • concomitant ritonavir or atazanavir
        • GFR 30-60: decrease dose 50%
        • GFR < 30: decrease dose 75%
        • HD/PD: no supplement
    • Pediatric
      • all uses without ritonavir or atazanavir
        • GFR < 30: decrease dose 50% or give q24h
        • HD/PD: no supplement
      • concomitant ritonavir or atazanavir
        • not defined
  • Hepatic Dosing
    • Adult: no adjustment
    • Pediatric: no adjustment

Contraindications

  • Allergy to class/drug
  • Liver disease
  • Renal disease
  • prolonged QT
  • ventricular arrythmias or history of
  • history of torsades de pointes
  • uncorrected electrolyte abnormalities
  • significant bradycardia
  • caution if recent MI
  • caution if CHF
  • caution in female and elderly
  • caution in myasthenia gravis

Adverse Reactions

Serious

  • superinfection
  • C-difficile-associated diarrhea
  • hepatotoxicity
  • interstitial nephritis
  • pancreatitis
  • QT prolongation
  • ventricular arrhythmias
  • torsades de pointes
  • thrombocytopenia
  • leukopenia
  • neutropenia
  • hearing loss, reversible
  • seizures
  • behavioral disturbances
  • psychosis
  • hallucinations
  • psychiatric disturbance
  • anaphylaxis
  • erythema multiforme
  • Stevens-Johnson Syndrome
  • drug rash with eosinophilia and systemic sx
  • myasthenia gravis exacerbation
  • rhabdomyolysis

Common

  • diarrhea
  • nausea and vomiting
  • taste changes
  • abdominal pain
  • dyspepsia
  • headache
  • rash

Pharmacology

  • Half-life: 3-4 hours (increased with dosage increase)[1]
  • Metabolism: hepatic (rapid first-pass metabolism), CYP3A4
  • Excretion: renal
  • Mechanism of Action: interferes with bacterial protein synthesis by binding to a component of the 50S subunit

Antibiotic Sensitivities[2]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G I
Strep. Pneumoniae I
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA I
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes S
Gram Negatives N. gonorrhoeae I
N. meningitidis X1
Moraxella catarrhalis S
H. influenzae S
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp R
Shigella sp R
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica R
Francisella tularensis X1
Brucella sp. R
Legionella sp. S
Pasteurella multocida X1
Haemophilus ducreyi X1
Vibrio vulnificus X1
Misc Chlamydophila sp S
Mycoplasm pneumoniae S
Rickettsia sp X1
Mycobacterium avium S
Anaerobes Actinomyces S
Bacteroides fragilis R
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) S
Fusobacterium necrophorum R
Peptostreptococcus sp. I

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. Ferrero JL, Bopp BA, Marsh KC, et al. Metabolism and Disposition of Clarithromycin in Man. Drug Metab Dispos. 1990;18(4):441–446. [PubMed 1976065]
  2. Sanford Guide to Antimicrobial Therapy 2014