Infectious Disease Compendium

Clarithromycin (Biaxin®)

Dosing

CrCl Formula

CrCl > 80: 250 - 500 mg q 12 h po.

CrCl 80-50: 250 - 500 mg q 12 h po.

CrCl 50-10: 250 - 500 mg q 24 h po.

CrCl < 10: 250 - 500 mg q 24 h po.

Hemodialysis: 250 - 500 mg q 24 h po.

Peritoneal dialysis: 250 - 500 mg q 24 h po.

Important side effects

Clarithromycin for acute exacerbations of chronic obstructive pulmonary disease or community acquired pneumonia may be associated with increased cardiovascular events (PubMed). "... clarithromycin was associated with an increased risk of myocardial infarction, arrhythmia, and cardiac mortality short term but no association with long term cardiovascular risks among the Hong Kong population." (PubMed)

Important drug interactions

When gven to patients on calcium-channel blockers increased risk for hypotension or shock requiring hospitalization; not an issue with azithromycin.

Alprazolam, antipsychotics, astemizole, atazanavir, atorvastatin, bepridil, bromocriptine, carbamazepine, chloral hydrate, chloroquine, cilostazol, cisapride, class i antiarrhythmic agents, class ia antiarrhythmic agents, class iii antiarrhythmic agents, colchicine, conjugated estrogens, cotrimoxazole, cyclosporine, delavirdine, diazepam, digoxin, disopyramide, dolasetron, droperidol, efavirenz, eletriptan, enflurane, ergot derivatives, erlotinib, erythromycin, erythromycin/sulfisoxazole, esterified estrogens, estradiol, estriol, estrone, estropipate, eszopiclone, fentanyl, fluconazole, fluoxetine, foscarnet, gemifloxacin, halofantrine, halothane, hexobarbital, imatinib, isoflurane, isradipine, itraconazole, lansoprazole, levomethadyl, lidoflazine, lovastatin, mefloquin, mesoridazine, methylprednisolone, midazolam, nevirapine, octreotide, pentamadine, phenothiazines, phenytoin, pimozide, prednisone, probucol, quinidine, rifabutin, rifapentine, ritonavir, saquinavir, sildenafil, simvastatin, spiramycin, sulfamethoxazole, tacrolimus, telithromycin, terfenadine, theophylline, thioridazine, tolterodine, triazolam, tricyclic antidepressants, trimethoprim, valproic acid, vasopressin, venlafaxine, verapamil, warfarin, zidovudine, ziprasidone, zolmitriptan.

Rants and Screeds

Pearls

Treatment of choice

Use for

Anthrax, Bacillary angiomatosis, Borrelia burgdorferi infections, Bronchitis, Cat scratch fever, Cellulitis, cryptosporidiosis, Endocarditis prophylaxis, erythrasma, Helicobacter pylori, Haemophilus, Legionella, Mediterranean Spotted Fever, Moraxella catarrhalis, Mycobacterium, Mycoplasm pneumoniae, Otitis media, Pertussis, Pharyngitis, Pneumonia, Sinusitis, Streptococci (all) infections, Toxoplasma encephalitis, Ureaplasma urealyticum.

Don't use for

Class

Macrolide.