Clarithromycin

C difficile risk
Medium
Oral Bioavailability
Moderate

Dosing

CrCl >30Clarithromycin: 500mg PO q12h Clarithromycin XL: 1000mg PO q24h

CrCl >30CrCl <30Clarithromycin: 500mg PO q12h Clarithromycin XL: 1000mg PO q24h Clarithromycin or Clarithromycin XL: 500 mg PO q24h

Clarithromycin or Clarithromycin XL: 500 mg PO q24h

Administer dose after dialysis on dialysis days

General Information

  • Pertussis

  • Nontuberculous mycobacteria (NTM) : prophylaxis (advanced HIV infection) and treatment (in combination with other agents)

  • Bartonella infections

  • Legionella infections

  • H. pylori (in combination)

Alternative:

  • Bacterial COPD exacerbation

  • Acute otitis media

  • Mild – moderate community acquired pneumonia

  • Pharyngitis

Monitor QTc in patients with increased risk

  • Prolongation of QTc interval

  • Cytopenias

  • GI upset

  • Drug interactions

  • Increased liver enzymes

  • Metallic taste

Recommend review of patient medications due to high frequency of significant interactions

  •  CYP450 interactions ++

  • Other QTc prolonging agents

  • Statins - increased rhabdo

  • CCBs - hypotension, AKI

  • Colchicine - increased bone marrow toxicity

  • Increased anticonvulsant levels

  • Increased tacrolimus levels

Antimicrobial class: Macrolide

Pregnancy category: C

Average serum half life: 5 hours

Urine penetration: Poor

Lung penetration: Therapeutic

CSF penetration: Poor

Biliary penetration: Therapeutic

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