Clarithromycin

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Clarithromycin Brand Name– Biaxin | Biaxin XL

What is Clarithromycin

Clarithromycin is an oral macrolide antibiotic similar to erythromycin and azithromycin.

Like azithromycin, clarithromycin penetrates lung tissue and macrophages to a greater degree than does erythromycin.

This may partially explain why clarithromycin is effective against Mycobacterium avium complex (MAC), an indication for which it was approved in December 1993. Although clarithromycin is effective against MAC when used as a single agent, clarithromycin-resistant organisms can appear.

Clarithromycin is commonly used in infections of the respiratory tract, sexually transmitted infections, otitis media, and infections in AIDS patients.

Clarithromycin also has been used to treat gastrointestinal Helicobacter pylori infection and is recommended as part of several triple-drug therapy regimens which include another antimicrobial agent and acid-suppressive therapy.

Clarithromycin was originally approved by the FDA in October 1991. It has subsequently been approved for treatment of H. pylori-associated duodenal ulcer and for the prevention and treatment of MAC in patients with advanced AIDS.

In 1996, clarithromycin was approved for the treatment of community-acquired pneumonia in children. In 2000, an extended-release formulation was approved; it is effective for sinusitis, chronic bronchitis, and was approved for the treatment of mild-to-moderate community-acquired pneumonia in 2001.

Clarithromycin is also being studied for preventing heart disease, however, its efficacy is unclear. The CLARICOR study reported a significant increase in mortality in clarithromycin-treated (500 mg PO qd for 14 days) patients over placebo; the difference was observed after one year or longer of follow-up. Clinical trials of other antibiotics and clarithromycin did not report a statistically significant effect on mortality.

The exact mechanism of this increase in mortality is unknown; as of December 2005, the FDA is not recommending any specific changes to clarithromycin therapy.

Indications

  1. Bacillus anthracis
  2. bartonellosis
  3. Bordetella pertussis
  4. Borrelia burgdorferi
  5. bronchitis
  6. Campylobacter jejuni
  7. Chlamydophila pneumoniae
  8. Clostridium perfringens
  9. community-acquired pneumonia
  10. Corynebacterium sp.
  11. Cryptosporidium parvum
  12. endocarditis prophylaxis
  13. Gardnerella vaginalis
  14. Haemophilus influenzae (beta-lactamase negative)
  15. Haemophilus influenzae (beta-lactamase positive)
  16. Haemophilus parainfluenzae
  17. Helicobacter pylori
  18. Helicobacter pylori (H. pylori) eradication
  19. Legionella pneumophila
  20. Listeria monocytogenes
  21. Moraxella catarrhalis
  22. Mycobacterium avium
  23. Mycobacterium avium complex (MAC) prophylaxis
  24. Mycobacterium avium complex infection
  25. Mycobacterium chelonae
  26. Mycobacterium fortuitum
  27. Mycobacterium intracellulare
  28. Mycobacterium kansasii
  29. Mycobacterium leprae
  30. Mycobacterium marinum
  31. Mycoplasma pneumoniae
  32. otitis media
  33. Pasteurella multocida
  34. Peptococcus sp.
  35. Peptostreptococcus sp.
  36. pertussis (whooping cough)
  37. pertussis prophylaxis
  38. pharyngitis
  39. pneumonia
  40. Prevotella melaninogenica
  41. Propionibacterium acnes
  42. rheumatic fever prophylaxis
  43. sinusitis
  44. skin and skin structure infections
  45. Staphylococcus aureus (MSSA)
  46. Streptococcus agalactiae (group B streptococci)
  47. Streptococcus pneumoniae
  48. Streptococcus pyogenes (group A beta-hemolytic streptococci)
  49. Streptococcus sp.
  50. tonsillitis
  51. Toxoplasma gondii
  52. Ureaplasma urealyticum
  53. Viridans streptococci

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. acute generalized exanthematous pustulosis (AGEP)
  4. agranulocytosis
  5. anaphylactoid reactions
  6. angioedema
  7. anorexia
  8. anxiety
  9. asthenia
  10. atrial fibrillation
  11. bleeding
  12. candidiasis
  13. cardiac arrest
  14. chest pain (unspecified)
  15. chills
  16. cholestasis
  17. confusion
  18. constipation
  19. depression
  20. diarrhea
  21. dizziness
  22. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  23. dysgeusia
  24. dyskinesia
  25. dyspepsia
  26. elevated hepatic enzymes
  27. eosinophilia
  28. epistaxis
  29. eructation
  30. esophagitis
  31. fatigue
  32. fever
  33. flatulence
  34. gastritis
  35. gastroesophageal reflux
  36. glossitis
  37. hallucinations
  38. headache
  39. hearing loss
  40. hepatic failure
  41. hepatitis
  42. hyperbilirubinemia
  43. hyperhidrosis
  44. hypoglycemia
  45. infection
  46. insomnia
  47. interstitial nephritis
  48. jaundice
  49. leukopenia
  50. maculopapular rash
  51. malaise
  52. mania
  53. myalgia
  54. myasthenia
  55. myopathy
  56. nausea
  57. neutropenia
  58. nightmares
  59. palpitations
  60. pancreatitis
  61. paresthesias
  62. parosmia
  63. pruritus
  64. pseudomembranous colitis
  65. psychosis
  66. pulmonary embolism
  67. purpura
  68. QT prolongation
  69. rash
  70. renal failure (unspecified)
  71. rhabdomyolysis
  72. seizures
  73. Stevens-Johnson syndrome
  74. stomatitis
  75. thrombocytopenia
  76. tinnitus
  77. tongue discoloration
  78. tooth discoloration
  79. torsade de pointes
  80. toxic epidermal necrolysis
  81. tremor
  82. urine discoloration
  83. urticaria
  84. ventricular tachycardia
  85. vertigo
  86. vomiting
  87. xerostomia

Monitoring Parameters

  • ECG
  • LFTs

Contraindications

  • apheresis
  • AV block
  • bradycardia
  • breast-feeding
  • cardiomyopathy
  • celiac disease
  • children
  • colitis
  • colostomy
  • diarrhea
  • females
  • fever
  • geriatric
  • GI disease
  • heart failure
  • hepatic disease
  • hepatitis
  • human immunodeficiency virus (HIV) infection
  • hyperparathyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypothermia
  • hypothyroidism
  • ileostomy
  • infants
  • inflammatory bowel disease
  • jaundice
  • laboratory test interference
  • long QT syndrome
  • macrolide hypersensitivity
  • mortality
  • myasthenia gravis
  • myocardial infarction
  • neonates
  • pheochromocytoma
  • pregnancy
  • pseudomembranous colitis
  • QT prolongation
  • renal failure
  • renal impairment
  • reproductive risk
  • rheumatoid arthritis
  • sickle cell disease
  • sleep deprivation
  • stroke
  • systemic lupus erythematosus (SLE)
  • torsade de pointes
  • ulcerative colitis
  • ventricular arrhythmias
  • viral infection

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