Clarithromycin

C. diff Risk

Medium

Oral Bioavailability

Moderate

Approximate Cost

$

Dosing

Adult

500mg PO BID

Renal

Dose adjust for CrCl < 30

General Information

Common Usage

  • CAP

  • Pertussis

  • URTI

  • H. pylori

  • Mycobacterial infections

Drug Monitoring

Laboratory

  • Consider periodic LFTs with prolonged use

  • Baseline Cr (dose-adjustment assessment)

Clinical

  • Hypersensitivity

  • GI effects

  • Drug interactions

  • QT prolongation with risk factors

Adverse Effects

  • GI effects

  • Cholestatic jaundice

  • QT prolongation

  • Allergic reaction

Major Interactions

  • CYP interactions

  • Other QTc prolonging agents

  • Recommend review of pt medications due to high frequency of significant interactions

  • Statins - increased rhabdo

  • CCBs - hypotension, AKI

  • Colchicine - increased bone marrow toxicity

  • Increased anticonvulsant levels

  • Increased tacrolimus levels

Additional Information

Very high tissue penetration and concentration intracellularly means in vivo activity may not be predicted by in vitro testing

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