Clarithromycin
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, acute 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 PO 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
- all uses with out ritonavir or atazanavir
- 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
- all uses without ritonavir or atazanavir
- Adult
- 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]
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