clarithromycin

(klar ith' ro my sin)

Biaxin, Biaxin XL

Pregnancy Category B

Drug class
Macrolide antibiotic

Therapeutic actions
Inhibits protein synthesis in susceptible bacteria, causing cell death.

Indications
• Treatment of upper respiratory infections caused by S. pyogenes, S. pneumoniae
• Treatment of lower respiratory infections caused by Mycoplasma pneumoniae, S.
pneumoniae, H. influenzae, M. catarrhalis
• Treatment of skin and skin-structure infections caused by S. aureus, S. pyogenes
• Treatment of disseminated mycobacterial infections due to M. avium and M.
intracellular
• Treatment of active duodenal ulcer with H. pylori in combination with proton
pump inhibitor
• Treatment of acute otitis media, acute maxillary sinusitis due to H. influenzae, M.
cararrhalis, S. pneumoniae
• ER tablets: Treatment of mild to moderate community-acquired pneumonia in
adults

Contraindications and cautions

• Contraindicated with hypersensitivity to clarithromycin, erythromycin, or any
macrolide antibiotic.
• Use cautiously with colitis, hepatic or renal impairment, pregnancy, lactation.

Available forms
Tablets—250, 500 mg; granules for suspension—125, 250 mg/5 mL; ER tablets–500 mg

Dosages
ADULTS
• Pharyngitis, tonsillitis; pneumonia due to S. pneumoniae, M. pneumoniae; skin or
skin-structure infections; lower respiratory infections due to S. pneumoniae, M.
catarrhalis: 250 mg PO q 12 hr for 7–14 days.
• Acute maxillary sinusitis, lower respiratory infection caused by H. influenzae:
500 mg PO q 12 hr for 7–14 days.
• Mycobacterial infections: 500 mg PO bid.
• Treatment of duodenal ulcers: 500 mg PO tid plus omeprazole 40 mg PO q AM
for 14 days, then omeprazole 20 mg PO q morning for 14 days.
 • Treatment of community acquired pneunomia: 500 mg/day PO of ER tablet for 7
days.
PEDIATRIC PATIENTS
Usual dosage, 15 mg/kg/day PO q 12 hr for 10 days.
• Mycobacterial infections: 7.5 mg/kg PO bid.
GERIATRIC PATIENTS OR PATIENTS WITH IMPAIRED RENAL FUNCTION
Decrease dosage or prolong dosing intervals as appropriate.

Pharmacokinetics
Route Onset Peak
Oral Varies 2 hr

Metabolism: Hepatic; T1/2: 3–7 hr

Distribution: Crosses placenta; enters breast milk
Excretion: Urine

Adverse effects
• CNS: Dizziness, headache, vertigo, somnolence, fatigue
• GI: Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena,
pseudomembranous colitis
• Other: Superinfections, increased PT, decreased WBC

Interactions
Drug-drug
• Increased serum levels and effects of carbamazepine, theophylline, lovastatin,
phenytoin
Drug-food
• Food decreases the rate of absorption of clarithromycin but does not alter
effectiveness
• Decreased metabolism and risk of toxic effects if combined with grapefruit juice;
avoid this combination.

Nursing considerations
Assessment
• History: Hypersensitivity to clarithromycin, erythromycin, or any macrolide
antibiotic; pseudomembranous colitis, hepatic or renal impairment, lactation,
pregnancy
• Physical: Site of infection; skin color, lesions; orientation, GI output, bowel
sounds, liver evaluation; culture and sensitivity tests of infection, urinalysis, liver
and renal function tests

Interventions
• Culture infection before therapy.
• Do not cut or crush, and ensure that patient does not chew ER tablets.
• Monitor patient for anticipated response.
• Administer without regard to meals; administer with food if GI effects occur.
Teaching points
• Take drug with food if GI effects occur. Take the full course of therapy. Do not
drink grapefruit juice while taking this drug.
• Shake suspension before use; do not refrigerate; do not cut, crush, or chew ER
tablets; swallow whole.
• These side effects may occur: Stomach cramping, discomfort, diarrhea; fatigue,
headache (medication may be ordered); additional infections in the mouth or
vagina (consult with care provider for treatment).
• Report severe or watery diarrhea, severe nausea or vomiting, rash or itching,
mouth sores, vaginal sores.

Adverse effects in Italic are most common; those in Bold are life-threatening.