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Community acquired pneumonia due to Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila and Streptococcus pneumoniae
Uncomplicated skin and skin structure infections due to Staphylococcus aureus or Streptococcus pyogenes
Disseminated or localised mycobacterial infections due to Mycobacterium avium or Mycobacterium intracellulare and skin and skin structure infections due to Mycobacterium chelonae
Prevention of disseminated Mycobacterium avium complex infection in HIV-infected adults with CD4 lymphocyte counts < 75 cells/mm 3
Acute bacterial exacerbation of chronic bronchitis due to Haemophilus influenzae, Moraxella catarrhalis or Streptococcus pneumoniae
Combination therapy for the treatment of peptic ulcer disease associated with Helicobacter pylori infection
Acute streptococcal pharyngitis and tonsillitis caused by Streptococcus pyogenes
Community acquired pneumonia including infections due to Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophilia
Skin and skin structure infections (e.g. impetigo)
Disseminated or localised infections due to Mycobacterium avium or Mycobacterium intracellulare in immuno-compromised children, including those with HIV infection or AIDS
Known hypersensitivity to macrolide antibiotic drugs or any of its excipients.
Concurrent administration of clarithromycin and any of the following drugs is contraindicated: astemizole, terfenadine, cisapride, domperidone, pimozide, as this may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation, and torsades de pointes .
Clarithromycin should not be given to patients with history of QT prolongation (congenital or documented acquired QT prolongation) or ventricular cardiac arrhythmia, including torsades de pointes
Clarithromycin should not be given to patients with electrolyte disturbances (hypokalaemia or hypomagnesaemia, due to the risk of prolongation of QT interval).
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Mechanism & pharmacology
“Clarithromycin exerts its antibacterial action by binding to the 50S ribosomal subunits of susceptible organisms and inhibiting protein synthesis.”
“The elimination half-life of clarithromycin was about three to four hours with 250 mg administered every 12 hours but increased to five to seven hours with 500 mg administered every 12 hours.”
Curated subset. The full adverse-effect list is in the TGA Product Information; click any citation above to open it.
Concomitant administration of clarithromycin and ergot alkaloids (eg ergotamine or dihydroergotamine) is contraindicated, as this may result in ergot toxicity
Concomitant administration of clarithromycin (a potent CYP3A4 inhibitor) and ivabradine is contraindicated, as this may result in increased plasma exposure of ivabradine
Concomitant administration of clarithromycin and oral midazolam is contraindicated
Concomitant administration of clarithromycin and lomitapide is contraindicated
Clarithromycin should not be used in patients who suffer from severe hepatic failure in combination with renal impairment.
Clarithromycin should not be used concomitantly with HMG-CoA reductase inhibitors (statins) that are extensively metabolised by CYP3A4 (lovastatin or simvastatin) due to the increased risk of myopathy, including rhabdomyolysis
Clarithromycin (and other strong CYP3A4 inhibitors) should not be used concomitantly with colchicine
“Available data indicate that N- demethylation and 14-(R)-hydroxylation of clarithromycin are mediated principally by members of the CYP3A subfamily, most likely CYP3A4, and that CYP2C19, CYP2D6, CYP2E1, CYP1A2, CYP2C9 and CYP2A6 play relatively minor roles.”