Clarithromycin, sold under the brand name Claricil among others, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, H. pylori infection, and Lyme disease, among others. Clarithromycin can be taken by mouth as a pill or liquid.

Acute Exacerbation of Chronic Bronchitis

Indicated for treatment of mild-to-moderate infections caused by susceptible isolates caused by Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.

250-500 mg PO q12hr for 7-14 days

Extended release: 1000 mg PO once daily for 7 days

Acute Maxillary Sinusitis

Indicated for the treatment of mild-to-moderate infections caused by susceptible isolates caused by Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.

500 mg PO q12hr for 14 days

Extended release: 1000 mg PO once daily for 14 days

Mycobacterial Infection Indicated treatment and prophylaxis of mycobacterial infections

500 mg PO q12hr for 7-14 days For treatment of disseminated infection caused by mycobacterium avium complex (MAC); use in combination with other antimycobacterial drugs (eg, ethambutol)

Peptic Ulcer Disease Indicated for H pylori eradication when treating patients with active or history of peptic ulcer disease

500 mg PO q8-12hr for 10-14 days

Administer as part of 2- or 3-drug combination regimen with bismuth subsalicylate, amoxicillin, H2 receptor antagonist, or proton pump inhibitor

Pharyngitis, Tonsillitis

250 mg PO q12hr for 10 days

Community-Acquired Pneumonia

Indicated for the treatment of mild-to-moderate infections caused by susceptible isolates caused by Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Mycoplasma pneumoniae, Streptococcus pneumoniae, or Chlamydophila pneumoniae

250 mg PO q12hr for 7-14 days

Extended release: 1000 mg PO once daily for 7 days

Skin/Skin Structure Infection

250 mg PO q12hr for 7-14 days

Pertussis (Off-label)

Used off-label for treatment of pertussis or for postexposure prophylaxis

500 mg PO twice daily for 7 days

Endocarditis (Off-label)

Used off-label for bacterial endocarditis prophylaxis

500 mg PO 30-60 minutes before procedure

Dosage Modifications

Coadministration with atazanavir: Decrease clarithromycin dose by 50%

Renal impairment

Moderate

  • CrCl 30-60 mL/min: No dosage adjustment necessary
  • CrCl 30-60 mL/min and concomitant atazanavir or ritonavir-containing regimens: Decrease clarithromycin dose by 50%

Severe

  • CrCl 30 mL/min: Decrease clarithromycin dose by 50%
  • CrCl 30 mL/min and concomitant atazanavir or ritonavir-containing regimens: Decrease clarithromycin dose by 75%

Dosing Considerations

Limitations of use

  • Extended-release tablet is indicated only for acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, and community-acquired pneumonia in adults
  • Resistance to macrolides in certain bacterial infections caused by Streptococcus pneumoniae and Staphylococcus aureus; when clinically indicated, perform susceptibility tests

Susceptible organisms

  • Actinobacillus actinomycetemcomitans, Actinomyces israelii, Actinomyces naeslundii, Actinomyces odontolyticus, Afipia felis, Arachnia propionica, Bartonella henselae, Bartonella quintana, Chlamydia pneumoniae (TWAR agent), Bordetella pertussis, Borrelia recurrentis, Calymmatobacterium granulomatis, Campylobacter jejuni, Chlamydia spp, Haemophilus ducreyi, Haemophilus influenzae, Helicobacter pylori, Legionella pneumophila, Mycobacterium avium complex (MAC), Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium genavense, Mycobacterium gordonae, Mycobacterium kansasii, Mycobacterium leprae, Mycobacterium marinum, Mycobacterium scrofulaceum, Mycobacterium simiae, Mycobacterium szulgai, Mycobacterium ulcerans, Mycobacterium xenopi, Mycoplasma pneumoniae, Moraxella (Branhamella) catarrhalis, Staphylococcus aureus, Streptococcus (group C, G), Streptococcus agalactiae (group B), Streptococcus bovis (group D), Streptococcus intermedius group (Streptococcus anginosus, Streptococcus intermedius, Streptococcus constellatus), Streptococcus pneumoniae (penicillin sensitive; minimal inhibitory concentration [MIC] 0.1 mcg/mL), Streptococcus pyogenes (group A), viridans streptococci, Ureaplasma urealyticum
  • H pylori (with lansoprazole and amoxicillin)
  • First-line: A felis, B henselae, B quintana, B pertussis, C jejuni, C pneumoniae, H ducreyi, H pylori, Legionella spp, MAC, M chelonae, M fortuitum, M genavense, M gordonae, M marinum, M scrofulaceum, M simiae, M xenopi; no unanimity on others (eg, H influenzae)