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
===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==
==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==
==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 16:34, 18 July 2025

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
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