Clarithromycin (Biaxin)

KEY POINTS

• Clarithromycin (Biaxin) is a macrolide antibiotic that works against susceptible organisms by binding to the 50S ribosomal subunit, which results in protein inhibition
• Uses include upper respiratory tract infection, Lyme disease, H. pylori, Mycobacterial infections, and more
  • Usual dose of immediate release is 250 to 500mg twice daily
    • Adjust dose when CrCl < 30mL/min
• Two major side effects to beware are altered cardiac conduction & hepatic effects
• Beware drug-drug interactions, clarithromycin is a major CYP3A4 substrate and strong inhibitor of CYP3A4
  • In general clarithromycin and erythromycin are used less frequently than azithromycin, because azithromycin has a more favorable adverse effect profile and less drug-drug interactions

RESOURCES

• Clarithromycin Package Insert
• H. pylori Guideline – American College of Gastroenterology
• Diagnosis, Treatment and Prevention of Nontuberculous Mycobacterial Diseases
• FDA Drug Safety Communication: FDA review finds additional data supports the potential for increased long-term risks with antibiotic clarithromycin (Biaxin) in patients with heart disease
• Clarithromycin use and the risk of mortality and cardiovascular events: A systematic review and meta-analysis
• Opportunistic Infections Guideline – AIDSinfo.gov
• IDSA Practice Guidelines