CLARITHROMYCIN (BIAXIN)

Clarithromycin (Biaxin) is a macrolide antibiotic.

Generic Name: clarithromycin

Brand Name

• Biaxin
• Biaxin XL

Drug Class

• Macrolide antibiotic
• Pregnancy Category C

Therapeutic actions

Inhibits protein synthesis in susceptible bacteria, causing cell death.

Indications

• Treatment of URIs caused by Streptococcus pyogenes, S. pneumoniae
• Treatment of LRIs caused by Mycoplasma pneumoniae, S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis
• Treatment of skin and skin-structure infections caused by Staphylococcus aureus, S. pyogenes
• Treatment of disseminated mycobacterial infections due to Myobacterium avium and M. intracellular
• Treatment of active duodenal ulcer associated with Helicobacter pylori in combination with proton pump inhibitor
• Treatment of acute otitis media, acute maxillary sinusitis due to H. influenzae, M. cararrhalis, S. pneumoniae
• Treatment of mild to moderate community-acquired pneumonia in adults

Contraindications and Cautions

• Contraindicated with hypersensitivity to clarithromycin, erythromycin, or any macrolide antibiotic.
• Use cautiously with colitis, hepatic or renal impairment, pregnancy, lactation.

Available forms

Tablets—250, 500 mg; granules for suspension—125, 250 mg/5 mL; ER tablets–500 mg

Dosages

ADULTS

• Pharyngitis, tonsillitis; pneumonia due to S. pneumoniae, M. pneumoniae; skin or skin-structure infections; LRIs due to S. pneumoniae, M. catarrhalis: 250 mg PO q 12 hr for 7–14 days.
• Acute maxillary sinusitis, LRI caused by H. influenzae: 500 mg PO q 12 hr for 7–14 days.
• Mycobacterial infections: 500 mg PO bid.
• Treatment of duodenal ulcers: 500 mg PO tid plus omeprazole 40 mg PO q AM for 14 days, then omeprazole 20 mg PO q morning for 14 days.
• Treatment of community-acquired pneumonia: 250 mg PO q 12 hr for 7–14 days or 1,000 mg PO of ER tablet q 24 hr for 7 days.

PEDIATRIC PATIENTS

Usual dosage, 15 mg/kg/day PO q 12 hr for 10 days.

Mycobacterial infections: 7.5 mg/kg PO bid.

GERIATRIC PATIENTS OR PATIENTS WITH IMPAIRED RENAL FUNCTION

Decrease dosage or prolong dosing intervals as appropriate.

Adverse effects

• CNS: Dizziness, headache, vertigo, somnolence, fatigue
• GI: Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous colitis
• Other: Superinfections, increased PT, decreased WBC

Interactions

• Drug-drug: Increased serum levels and effects of carbamazepine, theophylline, lovastatin, phenytoin
• Drug-food: Food decreases the rate of absorption of clarithromycin but does not alter effectiveness
• Decreased metabolism and risk of toxic effects if combined with grapefruit juice; avoid this combination.

Patient Education

• Take drug with food if GI effects occur. Take the full course of therapy. Do not drink grapefruit juice while taking this drug.
• Shake suspension before use; do not refrigerate; do not cut, crush, or chew ER tablets; swallow them whole.
• You may experience these side effects: Stomach cramping, discomfort, diarrhoea; fatigue, headache (medication may be ordered); additional infections in the mouth or vagina (consult with care provider for treatment).
• Report severe or watery diarrhoea, severe nausea or vomiting, rash or itching, mouth sores, vaginal sores.