Spectrum: Local Antimicrobial Stewardship, for Billings Clinic

Clarithromycin

C. diff Risk

Medium

Oral Bioavailability

Moderate

Approximate Cost

Spectrum Of Activity

General Spectrum of Activity

Spectrum Of Activity

General Spectrum of Activity

Antibiogram Data

Dosing

Renal

Adult

500mg PO BID

General Information

Common Usage

Common Usage

  • CAP (use Azithromycin instead)

  • Pertussis (use Azithromycin instead)

  • H. pylorI and mycobacterial infections

Drug Monitoring

Drug Monitoring

Monitor QTc in patients with increased risk

Adverse Effects

Adverse Effects

  • Neutropenia

  • GI upset

  • Prolongation of QTc interval

  • Drug interactions

Major Interactions

Major Interactions

Recommend review of patient medications due to high frequency of significant interactions

  •  CYP450 interactions ++ (inhibits 3A4 and PGP)

  • Other QTc prolonging agents

  • Statins - increased rhabdo

  • CCBs - hypotension, AKI

  • Colchicine - increased bone marrow toxicity

  • Increased anticonvulsant levels

  • Increased tacrolimus levels

Additional Information

Additional Information

Very high tissue penetration and concentration intracellularly.

Offers little advantage over Azithromycin for common infections such as pneumonia and pertussis. May consider Clarithromycin in MAC.

Clarithromycin used for H. pylori infections.

Pharmacology

Pharmacology

Antimicrobial class: Macrolide

Pregnancy category: C

Average serum half life: 5 hours

Biliary penetration: Therapeutic

CSF penetration: Poor

Lung penetration: Therapeutic

Urine penetration: Poor