Therapeutic Classification: agents for atypical mycobacterium, anti-infectives, antiulcer agents
Pharmacologic Classification: macrolides
Absorption: Rapidly absorbed (50%) after oral administration.
Distribution: Widely distributed to tissues.
Metabolism/Excretion: Primarily metabolized by the liver via the CYP3A isoenzymes; 10–15% converted by the liver to 14-hydroxyclarithromycin, which has anti-infective activity. 20–30% excreted unchanged in urine.
Half-Life: 250-mg dose: 3–4 hr; 500-mg dose: 5–7 hr.
Acute Bacterial Exacerbation of Chronic Bronchitis
- PO (Adults ): Immediate release:250–500 mg every 12 hr for 7–14 days. Extended release:1 g once daily for 7 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults ): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
Acute Maxillary Sinusitis
- PO (Adults ): Immediate release: 500 mg every 12 hr for 14 days. Extended release: 1 g once daily for 14 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults ): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
Community-Acquired Pneumonia
- PO (Adults ): Immediate release: 250 mg every 12 hr for 7–14 days. Extended release: 1 g once daily for 7 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
- PO (Children ≥6 mo): Immediate release: 7.5 mg/kg every 12 hours for 10 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults and Children ≥6 mo): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
Uncomplicated Skin/Skin Structure Infections
- PO (Adults ): Immediate release: 250 mg every 12 hr for 7–14 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
- PO (Children ≥6 mo): Immediate release: 7.5 mg/kg every 12 hours for 10 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults and Children ≥6 mo): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
Pharyngitis/Tonsillitis
- PO (Adults ): Immediate release: 250 mg every 12 hr for 10 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
- PO (Children ≥6 mo): Immediate release: 7.5 mg/kg every 12 hours for 10 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults and Children ≥6 mo): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
Acute Otitis Media
- PO (Children ≥6 mo): Immediate release: 7.5 mg/kg every 12 hours for 10 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Children ≥6 mo): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
Treatment and Prophylaxis of Disseminated Mycobacterium avium Disease
- PO (Adults ): Immediate release: 500 mg every 12 hr. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
- PO (Children ≥6 mo): Immediate release: 7.5 mg/kg every 12 hours. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults and Children ≥6 mo): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
H. pylori Infection
- PO (Adults ): Immediate release: 500 mg every 12 hr in combination with amoxicillin or metronidazole (if penicillin allergic), plus a potassium-competitive acid blocker or a high-dose proton pump inhibitor; continue regimen for 14 days. Concurrent use with atazanavir: ↓clarithromycin dose by 50%.
Renal Impairment
- PO (Adults ): CCr 30–60 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 50%. CCr <30 mL/min: ↓dose by 50%. CCr <30 mL/min AND concurrent use of atazanavir or ritonavir: ↓clarithromycin dose by 75%.
