II. Indications
- Conditions
- Community Acquired Pneumonia
- Limit to suspected Mycoplasma pneumonia or Legionella pneumonia
- Macrolide resistant Pneumococcus is common
- Consider Doxycycline as alternative
- Streptococcal Pharyngitis
- Macrolides are only indicated in significant allergy to beta-lactams
- Non-tuberculous Mycobacterial infections
- Helicobacter infections
- Community Acquired Pneumonia
- Activity
- Macrolide resistance is increasing
- Resistance to one Macrolide is resistance to all
- Spectrum includes organisms covered by Erythromycin
- Streptococcus Pneumoniae (Pneumococcus)
- Staphylococcus Aureus
- Toxoplasmosis gondii
- Mycobacterium leprae
- Mycobacterium Avium Complex
- Borrelia Burgdorferi
- Macrolide resistance is increasing
III. Medications
- Tablets: 250 and 500 mg
- Suspension: 125 and 250 mg/5 ml
IV. Dosing
- See Pertussis
- May take with or without food
-
General
- Adult: 250 to 500 mg orally twice daily
- Child: 7.5 mg/kg orally twice daily
-
Group A Streptococcal Pharyngitis (second line agent in beta lactam allergy)
- Adult: Take 250 mg orally twice daily for 10 days
- Child: 7.5 mg orally twice daily for 10 days
-
Acute Exacerbation of Chronic Bronchitis
- Adult: Take 250 mg orally twice daily for 7 to 14 days
-
Mycobacterium Avium Complex Disease (e.g. AIDS)
- Adult: 500 mg orally twice daily
- Active disease is treated with at least 2 drugs
-
Renal Dosing
- eGFR 30 to 60 ml/min: Decrease dose by 50%
- eGFR <30 ml/min: Decrease dose by 75%
V. Pharmacokinetics
- Half Life: 5 hours
VI. Adverse Effects
- See Macrolide
- Dysgeusia or Distorted Taste (20%)
- Calcium Channel Blocker Drug Interaction (see below)
- Myasthenia Gravis (risk of exacerbation)
-
QT Prolongation
- Appears to be a class effect of Macrolides, but seen more with Azithromycin
- Higher risk with known QTc Prolongation, Hypokalemia, Hypomagnesemia, Class IA or III Antiarrhythmics
- Increased cardiovascular deaths
- Observation in some studies as of 2018, but needs confirmation
- Inghammer (2017) Am J Epidemiol +PMID:29155931 [PubMed]
- Svanström (2014) BMJ 349:g4930 +PMID:25139799 [PubMed]
VII. Safety
- Considered safe in Lactation
- Pregnancy Category C
- Clarithromycin is considered a potential Teratogen (Cleft Lip association)
- Macrolides in general may increase heart defects with first trimester exposure of 5-7 days
- Fan (2020) BMJ 368: m331 +PMID:32075790 [PubMed]
VIII. Drug Interactions
- Clarithromycin is a strong CYP3A4 inhibitor
- Includes Calcium Channel Blockers as below
- Numerous interactions including Carbamazepine, Quetiapine, Simvastatin
- Toxicity risks with Ergotamines and Colchicine
-
Warfarin
- May increase INR
-
Calcium Channel Blockers
- Clarithromycin increases Calcium Channel Blocker levels via CYP3A4 inhibition
- Highest risk with Dihydropyridine Calcium Channel Blockers (Nifedipine, Felodipine)
- Highest risk in age over 65 years old
- Provokes Hypotension and Bradycardia
- Risk of Acute Kidney Injury (often requiring hospitalization)
- Number needed to harm: 1 in 465 for over age 65 years
- References
IX. Resources
- Clarithromycin Tablet (DailyMed)
Images: Related links to external sites (from Bing)
Related Studies
clarithromycin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
CLARITHROMYCIN 125 MG/5 ML SUS | Generic | $0.86 per ml |
CLARITHROMYCIN 250 MG TABLET | Generic | $0.47 each |
CLARITHROMYCIN 250 MG/5 ML SUS | Generic | $1.43 per ml |
CLARITHROMYCIN 500 MG TABLET | Generic | $0.41 each |
CLARITHROMYCIN ER 500 MG TAB | Generic | $4.32 each |
Ontology: Clarithromycin (C0055856)
Definition (NCI_NCI-GLOSS) | An antibiotic drug used to treat infection. It belongs to the family of drugs called macrolides. |
Definition (NCI) | A semisynthetic 14-membered ring macrolide antibiotic. Clarithromycin binds to the 50S ribosomal subunit and inhibits RNA-dependent protein synthesis in susceptible organisms. Clarithromycin has been shown to eradicate gastric MALT (mucosa-associated lymphoid tissue) lymphomas, presumably due to the eradication of tumorigenic Helicobacter pylori infection. This agent also acts as a biological response modulator, possibly inhibiting angiogenesis and tumor growth through alterations in growth factor expression. (NCI04) |
Definition (MSH) | A semisynthetic macrolide antibiotic derived from ERYTHROMYCIN that is active against a variety of microorganisms. It can inhibit PROTEIN SYNTHESIS in BACTERIA by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. |
Definition (CSP) | semi-synthetic macrolide antibiotic; derivative of erythromycin. |
Definition (PDQ) | A semisynthetic 14-membered ring macrolide antibiotic. Clarithromycin binds to the 50S ribosomal subunit and inhibits RNA-dependent protein synthesis in susceptible organisms. Clarithromycin has been shown to eradicate gastric MALT (mucosa-associated lymphoid tissue) lymphomas, presumably due to the eradication of tumorigenic Helicobacter pylori infection. This agent also acts as a biological response modulator, possibly inhibiting angiogenesis and tumor growth through alterations in growth factor expression. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42308&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42308&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1054" NCI Thesaurus) |
Concepts | Antibiotic (T195) , Organic Chemical (T109) |
MSH | D017291 |
SnomedCT | 387487009, 83999008 |
LNC | LP15406-9, MTHU006897 |
English | 6-O-Methylerythromycin, Clarithromycin, Erythromycin, 6-O-methyl-, clarithromycin, clarithromycin (medication), CLARITHROMYCIN, Clarithromycin [Chemical/Ingredient], Clarithromycin (product), Clarithromycin (substance), CLARITH |
Swedish | Klaritromycin |
Finnish | Klatritromysiini |
Russian | KLARITROMITSIN, КЛАРИТРОМИЦИН |
Japanese | クラリスロマイシン |
Italian | 6-O-Metileritromicina, Claritromicina |
Polish | Klarytromycyna |
Czech | klarithromycin, clarithromycin, klaritromycin |
Spanish | 6-O-metileritromicina, claritromicina (producto), claritromicina (sustancia), claritromicina, Claritromicina |
French | Clarithromycine |
German | Clarithromycin |
Portuguese | Claritromicina |
Ontology: Biaxin (C0701281)
Concepts | Antibiotic (T195) , Organic Chemical (T109) |
MSH | D017291 |
English | biaxin, Biaxin |