Clarithromycin

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Generic Name of Clarithromycin - Learn More

Clarithromycin

Clarithromycin Precaution - What You Need to Know

Before starting treatment with Clarithromycin, it is crucial for patients to consult with their healthcare provider to ensure the medication is appropriate for their condition. Key precautions include:

- Liver and Kidney Disorders: Clarithromycin is metabolized in the liver and excreted through the kidneys. Patients with liver or kidney disease may require dosage adjustments or close monitoring, as these conditions can affect drug clearance and increase the risk of side effects.
- QT Prolongation: Clarithromycin may prolong the QT interval, increasing the risk of arrhythmias, especially in patients with a history of heart disease, electrolyte imbalances, or those on other medications that affect the heart’s rhythm. Regular heart monitoring may be recommended for these individuals.
- Pregnancy and Breastfeeding: Clarithromycin is generally considered a Category C drug during pregnancy, meaning it should only be used if the potential benefits outweigh the risks. It should be avoided in the first trimester. Clarithromycin is excreted in breast milk, so caution should be exercised when administering to breastfeeding mothers.
- Drug Interactions: Clarithromycin interacts with a variety of other drugs, including anticoagulants, certain antiarrhythmic drugs, and other medications that impact liver enzymes (e.g., cytochrome P450). Patients should inform their healthcare provider about all medications they are taking to avoid harmful interactions.
- Allergic Reactions: Individuals with a history of hypersensitivity to macrolide antibiotics, including clarithromycin, should not use this drug. Symptoms like skin rash, swelling, or difficulty breathing should be reported immediately.

Clarithromycin Indication - Uses and Benefits

Clarithromycin is an antibiotic belonging to the macrolide class and is primarily used to treat bacterial infections. Its indications include:

- Respiratory Infections: Clarithromycin is used to treat bacterial infections of the upper and lower respiratory tract, such as pneumonia, bronchitis, and sinusitis. It is effective against a wide range of bacterial pathogens.
- Skin and Soft Tissue Infections: Clarithromycin is also prescribed to treat skin infections caused by susceptible bacteria, including cellulitis and impetigo.
- Helicobacter pylori Eradication: Clarithromycin is used in combination with other medications to treat Helicobacter pylori infections, which are associated with peptic ulcers.
- Chlamydia Infections: It is used to treat infections caused by Chlamydia trachomatis, including sexually transmitted infections.
- Mycobacterium Avium Complex (MAC) Infection: Clarithromycin is used to treat MAC infections in immunocompromised individuals, particularly those with HIV/AIDS.

Clarithromycin Contraindications - Important Warnings

Clarithromycin is contraindicated in certain situations due to the potential risks it poses to patients:

- Hypersensitivity: Clarithromycin should not be used in patients who are allergic to clarithromycin, other macrolide antibiotics, or any of the components of the medication.
- Liver Disease: Severe hepatic impairment is a contraindication for clarithromycin use because it is metabolized in the liver, and impaired liver function may result in drug accumulation and increased risk of side effects.
- Concurrent Use with Certain Medications: Clarithromycin should not be combined with certain medications, including cisapride, pimozide, ergotamine, or dihydroergotamine, due to the risk of serious cardiac side effects such as arrhythmias. It also should not be used with certain drugs that significantly affect the cytochrome P450 enzyme system, such as some antifungals (e.g., ketoconazole).
- QT Prolongation or Arrhythmias: Patients with known QT prolongation, ventricular arrhythmias, or a history of heart rhythm problems should avoid clarithromycin due to the risk of exacerbating these conditions.

Clarithromycin Side Effects - What to Expect

Clarithromycin, like all medications, can cause side effects, ranging from mild to severe. Common side effects include:

- Gastrointestinal Issues: Nausea, vomiting, diarrhea, abdominal pain, and dyspepsia (indigestion) are among the most frequent side effects, typically occurring in the first few days of treatment.
- Taste Disturbance: Some individuals report a metallic or bitter taste, particularly with higher doses or prolonged use.
- Liver Effects: Liver enzyme elevations are possible and may indicate hepatotoxicity. Jaundice, dark urine, or unexplained fatigue should be reported to a healthcare provider immediately.
- Skin Rash: Allergic reactions may present as a rash, itching, or swelling, particularly in individuals with a hypersensitivity to macrolides. Severe allergic reactions, including anaphylaxis, though rare, can occur and require immediate medical attention.
- QT Prolongation: Clarithromycin can cause QT interval prolongation, leading to arrhythmias. Symptoms of an arrhythmia may include palpitations, dizziness, or fainting.
- Hearing Loss: High doses or prolonged use of clarithromycin may lead to reversible hearing loss or tinnitus in some patients, particularly those with preexisting hearing conditions or kidney dysfunction.
- Superinfection: Prolonged use of clarithromycin can lead to the overgrowth of non-susceptible organisms, including fungi, leading to superinfections.

Serious side effects that require medical attention include severe gastrointestinal symptoms, skin reactions, signs of liver damage, or signs of an allergic reaction like difficulty breathing or swelling of the throat.

Clarithromycin Pregnancy Category ID - Safety Information

3

Clarithromycin Mode of Action - How It Works

Clarithromycin works by inhibiting bacterial protein synthesis, which leads to the death of susceptible bacteria. It binds to the 50S subunit of the bacterial ribosome, preventing the formation of proteins essential for bacterial growth and survival. This mechanism is bacteriostatic, meaning that clarithromycin stops the bacteria from multiplying, but the immune system also helps to eliminate the bacteria.

- Bacteriostatic Action: Clarithromycin inhibits the growth of bacteria by interfering with the bacterial ribosome, making it effective against both Gram-positive and some Gram-negative bacteria.
- Broad-Spectrum Activity: It is effective against a wide variety of pathogens, including *Streptococcus pneumoniae*, *Haemophilus influenzae*, *Mycobacterium avium*, and *Chlamydia trachomatis*.

By preventing protein synthesis, clarithromycin disrupts bacterial reproduction, giving the body's immune system a chance to clear the infection.

Clarithromycin Drug Interactions - What to Avoid

Clarithromycin interacts with a range of drugs, which can affect its efficacy or increase the risk of side effects:

- Cytochrome P450 Interactions: Clarithromycin inhibits cytochrome P450 3A4, a liver enzyme involved in metabolizing many drugs. As a result, it can increase the blood levels of medications metabolized by this enzyme, such as statins (e.g., simvastatin), warfarin, and some benzodiazepines (e.g., midazolam).
- Anticoagulants: The combination of clarithromycin with warfarin or other anticoagulants increases the risk of bleeding due to enhanced anticoagulant effects. Regular monitoring of coagulation parameters is recommended.
- Antihistamines: Combining clarithromycin with certain antihistamines (e.g., terfenadine or astemizole) can lead to life-threatening arrhythmias, as both drugs can prolong the QT interval.
- HIV Medications: Clarithromycin may interact with antiretroviral drugs, including protease inhibitors, leading to increased blood levels of either the antibiotic or the HIV medication. Dose adjustments may be required.
- Antifungal Agents: Certain antifungal drugs, such as ketoconazole or itraconazole, can increase the levels of clarithromycin in the blood, leading to a higher risk of side effects.

Patients should inform their healthcare provider of all current medications, including over-the-counter drugs, herbal supplements, and vitamins, to prevent interactions.

Clarithromycin Adult Dose - Recommended Dosage

The typical adult dosage of clarithromycin varies depending on the infection being treated:

- Upper Respiratory Tract Infections (e.g., sinusitis, pharyngitis): 250-500 mg twice daily for 7-14 days.
- Lower Respiratory Tract Infections (e.g., pneumonia): 500 mg twice daily for 7-14 days.
- Skin and Soft Tissue Infections: 250-500 mg twice daily for 7-14 days.
- Helicobacter pylori Eradication: When used in combination with other medications, the usual dose is 500 mg twice daily for 10-14 days.
- Mycobacterium Avium Complex (MAC) Infection: The usual dose is 500 mg twice daily.

The dose may be adjusted based on the severity of the infection and the patient’s response to treatment.

Clarithromycin Child Dose - Dosage for Children

Clarithromycin can be used in children, but the dose is based on weight and the type of infection being treated:

- Children (6 months to 12 years): The typical dose is 7.5 mg/kg twice daily, up to a maximum of 500 mg per dose.
- Helicobacter pylori Eradication: The dose is typically 7.5 mg/kg twice daily, up to a maximum of 500 mg per dose, depending on the age and weight of the child.

Dosing adjustments may be necessary for children with renal impairment. Always consult with a healthcare provider for proper dosing.

Clarithromycin Renal Dose - Dosage for Kidney Conditions

In patients with renal impairment, the dose of clarithromycin may need to be reduced to prevent accumulation of the drug in the body. The typical adjustment is:

- Creatinine Clearance 30-60 mL/min: Reduce the dose by 50%. This means 250 mg twice daily.
- Creatinine Clearance <30 mL/min: Clarithromycin should be used with caution, and the dose may need to be reduced further or avoided depending on the severity of renal impairment.

In patients with severe renal impairment or end-stage renal disease, an alternative antibiotic may be considered, as clarithromycin can accumulate to harmful levels.