Clarithromycin

C difficile risk
Medium
Oral Bioavailability
Excellent
Cost
$1/day

Dosing

Defined criteria for use and/or important safety considerations. See below for more information.

500 mg PO q12h

CrCl > 30 mL/minCrCl < 30 mL/minNo renal adjustment required500 mg PO q24h

500 mg PO q24h

  • Give dose after dialysis on HD days

No data, consider 500 mg PO q24h

No Data

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

  • Increasing resistance to S. pneumoniae.

  • Should not be used as monotherapy in individuals with nontuberculous mycobacteria

Monitor QTc in patients with increased risk

  • Prolongation of QTc interval

  • Cytopenias

  • GI upset

  • Drug interactions

  • Increased liver enzymes

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

FDA: caution regarding clarithromycin in patients with heart disease because of a potential increased risk of heart problems or death that can occur years later

Antimicrobial class: Macrolide

Pregnancy category: C

Average serum half life: 5 hours

Biliary penetration: Therapeutic

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Poor

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