Clarithromycin

C. diff Risk

Medium

Oral Bioavailability

Excellent

Approximate Cost

$1/day

Dosing

General Pediatric

15 mg/kg/24h PO divided q12h
Maximum: 1 g/24h

Renal

Renally cleared, requires dosage adjustment with changes in renal function. Consult a pharmacist for renal dosing.

General Information

Common Usage

Second line for community aquired pneumonia (drug of choice if atypical), URTI, H. pylori, and mycobacterial infections

Drug Monitoring

Monitor QTc in patients with increased risk

Adverse Effects

  • GI upset, diarrhea

  • Rash

  • Prolongation of QTc interval

Major Interactions

Substrate of CYP3A4. Multiple CYP450 interactions possible - consult a pharmacist for more detail. May increase digoxin, carbamazepine level. Caution with QTc prolonging medications

Pharmacology

Antimicrobial class: Macrolide

Route of Elimination: Urine (20-40% as unchanged drug, additional 10%-15% as active metabolite); feces (29% to 40% mostly as metabolites)

Average serum half life: Adult: Clarithromycin: 3-7 hours
14-OH-clarithromycin (active metabolite): 5-9 hours