Clarithromycin: Difference between revisions

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==General==
==General==
*Type:  
*Type: [[Is DrugClass::Macrolide]]
*Dosage Forms:
*Dosage Forms: 250, 500, 500ER; 125, 250/5ml
*Common Trade Names:  
*Common Trade Names: Biaxin, Biaxin XL


==Adult Dosing==
==Adult Dosing==
===Infections, bacterial===
*250-500mg PO q12h x 7-14d
*Alt: 1000mg ER PO QD x 7-14d
===Indications by Disease===
{{#ask: [[Has DrugName::Clarithromycin]] [[Has Population::Adult]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Pediatric Dosing==
==Pediatric Dosing==
===Infections, bacteria===
*> 6 months: 15mg/kg/day PO divided q12h, max 1000mg/day
===Indications by Disease===
{{#ask: [[Has DrugName::Clarithromycin]] [[Has Population::Pediatric]]
|?Treats disease=Disease
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Special Populations==
==Special Populations==
*Pregnancy:
*Pregnancy: C (risk cannot be ruled out)
*Lactation:
*Lactation: safety unknown
*Renal Dosing
*Renal Dosing
**Adult
**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
**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
*Hepatic Dosing
**Adult
**Adult: no adjustment
**Pediatric
**Pediatric: no adjustment


==Contraindications==
==Contraindications==
*Allergy to class/drug
*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
*caution with digoxin co-administration


==Adverse Reactions==
==Adverse Reactions==
===Serious===
===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===
===Common===
*diarrhea
*nausea and vomiting
*taste changes
*abdominal pain
*dyspepsia
*headache
*rash


==Pharmacology==
==Pharmacology==
*Half-life:  
*Half-life: 3-4 hours (increased with dosage increase)<ref>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]</ref>
*Metabolism:  
*Metabolism: hepatic (rapid first-pass metabolism), CYP3A4
*Excretion:  
*Excretion: renal
*Mechanism of Action:
*Mechanism of Action: interferes with bacterial protein synthesis by binding to a component of the 50S subunit
 
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''Group'''
| align="center" style="background:#f0f0f0;"|'''Organism'''
| align="center" style="background:#f0f0f0;"|'''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===
{{Template:Antibacterial Spectra Key}}


==See Also==
==See Also==
*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
 
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 11:07, 20 March 2026

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




Indications by Disease

DiseaseDoseContext
COPD exacerbation1000mg ER PO q24 x 7d (with food, do not cut/crush/chew); Alt: 250-500mg PO q12h x 7-14dChronic bronchitis, acute bacterial exacerbation
Endocarditis500mg (15mg/kg) PODental Procedure Prophylaxis
Helicobacter pyloritriple treatment: 500mg PO q12hr x 7-14d; dual treatment: 500mg PO q8h x 14d (give with Omeprazole 40mg QD x 14d)H. pylori infection
Infectious tenosynovitis500mg PO twice dailyMycobacteria
Mycobacterium avium complex500mg PO q12hPrimary prophylaxis
Mycobacterium avium complex500mg PO q12h (use with ethambutol)Treatment, disseminated
Mycobacterium avium complex500mg PO q12h (use with ethambutol)Secondary prophylaxis
Pertussis500mg BID x7 daysAdults
Pneumonia (main)500 mg BID or clarithromycin ER 1,000 mg dailyOutpatient, Healthy
Pneumonia (main)500 mg BID OR clarithromycin ER 1,000 mg dailyOutpatient, Unhealthy
Pneumonia (main)500 mg BIDInpatient, CAP Non-ICU
Streptococcal pharyngitis7.5 mg/kg/dose PO BID (maximum = 250 mg/dose) x 10 daysPenicillin Allergy (anaphylaxis)

Pediatric Dosing

Infections, bacteria

  • > 6 months: 15mg/kg/day PO divided q12h, max 1000mg/day





Indications by Disease

DiseaseDoseContext
Acute otitis media7.5mg/kg PO BID x 10 daysPenicillin Allergy
Helicobacter pylori20mg/kg/day PO divided BID x 7-14d; max 1000mg/dayH. pylori infection
Mycobacterium avium complex20mo-12yrs: 15mg/kg/day PO divided q12h (max 500mg/dose); >13yrs: 500mg PO q12hPrimary prophylaxis, HIV
Mycobacterium avium complex20mo-12yrs: 15-30mg/kg/day PO divided q12h (max 500mg/dose, use with ethambutol); >13yrs: 500mg PO q12h (use with ethambutol)Treatment, disseminated
Mycobacterium avium complex20mo-12yrs: 15mg/kg/day PO divided q12h (max 500mg/dose, use with ethambutol); >13yrs: 500mg PO q12h (use with ethambutol)Secondary prophylaxis, HIV
Pertussis>6 months: 7.5mg/kg PO BID x 7 days (max 500mg/dose)>1 month old
Pharyngitis>6mo: 15mg/kg/day PO divided q12h x 7-10dPharyngitis/tonsillitis, streptococcal
Streptococcal pharyngitis7.5mg/kg PO BID x 10 days (max 250mg/dose)Pediatric PCN Allergy (severe)

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
  • caution with digoxin co-administration

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
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