Formulary
Clarithromycin: Indications, Dosing, Side Effects and Interactions
Clarithromycin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 17 min read
Clarithromycin: Indications, Dosing, Side Effects and Interactions
Clarithromycin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Mild diabetic foot infection**
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 7 days then review.
**Leg ulcer infection**
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 7 days.
**Cellulitis,Erysipelas**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250-500 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Adult** (By Intravenous Infusion): 500 mg every 12 hours.
**Impetigo,Secondary bacterial infection of eczema**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250 mg twice daily for 5-7 days, alternatively 500 mg twice daily for 5-7 days, increased dose used in severe infections.
- **Adult** (By Mouth Using Immediate-Release Medicines): 250 mg twice daily for 5-7 days, alternatively 500 mg twice daily for 5-7 days, increased dose used in severe infections.
**Community-acquired pneumonia**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250-500 mg twice daily for 5 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 5 days.
- **Adult** (By Intravenous Infusion): 500 mg every 12 hours.
**Hospital-acquired pneumonia**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 500 mg twice daily for 5 days then review.
**Respiratory-tract infections,Mild to moderate skin and soft-tissue infections**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250 mg twice daily usually for 7-14 days, alternatively 500 mg twice daily usually for 7-14 days, increased dose used if required in severe infections.
- **Adult** (By Mouth Using Immediate-Release Medicines): 250 mg twice daily usually for 7-14 days, alternatively 500 mg twice daily usually for 7-14 days, increased dose used if required in severe infections.
- **Child** (By Mouth Using Modified-Release Medicines): 12-17 years 500 mg once daily usually for 7-14 days, alternatively 1 g once daily usually for 7-14 days, increased dose used if required in severe infections.
- **Adult** (By Mouth Using Modified-Release Medicines): 500 mg once daily usually for 7-14 days, alternatively 1 g once daily usually for 7-14 days, increased dose used if required in severe infections.
- **Adult** (By Intravenous Infusion): 500 mg every 12 hours maximum duration 5 days, switch to oral route when appropriate, to be administered into a large proximal vein.
**Acute exacerbation of chronic obstructive pulmonary disease**
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 5 days.
- **Adult** (By Intravenous Infusion): 500 mg every 12 hours, to be administered into a large proximal vein.
**Acute exacerbation of bronchiectasis**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250-500 mg twice daily for 7-14 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 7-14 days.
**Acute cough [if systemically very unwell or at higher risk of complications],Acute sore throat**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250-500 mg twice daily for 5 days (10 days for scarlet fever).
- **Adult** (By Mouth Using Immediate-Release Medicines): 250-500 mg twice daily for 5 days.
**Prevention of secondary case of invasive group A streptococcal infection**
- **Neonate** (By Mouth Using Immediate-Release Medicines): 7.5 mg/kg twice daily for 10 days.
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250-500 mg twice daily for 10 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 250-500 mg twice daily for 10 days.
**Acute otitis media**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250-500 mg twice daily for 5-7 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 250 mg twice daily usually for 7-14 days, alternatively 500 mg twice daily usually for 7-14 days, increased dose used if required in severe infections.
- **Adult** (By Intravenous Infusion): 500 mg every 12 hours maximum duration 5 days, switch to oral route when appropriate, to be administered into a large proximal vein.
**Mild diphtheria [confirmed or probable]**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 500 mg twice daily for 14 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 14 days.
**Prevention of secondary case of diphtheria**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 500 mg twice daily for 7 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 7 days.
**Prevention of pertussis**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 500 mg twice daily for 7 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 7 days.
**Helicobacter pylorieradication [in combination with other drugs]**
- **Adult** (By Mouth Using Immediate-Release Medicines): Helicobacter pylori eradication [in combination with other drugs] 500 mg twice daily for 7 days for first- and second-line eradication therapy; 10 days for third-line eradication therapy.
**Acute sinusitis**
- **Child** (By Mouth Using Immediate-Release Medicines): 12-17 years 250 mg twice daily for 5 days, alternatively 500 mg twice daily for 5 days.
- **Adult** (By Mouth Using Immediate-Release Medicines): 500 mg twice daily for 5 days.
**Cellulitis, Erysipelas for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Child 12-17 years** (By mouth using immediate-release medicines): 250-500 mg twice daily for 5-7 days then review (review after 7 days if infection near the eyes or nose).
- **Child 1 month-11 years** (By intravenous infusion): 7.5 mg/kg every 12 hours (max. per dose 500 mg).
- **Child 12-17 years** (By intravenous infusion): 500 mg every 12 hours.
**Impetigo, Secondary bacterial infection of eczema for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5-7 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250 mg twice daily for 5-7 days, alternatively 500 mg twice daily for 5-7 days, increased dose used in severe infections.
**Community-acquired pneumonia for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250-500 mg twice daily for 5 days.
- **Child 1 month-11 years** (By intravenous infusion): 7.5 mg/kg every 12 hours (max. per dose 500 mg).
- **Child 12-17 years** (By intravenous infusion): 500 mg every 12 hours.
**Hospital-acquired pneumonia for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5 days then review.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5 days then review.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5 days then review.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5 days then review.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5 days then review.
- **Child 12-17 years** (By mouth using immediate-release medicines): 500 mg twice daily for 5 days then review.
**Respiratory-tract infections, Mild to moderate skin and soft-tissue infections for clarithromycin**
- **Neonate** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily.
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250 mg twice daily usually for 7-14 days, alternatively 500 mg twice daily usually for 7-14 days, increased dose used if required in severe infections.
- **Child 12-17 years** (By mouth using modified-release medicines): 500 mg once daily usually for 7-14 days, alternatively 1 g once daily usually for 7-14 days, increased dose used if required in severe infections.
- **Child 1 month-11 years** (By intravenous infusion): 7.5 mg/kg every 12 hours (max. per dose 500 mg) maximum duration 5 days, switch to oral route when appropriate, to be administered into a large proximal vein.
- **Child 12-17 years** (By intravenous infusion): 500 mg every 12 hours maximum duration 5 days, switch to oral route when appropriate, to be administered into a large proximal vein.
**Acute exacerbation of bronchiectasis for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 7-14 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 7-14 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 7-14 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 7-14 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 7-14 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250-500 mg twice daily for 7-14 days.
**Acute cough [if systemically very unwell or at higher risk of complications], Acute sore throat for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5 days (10 days for scarlet fever).
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5 days (10 days for scarlet fever).
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5 days (10 days for scarlet fever).
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5 days (10 days for scarlet fever).
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5 days (10 days for scarlet fever).
- **Child 12-17 years** (By mouth using immediate-release medicines): 250-500 mg twice daily for 5 days (10 days for scarlet fever).
**Prevention of secondary case of invasive group A streptococcal infection for clarithromycin**
- **Neonate** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 10 days.
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 10 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 10 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 10 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 10 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 10 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250-500 mg twice daily for 10 days.
**Acute otitis media for clarithromycin**
- **Neonate** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily.
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5-7 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5-7 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250-500 mg twice daily for 5-7 days.
- **Child 1 month-11 years** (By intravenous infusion): 7.5 mg/kg every 12 hours (max. per dose 500 mg) maximum duration 5 days, switch to oral route when appropriate, to be administered into a large proximal vein.
- **Child 12-17 years** (By intravenous infusion): 500 mg every 12 hours maximum duration 5 days, switch to oral route when appropriate, to be administered into a large proximal vein.
**Mild diphtheria [confirmed or probable] for clarithromycin**
- **Child 1 month-11 years** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily (max. per dose 500 mg) for 14 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 500 mg twice daily for 14 days.
**Prevention of secondary case of diphtheria for clarithromycin**
- **Child 1 month-11 years** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily (max. per dose 500 mg) for 7 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 500 mg twice daily for 7 days.
**Prevention of pertussis for clarithromycin**
- **Neonate** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 7 days.
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 7 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 7 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 7 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 7 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 7 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 500 mg twice daily for 7 days.
**Helicobacter pylori eradication in combination with omeprazole, and amoxicillin or metronidazole for clarithromycin**
- **Child 1-5 years** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily.
- **Child 6-11 years** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily (max. per dose 500 mg).
- **Child 12-17 years** (By mouth using immediate-release medicines): 500 mg twice daily.
**Acute sinusitis for clarithromycin**
- **Child 1 month-11 years (body-weight up to 8 kg)** (By mouth using immediate-release medicines): 7.5 mg/kg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 8-11 kg)** (By mouth using immediate-release medicines): 62.5 mg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 12-19 kg)** (By mouth using immediate-release medicines): 125 mg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 20-29 kg)** (By mouth using immediate-release medicines): 187.5 mg twice daily for 5 days.
- **Child 1 month-11 years (body-weight 30-40 kg)** (By mouth using immediate-release medicines): 250 mg twice daily for 5 days.
- **Child 12-17 years** (By mouth using immediate-release medicines): 250 mg twice daily for 5 days, alternatively 500 mg twice daily for 5 days.
Cautions
With intravenous use Electrolyte disturbances (predisposition to QT interval prolongation); may aggravate myasthenia gravis; predisposition to QT interval prolongation With oral use Electrolyte disturbances (predisposition to QT interval prolongation); may aggravate myasthenia gravis; predisposition to QT interval prolongation
Side effects
Common or very common Appetite decreased; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; headache; hearing impairment; insomnia; nausea; pancreatitis; paraesthesia; skin reactions; taste altered; vasodilation; vision disorders; vomiting Uncommon Angioedema; anxiety; arrhythmias; candida infection; chest pain; constipation; drowsiness; eosinophilia; hepatic disorders; leucopenia; neutropenia; palpitations; QT interval prolongation; severe cutaneous adverse reactions (SCARs); tinnitus; vertigo Rare or very rare Infantile hypertrophic pyloric stenosis (in children); myasthenia gravis; nephritis tubulointerstitial; pseudomembranous enterocolitis Frequency not known Clostridioides difficile colitis; hallucination; hypotension; seizure; smell altered; thrombocytopenia; tongue discolouration Side-effects For clarithromycin General side-effects: Uncommon Burping; dry mouth; haemorrhage; muscle complaints; oral disorders; thrombocytosis; tremor Frequency not known Abnormal dreams; agranulocytosis; depersonalisation; depression; mania; myopathy; psychotic disorder; renal failure; tooth discolouration; urine discolouration Specific side-effects: Uncommon With oral use Increased risk of infection With parenteral use Cardiac arrest; dyskinesia; loss of consciousness; pulmonary embolism Frequency not known With oral use Disorientation
Interactions
**Severe interactions:**
- Steady state concentrations of the active metabolite 14-OH-clarithromycin were not significantly affected by concomitant administration of fluconazole.
- Theophylline, carbamazepine Results of clinical studies indicate that there was a modest but statistically significant (p 0.05) increase of circulating theophylline or carbamazepine levels when...
- Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias.
- Clarithromycin should be used with caution in patients receiving these medicines known to prolong the QT interval due to the potential to induce cardiac arrhythmia and serious adverse cardiovascular...
**Other interactions (89):**
- Similar effects have been observed in patients taking clarithromycin and pimozide concomitantly (see section 4.3).
- In one study in 14 healthy volunteers, the concomitant administration of clarithromycin and terfenadine resulted in a two to three fold increase in the serum level of the acid metabolite of...
- Ergot alkaloids: Post-marketing reports indicate that co-administration of clarithromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by...
- Oral midazolam When midazolam was co-administered together with clarithromycin tablets (500 mg twice per day), the AUC of midazolam increased 7-fold following the administration of oral midazolam.
- Reports of rhabdomyolysis have been received for patients taking clarithromycin concomitantly with these statins.
- If treatment with clarithromycin cannot be avoided, therapy with lovastatin or simvastatin must be suspended during the course of treatment.
Pregnancy
Manufacturer advises avoid, particularly in the first trimester, unless potential benefit outweighs risk.
Breast feeding
Manufacturer advises avoid unless potential benefit outweighs risk-present in milk.
Hepatic impairment
Manufacturer advises caution; avoid in severe failure if renal impairment also present.
Renal impairment
Avoid if severe hepatic impairment also present. M For modified-release preparations, avoid if creatinine clearance less than 30 mL/minute. M Dose adjustments For immediate-release preparations, use half normal dose if creatinine clearance less than 30 mL/minute, max. duration 14 days. M For modified-release preparations, use half normal dose if creatinine clearance 30-60 mL/minute. M See Prescribing in renal impairment .
Medicinal forms
Tablet,Tablet,Suspension,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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