Uses and Administration Clarithromycin is a macrolide antibiotic. It is given in the treatment of respiratory-tract infections (including otitis media) and in skin and soft-tissue infections. Clarithromycin is also used for the prophylaxis and treatment of opportunistic mycobacterial infections and has been used in the treatment of leprosy. It is used in some countries as an alternative to penicillins for prophylaxis of endocarditis. For details of all these infections and their treatment, please consult a Pharmacist near you.
Clarithromycin may be given to eradicate Helicobacter pylori in treatment regimens for peptic ulcer disease in Kenya. It has been tried in protozoal infections too, including toxoplasmosis.
Clarithromycin is given by mouth or by intravenous infusion. Usual doses in adults are 250 mg twice daily by mouth, increased to 500 mg twice daily if necessary in severe infection. Modified-release tablets allowing once-daily use are available in some countries including Kenya. A course is usually for 7 to 14 days. Children may be given 7.5 mg/kg twice daily for 5 to 10 days.
The usual intravenous dose is 500 mg twice daily, given as an intravenous infusion over 60 minutes using a solution containing about 0.2% of clarithromycin. Intravenous treatment may continue for 2 to 5 days, but should be changed to clarithromycin by mouth when possible.
For treatment and prophylaxis of disseminated infection due to Mycobacterium avium complex, clarithromycin may be given in a dose of 500 mg twice daily by mouth; for treatment, it should be given with other antimycobacterials. For leprosy, clarithromycin 500 mg daily by mouth has been given as part of an alternative multidrug therapy regimen.
For the eradication of H. pylori associated with peptic ulcer disease in Kenya, clarithromycin, usually in a dose of 500 mg twice daily, is given with another antibacterial (Preferably Amoxicillin) and either a proton pump inhibitor or a histamine H2-receptor antagonist, for 7 to 14 days e.g (Esomeprazole or Pantoprazole)
Adverse Effects and Precautions
Gastrointestinal disturbances are the most frequent adverse effect but are usually mild and less frequent with clarithromycin. Taste disturbances, stomatitis, glossitis, tooth discoloration, and headache have occurred. There have also been reports of transient CNS effects such as anxiety, dizziness, insomnia, hallucinations, and confusion; convulsions have also occurred. Other adverse effects include hypoglycaemia, leucopenia, and thrombocytopenia. Interstitial nephritis and renal failure have been reported rarely.
Intravenous administration may cause phlebitis and pain at the injection site.
Caution is required in patients with hepatic or renal impairment and doses should be reduced in those with severe renal impairment. It should not be used during pregnancy if possible as high doses have been associated with embryotoxicity in animal studies.
Single-ingredient Preparations The symbol ¬§ denotes a preparation which is discontinued or no longer actively marketed.
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