Adult Dosing
Pharyngitis/tonsillitis
- 250 mg PO bid x 10 days (Biaxin tab)
Acute maxillary sinusitis
- 500 mg PO bid x 14 days (Biaxin tab)
- 2 x 500 mg PO qd x 14 days (Biaxin XL tab)
Acute exacerbation of chronic bronchitis
- 250-500 mg PO bid x 7-14 days (Biaxin tab)
- 2 x 500 mg PO qd x 7 days (Biaxin XL tab)
Community-acquired pneumonia
- 250 mg PO bid x 7-14 days (Biaxin tab)
- 2 x 500 mg PO qd x 7 days (Biaxin XL tab)
Uncomplicated skin and skin structure infections
- 250 mg PO bid x 7-14 days (Biaxin tab)
Prophylaxis and treatment of disseminated infection due to Mycobacterium avium complex
H. pylori eradication to reduce risk of duodenal ulcer recurrence
Triple therapy (clarithromycin/lansoprazole/amoxicillin)
- Clarithromycin 500 mg plus lansoprazole 30 mg plus amoxicillin 1 g bid for 10-14 days
Triple therapy (clarithromycin/omeprazole/amoxicillin)
- Clarithromycin 500 mg plus omeprazole 20 mg plus amoxicillin 1 g bid for 10 days
Dual therapy (clarithromycin/omeprazole)
- Clarithromycin 500 mg PO tid and omeprazole 40 mg qd (qam) for 14 days; additional omeprazole 20 mg qd for 14 days is recommended for ulcer healing and symptom relief
Dual therapy (clarithromycin/ranitidine bismuth citrate)
- Clarithromycin 500 mg PO bid-tid and ranitidine bismuth citrate 400 mg PO bid for 14 days; additional ranitidine bismuth citrate 400 mg PO bid for 14 days for ulcer healing and symptom relief
Bronchiectasis [Not FDA Approved]
Note: Contraindicated in patients with CrCl <25 mL/min
Pediatric Dosing
Mild to moderate infections caused by susceptible strains of microorganisms
- Safety and effectiveness in pediatric patients <6 month of age have not been established
- Children >6 mo: 7.5 mg/kg PO bid x 10 days
Prophylaxis and treatment of disseminated infections due to Mycobacterium avium complex
- Safety in MAC pediatric patients <20 month of age have not been studied
- 7.5 mg/kg PO bid [Max: 500 mg]
Pharyngitis (Acute)[Non-FDA Approved]
- 15 mg/kg/day PO divided bid [Max 500 mg/day]
Pediatrics Pneumonia [Non-FDA Approved]
- Children >6 months of age: 15 mg/kg/day PO bid; Max: 500 mg bid
[Outline]
Renal Dose Adjustment (Based on CrCl)
- Severe renal impairment (<30 mL/min): Give half of normal dose or double the dosing interval
Hepatic Dose Adjustment
- Hepatic impairment: No dose adjustments
See Supplemental Patient Information
- The safety and efficacy of clarithromycin extended-release tablets in treating other infections, for which other formulations of clarithromycin are approved, have not been established
- Avoid use in pregnant women except in clinical circumstance where alternate therapy is not there. If pregnancy occurs during therapy, patient should be cautioned about the potential hazard to fetus
- Clarithromycin has shown adverse effects of pregnancy outcome and/or embryo-fetal development in monkeys, rats, mice, and rabbits at doses that produced plasma levels 2-17 times the serum levels achieved in humans treated at the maximum recommended human doses
- Severe hepatic dysfunction including elevated liver enzymes, and hepatocellular/holestatic hepatitis, with or without jaundice may occur with clarithromycin. Hepatic failure with fatal outcome has been reported and is usually associated with serious underlying diseases or concomitant medications. Discontinue clarithromycin immediately if hepatitis occurs
- QT interval prolongation, arrhythmia, and torsades de pointes have been reported during postmarketing settings in patients receiving clarithromycin. Avoid clarithromycin in patients with ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia and in patients receiving Class IA or Class III antiarrhythmic agents. Elderly patients may be more sensitive to drug-associated effects on the QT interval
- Serious adverse events such as colchicine toxicity, rhabdomyolysis, and hypotension, may occur in patients receiving clarithromycin concomitantly with CYP3A4 substrates
- Clostridium difficile associated diarrhea (CDAD) ranging in severity from mild diarrhea to fatal colitis may occur; it alters the normal flora of the colon leading to overgrowth of C.difficile
- C.difficile produces toxins A and B which contribute to CDAD. Hypertoxin producing strains may cause increased morbidity and mortality since these infections can be refractory to antibiotic therapy and may require colectomy. Careful medical history is necessary since CDAD may occur >2 months after administration of the drug
- Discontinue the therapy immediately and initiate appropriate treatment if severe acute hypersensitivity reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, Henoch-Schonlein purpura, drug rash with eosinophilia and systemic symptoms occur
- Significant hypoglycemia may occur with oral hypoglycemic agents and insulin; careful monitoring of glucose is recommended
- If CDAD is suspected/confirmed, discontinue the treatment and provide fluid, electrolyte, and protein supplementation along with antibiotics for C. difficile and institute surgical evaluation as clinically indicated
- Prescribing antibiotics in the absence of proven or strongly suspected bacterial infection or a prophylactic indication increases the risk of development of drug-resistant bacteria
- Do not co-administer ranitidine bismuth citrate with clarithromycin in patients with CrCl <25 mL/min or in patients with a history of acute porphyria
- New onset or exacerbation of symptoms of myasthenia gravis has been reported in patients receiving clarithromycin therapy
Caution: Use cautiously in
- Severe renal impairment
- Myasthenia gravis
- QT prolongation
- Risk of QT prolongation
- Hypokalemia
- Hypomagnesemia
- Bradycardia
- Myocardial ischemia or infarction
- Cardiomyopathy
Supplemental Patient Information
- Advise patients that they may develop diarrhea during therapy but usually ends when the antibiotic is discontinued
- Advise patients to contact their physician immediately if they develop watery or bloody stools during or after therapy
Pregnancy Category:C
Breastfeeding: As clarithromycin is excreted in breastmilk in low levels and administered directly to infants, it is acceptable in nursing women. Low levels in milk are unlikely to cause adverse effects in breastfed infants. Monitor infants for diarrhea, candidiasis or colitis. Unconfirmed epidemiologic evidence indicates that maternal use of macrolide antibiotics during breastfeeding might increase the risk of hypertrophic pyloric stenosis in infants. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) last accessed 4 Jan 2011. Manufacturer recommends caution when administered in nursing mothers.
US Trade Name(s)
US Availability
clarithromycin (generic)
- TABS: 250, 500 mg
- GRAN for SUSP: 125 mg/5mL
- GRAN for SUSP: 250 mg/5mL
Biaxin
- TABS: 250 mg, 500 mg
- GRAN for SUSP: 125 mg/5mL
- GRAN for SUSP: 250 mg/5mL
Biaxin XL
Canadian Trade Name(s)
- Biaxin
- Biaxin BID
- Biaxin XL
Canadian Availability
clarithromycin (generic)
Biaxin
- SUSP: 125 mg/5mL
- SUSP: 250 mg/5mL
Biaxin BID
Biaxin XL
UK Trade Name(s)
UK Availability
clarithromycin (generic)
- TABS: 250, 500 mg
- SUSP: 125 mg/5mL
- SUSP: 250 mg/5mL
Klaricid
- TABS: 250, 500 mg
- SUSP: 125 mg/5mL
- SUSP: 250 mg/5mL
- GRAN FOR SUSPN: 250 mg/sachet
Klaricid XL
Australian Trade Name(s)
- Clarac
- Clarihexal
- Clarithro
- Kalixocin
- Klacid
Australian Availability
clarithromycin (generic)
Clarac, Clarihexal, Clarithro, Kalixocin
Klacid
- TABS: 250, 500 mg
- SUSP: 250 mg/5mL
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Clarithromycin 125 MG/5ML SUSR [Bottle] (DAVA PHARMACEUTICALS)
100 5ml = $39.99
300 5ml = $115.98 - Biaxin XL 500 MG TB24 [Bottle] (ABBOTT)
20 mg = $135
60 mg = $378.99 - Clarithromycin 250 MG TABS [Bottle] (SANDOZ)
30 mg = $148.99
90 mg = $426.99 - Clarithromycin 500 MG TB24 [Bottle] (WATSON LABS)
60 mg = $295.99
180 mg = $859.96 - Clarithromycin 125 MG/5ML SUSR [Bottle] (DAVA PHARMACEUTICALS)
50 5ml = $27.99
150 5ml = $69.97 - Biaxin 250 MG TABS [Bottle] (ABBOTT)
60 mg = $361
180 mg = $1025.97 - Biaxin 500 MG TABS [Bottle] (ABBOTT)
20 mg = $129.98
60 mg = $369.98 - Clarithromycin 500 MG TABS [Bottle] (TEVA PHARMACEUTICALS USA)
30 mg = $125.99
90 mg = $355.96 - Clarithromycin 250 MG/5ML SUSR [Bottle] (DAVA PHARMACEUTICALS)
100 5ml = $79.99
300 5ml = $225.97 - Clarithromycin 250 MG/5ML SUSR [Bottle] (DAVA PHARMACEUTICALS)
50 5ml = $42.99
150 5ml = $115.98
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
