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
    • 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