Macrolide類抗生素

Chronic obstructive pulmonary disease, acute exacerbation: due to susceptible H. influenzae, H. parainfluenzae, M. catarrhalis, or S. pneumoniae
Helicobacter pylori eradication: To reduce the risk of duodenal ulcer recurrence as a component of combination therapy (triple therapy) in adults with H. pylori infection and duodenal ulcer disease
Mycobacterial (nontuberculous) infection: Prophylaxis and treatment of disseminated mycobacterial infections due to Mycobacterium avium complex (MAC) in patients with advanced HIV infection
Otitis media: in pediatric patients due to susceptible H. influenzae, M. catarrhalis, or S. pneumoniae
Pneumonia, community-acquired: due to susceptible M. pneumoniae, S. pneumoniae, Chlamydophila pneumoniae, H. influenzae, H. parainfluenzae, or M. catarrhalis
Skin/skin structure infection: due to susceptible S. aureus or S. pyogenes
Streptococcal pharyngitis, group A: Treatment of pharyngitis/tonsillitis due to susceptible S. pyogenes

Antibiotic, Macrolide

1. Bioavailability: ~50%
2. Half-life elimination: (Clarithromycin) 3-7 hours; (14-OH-clarithromycin) 5-9 hours

1. Hypersensitivity to clarithromycin, erythromycin, any of the macrolide antibiotics, or any component of the formulation.
2. History of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin.
3. Concomitant use with cisapride, ergot alkaloids (eg, ergotamine, dihydroergotamine), HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (eg, lovastatin, simvastatin), lomitapide<20231212>, or pimozide.
4. Concomitant use with colchicine in patients with renal or hepatic impairment.
5. History of QT prolongation (congenital or documented acquired QT prolongation) or ventricular cardiac arrhythmia, including torsades de pointes; hypokalemia. <20231212>

C

Clarithromycin and its active metabolite (14-hydroxy clarithromycin) are present in breast milk.

Headache, insomnia, skin rash, dysgeusia, vomiting, diarrhea, nausea, abdominal pain, dyspepsia, prolonged prothrombin time, abnormal hepatic function, anaphylactoid reaction, candidiasis (including oral), increased blood urea nitrogen

Usual dosage:
(Adults and children >12 year of age) 250 to 500 mg every 12 hours for 5 to 14 days
Helicobacter pylori eradication:
500mg two to three times daily, combined with other drugs
Mycobacterial (nontuberculous) infection:
500mg twice daily
Pneumonia, community-acquired:
(Adults and children >12 year of age) 250 to 500 mg every 12 hours for 6 to 14 days

Use only in children over 12 years of age

1. CrCl ≥30 mL/min: No dosage adjustment necessary.
2. CrCl <30 mL/min: Decrease clarithromycin dose by 50%
3. Hemodialysis: Administer after HD session is completed
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In combination with atazanavir or ritonavir:
1. CrCl 30-60 mL/min: Decrease clarithromycin dose by 50%
2. CrCl <30 mL/min: Decrease clarithromycin dose by 75%.

No dosage adjustment necessary if renal function is normal; however, in patients with hepatic impairment and concomitant severe renal impairment, a dosage reduction or prolonged dosing intervals may be appropriate.