Clarithromycin Dosage

This dosage information may not include all the information needed to use Clarithromycin safely and effectively. See additional information for Clarithromycin.

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for Tonsillitis/Pharyngitis

Due to Streptococcus pyogenes:
Immediate release: 250 mg orally every 12 hours for 10 days

Usual Adult Dose for Sinusitis

Acute maxillary sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or S pneumoniae:
Immediate release: 500 mg orally every 12 hours for 14 days
Extended release tablets: 1000 mg orally every 24 hours for 14 days

Usual Adult Dose for Bronchitis

Acute exacerbation of chronic bronchitis:
Immediate release:
Due to H influenzae: 500 mg orally every 12 hours for 7 to 14 days
Due to H parainfluenzae: 500 mg orally every 12 hours for 7 days
Due to M catarrhalis or S pneumoniae: 250 mg orally every 12 hours for 7 to 14 days

Extended release tablets:
Due to H influenzae, H parainfluenzae, M catarrhalis, or S pneumoniae: 1000 mg orally every 24 hours for 7 days

Usual Adult Dose for Pneumonia

Community-acquired pneumonia:
Immediate release:
Due to H influenzae: 250 mg orally every 12 hours for 7 days
Due to S pneumoniae or Chlamydophila pneumoniae: 250 mg orally every 12 hours for 7 to 14 days

Extended release tablets:
Due to H influenzae, H parainfluenzae, M catarrhalis, S pneumoniae, or C pneumoniae: 1000 mg orally every 24 hours for 7 days

Usual Adult Dose for Mycoplasma Pneumonia

Community-acquired pneumonia due to Mycoplasma pneumoniae:
Immediate release: 250 mg orally every 12 hours for 7 to 14 days
Extended release tablets: 1000 mg orally every 24 hours for 7 days

Usual Adult Dose for Skin and Structure Infection

Uncomplicated infections due to Staphylococcus aureus or S pyogenes:
Immediate release: 250 mg orally every 12 hours for 7 to 14 days

Usual Adult Dose for Helicobacter pylori Infection

H pylori eradication to reduce the risk of duodenal ulcer recurrence:
Immediate release:
Triple therapy:
Clarithromycin plus lansoprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 to 14 days
Clarithromycin plus omeprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 days

Dual therapy:
Clarithromycin plus omeprazole: Clarithromycin 500 mg orally every 8 hours for 14 days
Clarithromycin plus ranitidine bismuth citrate: Clarithromycin 500 mg orally every 8 to 12 hours for 14 days

Usual Adult Dose for Mycobacterium avium-intracellulare - Prophylaxis

Immediate release:
Prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection: 500 mg orally twice a day

Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Infectious Diseases Society of America (IDSA) recommendations for HIV-infected patients:
Primary prevention of disseminated MAC disease: 500 mg orally twice a day

Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to antiretroviral therapy.

Usual Adult Dose for Mycobacterium avium-intracellulare - Treatment

Immediate release:
Treatment of disseminated mycobacterial infections due to MAC: 500 mg orally twice a day

Clarithromycin should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.

Clarithromycin therapy should continue for life if clinical mycobacterial improvements are observed.

CDC, NIH, and IDSA recommendations:
Treatment of disseminated MAC infections in HIV-infected patients: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Combination therapy with at least 2 drugs is recommended. Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)

American Heart Association (AHA) recommendations for patients allergic to penicillins:
Immediate release: 500 mg orally as a single dose 30 to 60 minutes before the procedure

Usual Adult Dose for Legionella Pneumonia

(Not approved by FDA)

Legionnaires' disease:
Immediate release: 500 mg orally every 12 hours
Duration: 10 days for mild to moderate infections in immunocompetent patients; 3 weeks may be necessary to prevent relapse, especially in patients with more severe infections or with underlying comorbidity or immunodeficiency

Usual Adult Dose for Pertussis Prophylaxis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release: 500 mg orally every 12 hours for 7 days

Usual Adult Dose for Pertussis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release: 500 mg orally every 12 hours for 7 days

Usual Pediatric Dose for Tonsillitis/Pharyngitis

Due to S pyogenes:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Sinusitis

Acute maxillary sinusitis due to H influenzae, M catarrhalis, or S pneumoniae:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Pneumonia

Community-acquired pneumonia due to M pneumoniae, S pneumoniae, or C pneumoniae:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Otitis Media

Acute infections due to H influenzae, M catarrhalis, or S pneumoniae:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Skin and Structure Infection

Uncomplicated infections due to S aureus or S pyogenes:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Abscesses usually require surgical drainage.

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Prophylaxis

Immediate release:
Prevention of disseminated MAC disease in patients with advanced HIV infection:
20 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day

CDC, NIH, IDSA, and American Academy of Pediatrics (AAP) recommendations for HIV-exposed and HIV-infected infants and children:
Primary prevention of MAC infections: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day

Secondary prevention of MAC infections: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day plus ethambutol, with or without rifabutin

CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Primary prevention of disseminated MAC disease: 500 mg orally twice a day

Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to antiretroviral therapy.

Usual Pediatric Dose for Mycobacterium avium-intracellulare - Treatment

Immediate release:
Treatment of disseminated mycobacterial infections due to MAC:
20 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day

Clarithromycin should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.

Clarithromycin therapy should continue for life if clinical mycobacterial improvements are observed.

CDC, NIH, IDSA, and AAP recommendations for HIV-exposed and HIV-infected infants and children:
Treatment of MAC infections: 7.5 to 15 mg/kg (maximum: 500 mg/dose) orally twice a day plus ethambutol, with or without rifabutin

CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Treatment of disseminated MAC infections: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Combination therapy with at least 2 drugs is recommended. Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

Usual Pediatric Dose for Pertussis Prophylaxis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release:
1 to 5 months: 7.5 mg/kg orally every 12 hours for 7 days
6 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally every 12 hours for 7 days

Usual Pediatric Dose for Pertussis

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release:
1 to 5 months: 7.5 mg/kg orally every 12 hours for 7 days
6 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally every 12 hours for 7 days

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

(Not approved by FDA)

AHA recommendations for children allergic to penicillins:
Immediate release: 15 mg/kg (maximum: 500 mg) orally as a single dose 30 to 60 minutes before procedure

Renal Dose Adjustments

CrCl less than 30 mL/min: The dose should be reduced by 50%. Decreased dosage or prolonged dosing intervals may be appropriate.

Concomitant atazanavir or ritonavir:
CrCl 30 to 60 mL/min: The clarithromycin dose should be reduced by 50%.
CrCl less than 30 mL/min: The clarithromycin dose should be reduced by 75%.

Concomitant ranitidine bismuth citrate:
CrCl less than 25 mL/min: Not recommended.

Liver Dose Adjustments

No adjustment recommended.

Precautions

Clarithromycin is contraindicated in patients with a history of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin.

Clarithromycin may potentially interact with many drugs. These interactions may be serious and/or life-threatening. Patients should be advised to report all concurrent medications they are taking. Coadministration of pimozide, cisapride, and dihydroergotamine or ergotamine with clarithromycin is contraindicated. Clarithromycin, a potent CYP450 3A inhibitor, may increase plasma concentrations of drugs metabolized by this pathway. Serious cardiovascular events, including QT prolongation, torsades de pointes, ventricular tachycardia, and ventricular fibrillation have been reported during postmarketing experience in patients using cisapride or pimozide concomitantly with clarithromycin and/or erythromycin. Fatalities have been reported.

Clarithromycin has been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Cases of torsades de pointes have been reported during postmarketing experience. Fatalities have been reported. Clarithromycin is contraindicated in patients with history of QT prolongation or ventricular cardiac arrhythmia, including torsades de pointes. Clarithromycin should be avoided in patients with ongoing proarrhythmic conditions (such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia), and patients receiving Class IA or Class III antiarrhythmic agents. Elderly patients may be more susceptible to drug-induced effects on QT interval and may be more susceptible to development of torsades de pointes arrhythmia than younger patients.

Concomitant administration of clarithromycin with HMG-CoA reductase inhibitors extensively metabolized by CYP450 3A4 (lovastatin or simvastatin) is contraindicated due to increased risk of myopathy, including rhabdomyolysis. If treatment with clarithromycin cannot be avoided, therapy with lovastatin or simvastatin must be suspended during the course of treatment.

Concomitant administration of clarithromycin and colchicine is contraindicated in patients with renal or hepatic impairment.

Hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice, has been reported with clarithromycin. This hepatic dysfunction may be severe and is usually reversible. In some instances, hepatic failure with fatal outcome has been reported and generally has been associated with serious underlying diseases and/or concomitant medications. Clarithromycin should be discontinued immediately if signs and symptoms of hepatitis occur.

Clarithromycin should not be used during pregnancy unless no alternative therapy is clinically appropriate. If pregnancy occurs while taking clarithromycin, the patient should be advised of the potential risk to the fetus.

If severe acute hypersensitivity reactions [such as anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS), and Henoch-Schonlein purpura] occur, clarithromycin should be discontinued at once and appropriate therapy should be immediately started.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibacterial agents and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following clarithromycin therapy. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Glucose should be monitored carefully when clarithromycin is administered with oral hypoglycemic agents and/or insulin as significant hypoglycemia can occur.

INR and prothrombin times should be monitored frequently during concomitant therapy with clarithromycin and oral anticoagulants. There is a risk of serious hemorrhage and significant elevations in INR and prothrombin time when clarithromycin is used with warfarin.

Safety and effectiveness of the extended release tablets have not been established for pharyngitis/tonsillitis, uncomplicated skin and skin structure infections, H pylori eradication, prophylaxis of disseminated MAC infections, or treatment of disseminated MAC infections. Safety and effectiveness of the extended release tablets have not been established in pediatric patients (less than 18 years of age).

Safety and effectiveness have not been established in pediatric patients less than 6 months of age. Safety of clarithromycin has not been established in MAC patients less than 20 months of age.

Dialysis

Data not available

As with other macrolides, clarithromycin serum concentrations are not expected to be appreciably affected by hemodialysis or peritoneal dialysis.

Other Comments

Clarithromycin is recommended for mild to moderate infections due to susceptible strains of the designated microorganisms.

The immediate release tablets and oral suspension can be taken without regard to food and can be taken with milk; however, the extended release tablets should be taken with food. The oral suspension should not be refrigerated.

To reduce the risk of development of drug-resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment. If no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy. Patients should be advised to avoid missing doses and to complete the entire course of therapy.

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