Pregnancy Risk Category C
How supplied
Tablets (film-coated): 250 mg, 500 mg
Suspension: 125 mg/5 ml, 250 mg/5 ml
Action
Binds to the 50S subunit of bacterial ribosomes, blocking protein synthesis; bacteriostatic or bactericidal, depending on concentration.
Indications & dosage
Pharyngitis or tonsillitis due to Streptococcus pyogenes--
Adults: 250 mg P.O. q 12 hours for 10 days.
Children: 15 mg/kg/day P.O. in divided doses q 12 hours for 10 days.
Acute maxillary sinusitis due to S. pneumoniae, Haemophilus influenzae, or Moraxella (Branhamella) catarrhalis--
Adults: 500 mg P.O. q 12 hours for 14 days.
Children: 15 mg/kg/day P.O. in divided doses q 12 hours for 10 days.
Acute exacerbations of chronic bronchitis due to M. catarrhalis or S. pneumoniae; pneumonia due to S. pneumoniae, Chlamydia pneumoniae, or Mycoplasma pneumoniae--
Adults: 250 mg P.O. q 12 hours for 7 to 14 days.
Acute exacerbations of chronic bronchitis due to H. influenzae--
Adults: 500 mg P.O. q 12 hours for 7 to 14 days.
Uncomplicated skin and skin-structure infections due to Staphylococcus aureus or S. pyogenes--
Adults: 250 mg P.O. q 12 hours for 7 to 14 days.
Children: 15 mg/kg/day P.O. in divided doses q 12 hours for 10 days.
Acute otitis media caused by H. influenzae, M. catarrhalis, or S. pneumoniae--
Children: 7.5 mg/kg P.O. q 12 hours for 10 days.
Mycobacterium avium complex (MAC) disease in patients with HIV infection--
Adults: 500 mg P.O. q 12 hours, with other antimycobacterial drugs, for life.
Children: 7.5 mg/kg P.O. (maximum of 500 mg) q 12 hours, with other antimycobacterial drugs, for life.
Prophylaxis against MAC disease in patients with advanced HIV infection--
Adults: 500 mg P.O. q 12 hours.
Children: 7.5 mg/kg P.O. (maximum of 500 mg) q 12 hours.
Active duodenal ulcer associated with Helicobacter pylori infection--
Adults: 500 mg P.O. t.i.d. for 14 days with omeprazole 40 mg P.O. each morning. Omeprazole therapy should continue at a dose of 20 mg P.O. each morning for days 15 to 28. Or, 500 mg P.O. t.i.d. for 14 days with ranitidine bismuth citrate 400 mg P.O. b.i.d. Ranitidine bismuth citrate therapy continues for days 15 to 28. Or, 500 mg P.O. b.i.d. plus lansoprazole 30 mg P.O. b.i.d. and amoxicillin 1 g P.O. b.i.d. for 14 days.
Dental prophylaxis in patients allergic to penicillin--
Adults: 500 mg P.O. 1 hour before procedure.
Children: 15 mg/kg P.O. 1 hour before procedure.
Adverse reactions
CNS: headache.
CV: ventricular arrhythmias.
GI: diarrhea, nausea, abnormal taste, dyspepsia, abdominal pain or discomfort, pseudomembranous colitis.
GU: increased BUN.
Hematologic: increased INR, leukopenia, thrombocytopenia.
Hepatic: elevated liver studies.
Skin: rash, Stevens-Johnson syndrome, urticaria.
Interactions
Drug-drug. Pimozide: altered metabolism of these drugs, with prolongation of QT interval and ventricular tachycardia. Don't use these drugs with clarithromycin.
Carbamazepine: may increase serum levels of carbamazepine. Monitor blood levels.
Digoxin: may increase serum digoxin levels. Monitor for digitalis toxicity.
Fluconazole: increased clarithromycin levels. Monitor closely.
Theophylline: increased plasma theophylline levels possible with other macrolides; effect of clarithromycin is unknown. Monitor theophylline levels carefully.
Warfarin: increased INR possible with other macrolides; effect of clarithromycin is unknown. Monitor INR carefully.
Zidovudine: decreased zidovudine levels. Monitor effectiveness of zidovudine closely.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to erythromycin or other macrolides and in those receiving cisapride, and pimozide.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING