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

Distribution:
1. Widely into most body tissues; manufacturer reports no data in regards to CNS penetration
2. Protein binding: 42% to 70%
Metabolism:
1. Partially hepatic via CYP3A4; undergoes extensive first-pass metabolism
2. Converted to 14-OH clarithromycin (active metabolite)
Excretion:
1. Urine (20% to 40% as unchanged drug; additional 10% to 15% as metabolite); feces (29% to 40% mostly as metabolites)
2. Clearance: Approximates normal GFR
Pharmacodynamics:
1. Half-life elimination: (clarithromycin) 3-7 hours; (14-OH-clarithromycin) 5-9 hours
2. Time to peak: 2-3 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, pimozide, ergot alkaloids (eg, ergotamine, dihydroergotamine), or HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (eg, lovastatin, simvastatin)
4. Concomitant use with astemizole, colchicine (regardless of hepatic/renal impairment), domperidone, midazolam (oral), ranolazine, saquinavir, terfenadine, ticagrelor or lomitapide .
5. Severe hepatic failure in combination with renal impairment; history of QT prolongation or ventricular cardiac arrhythmia, including torsades de pointes; hypokalemia; hypomagnesemia.<20231025>

The manufacturer recommends not be used in a pregnant woman unless there are no alternative therapies.

1. Decreased appetite, diarrhea, rash, and somnolence have been reported in breastfed infants.
2. According to the manufacturer, the decision to breastfeed during therapy should consider the risk and the benefits.

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

500 mg every 12 hours; infuse over 60 minutes

According to the manufacturer's labeling, use is not recommended.

In patients with hepatic impairment and concomitant severe renal impairment, a dosage reduction or prolonged dosing intervals may be appropriate.

For infusion, only reconstitute by sterile water for injection.