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Clarithromycin
Clarithromycin is a macrolide antibiotic used to treat a variety of bacterial infections, including respiratory tract infections, skin infections, and Helicobacter pylori infections that contribute to stomach ulcers. It works by inhibiting bacterial protein synthesis, preventing the bacteria from growing and replicating. Clarithromycin is commonly used for infections like bronchitis, pneumonia, sinusitis, and pharyngitis, as well as in combination therapies for treating stomach ulcers caused by H. pylori. It is available in tablet, suspension, and extended-release formulations.
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Frequently Asked Questions
How long does it take for Clarithromycin to start working?
You may begin to feel better within a few days, but it is essential to complete the full course of Clarithromycin to ensure the infection is fully treated.
Can I take Clarithromycin with food?
Yes, Clarithromycin can be taken with or without food, but taking it with food may help reduce gastrointestinal discomfort.
What should I do if I miss a dose?
If you miss a dose, take it as soon as you remember. If it’s close to your next scheduled dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Can I drink alcohol while taking Clarithromycin?
It is generally safe to drink alcohol in moderation while taking Clarithromycin, but alcohol may increase the risk of certain side effects like upset stomach. Consult your healthcare provider if you have concerns.
Is Clarithromycin safe for children?
Yes, Clarithromycin is safe for children and is commonly prescribed for pediatric infections. However, the dose will depend on the child’s weight and the severity of the infection. Always follow the pediatrician’s instructions.
Comprehensive Drug Guide
How Does Clarithromycin Work?
Clarithromycin works by binding to the 50S ribosomal subunit of bacteria, inhibiting protein synthesis. This prevents the bacteria from growing and multiplying, allowing the body’s immune system to combat the infection more effectively. Clarithromycin is effective against both Gram-positive and Gram-negative bacteria and is often used when other antibiotics, such as penicillins, are not suitable.
Common Dosages
- Tablets: 250 mg, 500 mg
- Oral Suspension: 125 mg/5 mL, 250 mg/5 mL
- Extended-release tablets: 500 mg
Typical Dosing
- For respiratory infections: 250 mg to 500 mg twice daily for 7 to 14 days, depending on the severity of the infection.
- For skin infections: 250 mg to 500 mg twice daily for 7 to 14 days.
- For H. pylori infections: 500 mg twice daily, often in combination with a proton pump inhibitor and another antibiotic, for 10 to 14 days.
Typical Dosing
FDA Approved Indications
- Acute bacterial exacerbations of chronic bronchitis
- Community-acquired pneumonia
- Sinusitis caused by susceptible bacteria
- Pharyngitis or tonsillitis caused by Streptococcus pyogenes
- Skin and skin structure infections
- Helicobacter pylori infection (as part of combination therapy to treat duodenal ulcers)
Who Shouldn't Take Clarithromycin?
- Known hypersensitivity to clarithromycin, erythromycin, or other macrolide antibiotics
- History of liver dysfunction associated with prior use of clarithromycin
- Use with drugs that are metabolized by CYP3A4 and have a narrow therapeutic window, such as pimozide, ergotamine, and lovastatin
- Patients with a history of QT prolongation or ventricular arrhythmias
Advice From The Pharmacist
- Take Clarithromycin with or without food, but taking it with food may help reduce stomach upset.
- Avoid drinking grapefruit juice while taking Clarithromycin, as it may increase the risk of side effects.
- Finish the entire course of the antibiotic, even if symptoms improve early, to prevent bacterial resistance.
- Store the oral suspension in the refrigerator and shake well before each use. Do not freeze.
- If you are taking extended-release Clarithromycin, do not crush or chew the tablets; swallow them whole.
Side Effects of Clarithromycin
Common Side Effects
- Nausea
- Diarrhea
- Abdominal pain
- Altered taste
- Headache
Uncommon/Severe Side Effects
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Liver dysfunction (yellowing of the skin or eyes, dark urine)
- Heart rhythm changes (QT prolongation)
- Clostridioides difficile-associated diarrhea
Risks and Warnings of Clarithromycin
- QT Prolongation: Clarithromycin can prolong the QT interval, increasing the risk of arrhythmias. Patients with heart conditions or those taking medications that also prolong the QT interval should inform their healthcare provider before starting this medication.
- Liver Dysfunction: Clarithromycin may cause liver problems, particularly in patients with pre-existing liver conditions. Discontinue the medication and consult your healthcare provider if symptoms of liver dysfunction occur.
- Drug Interactions: Clarithromycin can interact with many drugs, especially those metabolized by the liver enzyme CYP3A4. Always inform your healthcare provider about all medications you are taking before starting Clarithromycin.
Interactions with Clarithromycin
Common Drug Interactions
- Warfarin: Clarithromycin may increase the effects of warfarin, raising the risk of bleeding. Regular monitoring of INR levels is recommended.
- Statins: Clarithromycin can increase the levels of certain statins (like lovastatin and simvastatin) in the body, leading to an increased risk of muscle toxicity (rhabdomyolysis).
- Theophylline: Clarithromycin may increase the levels of theophylline, leading to potential toxicity. Monitor for signs of theophylline toxicity, such as nausea, vomiting, or seizures.
Alternatives to Clarithromycin
- Azithromycin: Another macrolide antibiotic commonly used for respiratory and skin infections, with a shorter treatment duration.
- Amoxicillin-Clavulanate: A beta-lactam antibiotic used for similar bacterial infections, particularly when macrolides are not suitable.
- Levofloxacin: A fluoroquinolone antibiotic that is effective for respiratory infections when other options are unsuitable.
