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clarithromycin

Pronunciation

Generic Name: clarithromycin (kla RITH roe MYE sin)
Brand Name: Biaxin, Biaxin XL, Biaxin XL-Pak

What is clarithromycin?

Clarithromycin is a macrolide antibiotic. Clarithromycin fights bacteria in your body.

Clarithromycin is used to treat many different types of bacterial infections affecting the skin and respiratory system. Clarithromycin is also used together with other medicines to treat stomach ulcers caused by Helicobacter pylori.

Clarithromycin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about clarithromycin?

You should not use this medicine if you have a life-threatening heart rhythm disorder, a history of Long QT syndrome, low levels of potassium in your blood, if you have ever had jaundice or liver problems caused by taking clarithromycin, or if you have liver or kidney disease and are also taking colchicine.

Slideshow: Amoxicillin: 13 Burning Questions

Many other drugs can interact with clarithromycin. There are certain medicines that can cause life-threatening drug interactions with clarithromycin, Tell each of your healthcare providers about all medicines you use now, and any medicine you start or stop using.

What should I discuss with my healthcare provider before taking clarithromycin?

You should not use this medicine if you are allergic to clarithromycin or similar medicines such as azithromycin (Zithromax, Z-Pak, Zmax), erythromycin, or telithromycin, or if you have:

  • a life-threatening heart rhythm disorder;

  • a history of Long QT syndrome;

  • low levels of potassium in your blood;

  • if you have ever had jaundice or liver problems caused by taking clarithromycin; or

  • if you have liver or kidney disease and you also take a medicine called colchicine.

Some medicines can cause unwanted or dangerous effects when used with clarithromycin. Your doctor may need to change your treatment plan if you use any of the following drugs:

  • cisapride;

  • pimozide;

  • lovastatin or simvastatin; or

  • ergotamine or dihydroergotamine.

To make sure clarithromycin is safe for you, tell your doctor if you have:

  • liver disease;

  • kidney disease;

  • myasthenia gravis;

  • porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system);

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • a family history of Long QT syndrome; or

  • if you take certain heart rhythm medicine--amiodarone, disopyramide, dofetilide, flecainide, dronedarone, ibutilide, mexiletine, procainamide, propafenone, quinidine, or sotalol.

It is not known whether clarithromycin will harm an unborn baby. Tell your doctor if you are pregnant or if you become pregnant while using this medicine.

In animal studies, clarithromycin caused birth defects. However, very high doses are used in animal studies. It is not known whether these effects would occur in people using regular doses. Ask your doctor about your risk.

Clarithromycin can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Do not give this medicine to a child younger than 6 months of age.

How should I take clarithromycin?

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

You may take clarithromycin tablets and oral suspension (liquid) with or without food.

Clarithromycin extended-release tablets (Biaxin XL) should be taken with food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Shake the oral suspension (liquid) well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Use this medicine for the full prescribed length of time. Clarithromycin is usually given for up to 7 to 14 days. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clarithromycin will not treat a viral infection such as the flu or a common cold.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

Do not keep the oral liquid in a refrigerator. Throw away any liquid that has not been used within 14 days.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe stomach pain, nausea, vomiting, or diarrhea.

What should I avoid while taking clarithromycin?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking clarithromycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Clarithromycin side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • headache with chest pain and severe dizziness, fast or pounding heartbeats, shortness of breath, fainting;

  • severe stomach pain, diarrhea that is watery or bloody;

  • fever, swollen glands, body aches, flu symptoms, new or worsening cough;

  • skin rash, easy bruising or bleeding, severe tingling, numbness, pain, muscle weakness;

  • problems with your hearing;

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

  • signs of a kidney problem--little or no urinating; painful or difficult urination; swelling in your feet or ankles; feeling tired or short of breath; or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Older adults may be more likely to have heart rhythm side effects, including a life-threatening fast heart rate.

Common side effects may include:

  • stomach pain, indigestion;

  • nausea, vomiting, diarrhea;

  • unusual or unpleasant taste in your mouth;

  • headache; or

  • rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Clarithromycin dosing information

Usual Adult Dose for Tonsillitis/Pharyngitis:

Immediate-release: 250 mg orally every 12 hours for 10 days

Comments:
-The drug of choice for treatment and prevention of streptococcal infections and prophylaxis of rheumatic fever is IM or oral penicillin.
-In general, this drug effectively eradicates Streptococcus pyogenes from the nasopharynx; efficacy in the subsequent prevention of rheumatic fever has not been established.

Use: For the treatment of pharyngitis/tonsillitis due to S pyogenes

Usual Adult Dose for Sinusitis:

Immediate-release: 500 mg orally every 12 hours for 14 days
Extended-release: 1000 mg orally every 24 hours for 14 days

Uses: For the treatment of acute maxillary sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or S pneumoniae

Usual Adult Dose for 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: 1000 mg orally every 24 hours for 7 days

Uses: For the treatment of acute bacterial exacerbation of chronic bronchitis due to H influenzae, H parainfluenzae, M catarrhalis, or S pneumoniae

Usual Adult Dose for 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: 1000 mg orally every 24 hours for 7 days

Uses: For the treatment of community-acquired pneumonia due to:
-Immediate-release: H influenzae, S pneumoniae, or C pneumoniae (TWAR)
-Extended-release: H influenzae, H parainfluenzae, M catarrhalis, S pneumoniae, C pneumoniae (TWAR)

Usual Adult Dose for Mycoplasma Pneumonia:

Immediate-release: 250 mg orally every 12 hours for 7 to 14 days
Extended-release: 1000 mg orally every 24 hours for 7 days

Use: For the treatment of community-acquired pneumonia due to Mycoplasma pneumoniae

Usual Adult Dose for Skin and Structure Infection:

Immediate-release: 250 mg orally every 12 hours for 7 to 14 days

Comments:
-Abscesses usually require surgical drainage.

Uses: For the treatment of uncomplicated skin and skin structure infections due to Staphylococcus aureus or S pyogenes

Usual Adult Dose for Helicobacter pylori Infection:

Immediate-release:
Triple therapy:
-In combination with lansoprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 to 14 days
-In combination with omeprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 days

Dual therapy:
-In combination with omeprazole: Clarithromycin 500 mg orally every 8 hours for 14 days
-In combination with ranitidine bismuth citrate: Clarithromycin 500 mg orally every 8 to 12 hours for 14 days

Comments:
-Helicobacter pylori eradication shown to reduce the risk of duodenal ulcer recurrence
-Regimens with this drug as the only antimicrobial agent are more likely to be associated with clarithromycin resistance in patients who fail therapy.
-Regimens containing this drug should not be used in patients with known or suspected clarithromycin-resistant isolates; efficacy of therapy is reduced.
-Susceptibility testing is recommended in patients who fail therapy; if resistance to this drug is established, a non-clarithromycin-containing regimen is recommended.
-The manufacturer product information for the other drugs indicated in combination with clarithromycin should be consulted.

Uses:
-Triple therapy: In combination with amoxicillin and (lansoprazole or omeprazole), for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 5-year history of duodenal ulcer) to eradicate H pylori
-Dual therapy: In combination with omeprazole or ranitidine bismuth citrate, for the treatment of patients with active duodenal ulcer associated with H pylori infection

Usual Adult Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

Immediate-release: 500 mg orally twice a day

Use: For the prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection

US CDC, National Institutes of Health (NIH), and HIV Medicine Association of the Infectious Diseases Society of America (HIVMA/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

Comments:
-Primary prophylaxis against disseminated MAC disease recommended for patients with CD4 count less than 50 cells/mm3 (after active disseminated MAC disease has been ruled out based on clinical assessment).
-This drug is a preferred prophylactic agent for primary prevention of disseminated MAC disease (except during pregnancy).
-The combination of this drug and rifabutin should not be used for primary MAC prophylaxis; not more effective than this drug alone.
-Primary MAC prophylaxis should be discontinued in patients responding to antiretroviral therapy (ART) with increase in CD4 count to greater than 100 cells/mm3 for at least 3 months; should restart if CD4 count declines to less than 50 cells/mm3.
-This drug should be used with ethambutol for chronic maintenance therapy; same regimen as for treatment.
-Patients with disseminated MAC disease should continue chronic maintenance therapy (secondary prophylaxis) unless immune reconstitution occurs due to ART.
-Chronic maintenance therapy may be stopped in patients at low risk of MAC recurrence; such patients have completed at least 12 months of MAC therapy, have no signs/symptoms of MAC disease, and have an increase in CD4 count to greater than 100 cells/mm3 for more than 6 months in response to ART; should restart if CD4 count declines to less than 100 cells/mm3.

Usual Adult Dose for Mycobacterium avium-intracellulare -- Treatment:

Immediate-release: 500 mg orally twice a day

Comments:
-Recommended as the primary agent for the treatment of disseminated infection due to MAC
-This drug should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.
-Therapy should continue if clinical response is observed; can discontinue this drug when patient considered at low risk of disseminated infection.

Uses: For the treatment of disseminated mycobacterial infections due to M avium or M intracellulare

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Patients:
-Treatment of disseminated MAC disease: 500 mg orally twice a day

Comments:
-This drug should be used with ethambutol.
-Combination therapy with at least 2 antimycobacterial drugs is recommended for initial treatment of MAC disease to prevent/delay resistance development.
-This drug is the preferred first agent (except during pregnancy); ethambutol is the recommended second agent.
-Addition of a third or fourth agent should be considered for patients with CD4 count less than 50 cells/mm3, high mycobacterial loads, or when effective ART is absent; some experts recommend rifabutin as a third agent.
-MAC isolates should be tested for susceptibility to this drug in all patients.
-Patients with disseminated MAC disease should continue chronic maintenance therapy (secondary prophylaxis) unless immune reconstitution occurs due to ART.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

American Heart Association (AHA) recommendations:
Immediate-release: 500 mg orally as a single dose 30 to 60 minutes before procedure

Comments:
-Recommended for patients allergic to penicillins

Usual Adult Dose for Legionella Pneumonia:

Some experts recommend:
Immediate-release: 500 mg orally every 12 hours

Duration of therapy:
-For mild to moderate infections in immunocompetent patients: 10 days
-To prevent relapse, especially in patients with more severe infections or with underlying comorbidity or immunodeficiency: 3 weeks may be necessary

Comments:
-Recommended for Legionnaires' disease

Usual Adult Dose for Pertussis Prophylaxis:

US CDC recommendations:
Immediate-release: 500 mg orally every 12 hours for 7 days

Comments:
-Recommended for treatment and postexposure prophylaxis
-Macrolides are preferred agents for the treatment of pertussis.

Usual Adult Dose for Pertussis:

US CDC recommendations:
Immediate-release: 500 mg orally every 12 hours for 7 days

Comments:
-Recommended for treatment and postexposure prophylaxis
-Macrolides are preferred agents for the treatment of pertussis.

Usual Pediatric Dose for Tonsillitis/Pharyngitis:

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of pharyngitis/tonsillitis due to S pyogenes

Usual Pediatric Dose for Sinusitis:

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of acute maxillary sinusitis due to H influenzae, M catarrhalis, or S pneumoniae

Usual Pediatric Dose for Mycoplasma Pneumonia:

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of community-acquired pneumonia due to M pneumoniae, S pneumoniae, or C pneumoniae (TWAR)

Usual Pediatric Dose for Pneumonia:

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of community-acquired pneumonia due to M pneumoniae, S pneumoniae, or C pneumoniae (TWAR)

Usual Pediatric Dose for Otitis Media:

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Uses: For the treatment of acute otitis media due to H influenzae, M catarrhalis, or S pneumoniae

Usual Pediatric Dose for Skin and Structure Infection:

Immediate-release:
6 months or older: 7.5 mg/kg orally every 12 hours for 10 days
Maximum dose: 500 mg/dose

Comments:
-Abscesses usually require surgical drainage.

Uses: For the treatment of uncomplicated skin and skin structure infections due to S aureus or S pyogenes

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

Immediate-release:
20 months or older: 7.5 mg/kg orally twice a day
Maximum dose: 500 mg/dose

Use: For the prevention of disseminated MAC disease in patients with advanced HIV infection

US CDC, NIH, HIVMA/IDSA, Pediatric Infectious Diseases Society (PIDS), and American Academy of Pediatrics (AAP) Recommendations for HIV-exposed and HIV-infected Children:
-Primary prevention of MAC infections: 7.5 mg/kg orally twice a day
-Chronic suppressive therapy for MAC infections: 7.5 mg/kg orally twice a day

Maximum dose: 500 mg/dose

Comments:
-Primary prophylaxis recommended for patients aged 6 years or older with CD4 count less than 50 cells/mm3, aged 2 to less than 6 years with CD4 count less than 75 cells/mm3, aged 1 to less than 2 years with CD4 count less than 500 cells/mm3, and aged less than 1 year with CD4 count less than 750 cells/mm3.
-Before prophylaxis is started, active disseminated MAC disease should be ruled out based on clinical assessment.
-Primary prophylaxis can be discontinued in patients 2 years or older if they have received stable combination ART (cART) for at least 6 months and have sustained an increase in CD4 count well above the age-specific target for starting prophylaxis (e.g., greater than 100 cells/mm3 for patients aged 6 years or older; greater than 200 cells/mm3 for patients aged 2 to less than 6 years) for longer than 3 months; specific recommendations for discontinuing MAC prophylaxis in patients younger than 2 years have not been established.
-This drug should be used with ethambutol (with or without rifabutin) for chronic suppressive therapy.
-To prevent recurrence, lifelong prophylaxis is recommended for children with history of disseminated MAC.
-Some experts recommend stopping chronic suppressive therapy in patients 2 years or older who have completed at least 12 months of MAC therapy, who have no signs/symptoms of MAC disease, who receive stable cART, and who have sustained an increase in CD4 count well above the age-specific target for starting primary prophylaxis (e.g., greater than 100 cells/mm3 for patients 6 years or older; greater than 200 cells/mm3 for patients aged 2 to less than 6 years) for at least 6 months; should restart if CD4 count falls below age-specific targets.

US CDC, NIH, and HIVMA/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

Comments:
-Primary prophylaxis against disseminated MAC disease recommended for patients with CD4 count less than 50 cells/mm3 (after active disseminated MAC disease has been ruled out based on clinical assessment).
-This drug is a preferred prophylactic agent for primary prevention of disseminated MAC disease (except during pregnancy).
-The combination of this drug and rifabutin should not be used for primary MAC prophylaxis; not more effective than this drug alone.
-Primary MAC prophylaxis should be discontinued in patients responding to ART with increase in CD4 count to greater than 100 cells/mm3 for at least 3 months; should restart if CD4 count declines to less than 50 cells/mm3.
-This drug should be used with ethambutol for chronic maintenance therapy; same regimen as for treatment.
-Patients with disseminated MAC disease should continue chronic maintenance therapy (secondary prophylaxis) unless immune reconstitution occurs due to ART.
-Chronic maintenance therapy may be stopped in patients at low risk of MAC recurrence; such patients have completed at least 12 months of MAC therapy, have no signs/symptoms of MAC disease, and have an increase in CD4 count to greater than 100 cells/mm3 for more than 6 months in response to ART; should restart if CD4 count declines to less than 100 cells/mm3.

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Treatment:

Immediate-release:
20 months or older: 7.5 mg/kg orally twice a day
Maximum dose: 500 mg/dose

Comments:
-Recommended as the primary agent for the treatment of disseminated infection due to MAC
-This drug should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.
-Therapy should continue if clinical response is observed; can discontinue this drug when patient considered at low risk of disseminated infection.

Uses: For the treatment of disseminated mycobacterial infections due to M avium or M intracellulare

US CDC, NIH, HIVMA/IDSA, PIDS, and AAP Recommendations for HIV-exposed and HIV-infected Children:
-Treatment of MAC infections: 7.5 to 15 mg/kg orally twice a day
Maximum dose: 500 mg/dose

Comments:
-This drug should be used with ethambutol (with or without rifabutin).
-Combination therapy with at least 2 antimycobacterial drugs is recommended to prevent/delay resistance development.
-Some experts use this drug as the preferred first agent; ethambutol is the recommended second agent; some experts recommend rifabutin as a third agent for severe disease.
-MAC isolates should be tested for susceptibility to this drug.
-Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

US CDC, NIH, and HIVMA/IDSA Recommendations for HIV-infected Adolescents:
-Treatment of disseminated MAC disease: 500 mg orally twice a day

Comments:
-This drug should be used with ethambutol.
-Combination therapy with at least 2 antimycobacterial drugs is recommended for initial treatment of MAC disease to prevent/delay resistance development.
-This drug is the preferred first agent (except during pregnancy); ethambutol is the recommended second agent.
-Addition of a third or fourth agent should be considered for patients with CD4 count less than 50 cells/mm3, high mycobacterial loads, or when effective ART is absent; some experts recommend rifabutin as a third agent.
-MAC isolates should be tested for susceptibility to this drug in all patients.
-Patients with disseminated MAC disease should continue chronic maintenance therapy (secondary prophylaxis) unless immune reconstitution occurs due to ART.

Usual Pediatric Dose for Pertussis Prophylaxis:

US CDC recommendations:
Immediate-release:
1 month or older: 7.5 mg/kg orally every 12 hours for 7 days
Maximum dose: 500 mg/dose

Comments:
-Recommended for treatment and postexposure prophylaxis
-Macrolides are preferred agents for the treatment of pertussis.

Usual Pediatric Dose for Pertussis:

US CDC recommendations:
Immediate-release:
1 month or older: 7.5 mg/kg orally every 12 hours for 7 days
Maximum dose: 500 mg/dose

Comments:
-Recommended for treatment and postexposure prophylaxis
-Macrolides are preferred agents for the treatment of pertussis.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

AHA recommendations:
Immediate-release: 15 mg/kg orally as a single dose 30 to 60 minutes before procedure
Maximum dose: 500 mg/dose

Comments:
-Recommended for children allergic to penicillins

What other drugs will affect clarithromycin?

Many drugs can interact with clarithromycin. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with clarithromycin, especially:

  • saquinavir;

  • carbamazepine;

  • colchicine;

  • theophylline;

  • a blood thinner (warfarin, Coumadin, Jantoven);

  • sildenafil (Viagra) and other erectile dysfunction medicines;

  • ergot medicine--ergonovine, methylergonovine; or

  • heart or blood pressure medicine such as amiodarone, amlodipine, diltiazem, disopyramide, dofetilide, procainamide, quinidine, sotalol, or verapamil.

This list is not complete and many other drugs can interact with clarithromycin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about clarithromycin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 17.01. Revision Date: 2015-03-09, 6:09:46 PM.

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