Therapeutic Indications

Clarithromycin is indicated for:

Acute exacerbation of chronic bronchitis, community acquired pneumonia

Irrespective of gender only Adolescents (12 years - 18 years old) Adults (18 years old or older)

For this indication, the medical literature mentions below treatments (click for details):

Treatment 1: Intravenous - 1000 mg in 2 divided doses daily

Treatment 2: Oral - 500-1000 mg in 2 divided doses daily

Streptococcal pharyngitis and tonsillitis

Irrespective of gender only Adolescents (12 years - 18 years old) Adults (18 years old or older)

For this indication, the medical literature mentions below treatments (click for details):

Treatment 1: Intravenous - 1000 mg in 2 divided doses daily

Treatment 2: Oral - 500-1000 mg in 2 divided doses daily

Acute bacterial sinusitis

Irrespective of gender only Adolescents (12 years - 18 years old) Adults (18 years old or older)

For this indication, the medical literature mentions below treatments (click for details):

Treatment 1: Intravenous - 1000 mg in 2 divided doses daily

Treatment 2: Oral - 500-1000 mg in 2 divided doses daily

Skin and soft tissue infections

Irrespective of gender only Adolescents (12 years - 18 years old) Adults (18 years old or older)

For this indication, the medical literature mentions below treatments (click for details):

Treatment 1: Intravenous - 1000 mg in 2 divided doses daily

Treatment 2: Oral - 500-1000 mg in 2 divided doses daily

Contraindications

Active ingredient Clarithromycin is contraindicated in the following cases:

Severe hepatic failure in combination with renal impairment

No gender/age discrimination

Clarithromycin should not be used in patients who suffer from severe hepatic failure in combination with renal impairment.

Ergot alkaloids

No gender/age discrimination

Post-marketing reports indicate that co-administration of clarithromycin with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by vasospasm, and ischaemia of the extremities and other tissues including the central nervous system. Concomitant administration of clarithromycin and ergot alkaloids is contraindicated.

Astemizole, cisapride, pimozide, terfenadine

No gender/age discrimination

Concomitant administration of clarithromycin and any of the following drugs is contraindicated: astemizole, cisapride, pimozide and terfenadine as this may result in QT prolongation and cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation, and torsades de pointes.

Elevated cisapride levels have been reported in patients receiving clarithromycin and cisapride concomitantly. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes. Similar effects have been observed in patients taking clarithromycin and pimozide concomitantly.

Macrolides have been reported to alter the metabolism of terfenadine resulting in increased levels of terfenadine which has occasionally been associated with cardiac arrhythmias, such as QT prolongation, ventricular tachycardia, ventricular fibrillation and torsades de pointes. In one study in 14 healthy volunteers, the concomitant administration of clarithromycin and terfenadine resulted in 2- to 3-fold increase in the serum level of the acid metabolite of terfenadine and in prolongation of the QT interval which did not lead to any clinically detectable effect. Similar effects have been observed with concomitant administration of astemizole and other macrolides.

Colchicine

No gender/age discrimination

As with other strong CYP3A4 inhibitors, clarithromycin should not be used in patients taking colchicine. Colchicine is a substrate for both CYP3A and the efflux transporter, P-glycoprotein (Pgp). Clarithromycin and other macrolides are known to inhibit CYP3A and Pgp. When clarithromycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by clarithromycin may lead to increased exposure to colchicine.

Lovastatin, simvastatin

No gender/age discrimination

Clarithromycin should not be used concomitantly with HMG-CoA reductase inhibitors (statins) that are extensively metabolized by CYP3A4, (lovastatin or simvastatin), due to the increased risk of myopathy, including rhabdomyolysis.

Ticagrelor, ranolazine

No gender/age discrimination

Concomitant administration of clarithromycin with ticagrelor or ranolazine is contraindicated.

Hypokalemia

No gender/age discrimination

Clarithromycin should not be given to patients with hypokalaemia (risk of prolongation of QT-time).

Hypersensitivity to macrolide antibiotic drugs

No gender/age discrimination

QT prolongation, ventricular cardiac arrhythmia, torsades de pointes

No gender/age discrimination

Clarithromycin should not be given to patients with history of QT prolongation (congenital or documented acquired QT prolongation) or ventricular cardiac arrhythmia, including torsades de pointes.