Clarithromycin: Action, Uses, Dosage, Administration, Side Effects, Nursing Interventions by Nurses Note

Clarithromycin

 ACTION OF CLARITHROMYCIN

Binds to ribosomal receptor sites of susceptible organisms, inhibiting protein synthesis of bacterial cell wall.

Therapeutic Effect: Bacteriostatic; may be bactericidal with high dosages or very susceptible microorganisms.

CLASSIFICATION OF CLARITHROMYCIN

PHARMACOTHERAPEUTIC: Macrolide.

 CLINICAL: Antibiotic.

USES OF CLARITHROMYCIN

Treatment of susceptible infections due to C. pneumoniae, H. influenzae, H. parainfluenzae, H. pylori, M. catarrhalis, M. avium, M. pneumoniae, S. aureus, S. pneumoniae, S. pyogenes, including bacterial exacerbation of bronchitis, otitis media, acute maxillary sinusitis, Mycobacterium avium complex (MAC), pharyngitis, tonsillitis, H. pylori duodenal ulcer, community-acquired pneumonia, skin and soft tissue infections. Prevention of MAC disease. OFF-LABEL: Prophylaxis of infective endocarditis, pertussis, Lyme disease.

PRECAUTIONS OF CLARITHROMYCIN

Contraindications: Hypersensitivity to clarithromycin, other macrolide antibiotics. History of QT prolongation or ventricular arrhythmias, including torsades de pointes. History of cholestatic jaundice or hepatic impairment with prior use of clarithromycin. Concomitant use with colchicine (in pts with renal/hepatic impairment), statins, pimozide, ergotamine, dihydroergotamine.

 Cautions: Hepatic/renal impairment, elderly with severe renal impairment, myasthenia gravis, coronary artery disease. Pts at risk of prolonged cardiac repolarization. Avoid use with uncorrected electrolytes (e.g., hypokalemia, hypomagnesemia), clinically significant bradycardia, class IA or III antiarrhythmics (see Classification).

PHARMACOKINETICS OF CLARITHROMYCIN

Well absorbed from GI tract. Protein binding: 65%–75%. Widely distributed (except CNS). Metabolized in liver. Primarily excreted in urine. Not removed by hemodialysis. Half-life: 3–7 hrs; metabolite, 5–9 hrs (increased in renal impairment).

LIFESPAN CONSIDERATIONS OF CLARITHROMYCIN

Pregnancy/Lactation: Unknown if distributed in breast milk. Children: Safety and efficacy not established in pts younger than 6 mos. Elderly: Age-related renal impairment may require dosage adjustment.

INTERACTIONS OF CLARITHROMYCIN

DRUG: May increase concentration/effects of acalabrutinib, ado-trastuzumab, axitinib, bosutinib, budesonide, eletriptan, lovastatin. May increase QT-prolonging effects of dronedarone. 

HERBAL: St. John’s wort may decrease plasma concentration. 

FOOD: None known. 

LAB VALUES: May increase serum BUN, ALT, AST, alkaline phosphatase, LDH, creatinine, PT. May decrease WBC.

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AVAILABILITY (Rx) OF CLARITHROMYCIN

Oral Suspension: 125 mg/5 mL, 250 mg/5 mL. Tablets: 250 mg, 500 mg.Tablets (Extended-Release): 500 mg.

ADMINISTRATION/HANDLING OF CLARITHROMYCIN

PO

• Give immediate-release tablets, oral suspension without regard to food. • Give q12h (rather than twice daily). • Shake suspension well before each use. • Extended-release tablets should be given with food. • Do not break, crush, dissolve, or divide extended-release tablets.

INDICATIONS/ROUTES/DOSAGE OF CLARITHROMYCIN

Usual Dosage Range

PO: ADULTS, ELDERLY: 250–500 mg q12h or 1,000 mg once daily (2 × 500-mg extended-release tablets). CHILDREN 6 MOS AND OLDER: (Immediate Release): 7.5 mg/kg q12h. Maximum: 500 mg/dose.

Dosage in Renal Impairment CrCl less than 30 mL/min: Reduce dose by 50% and administer once or twice daily. HD: Administer dose after dialysis complete.

SIDE EFFECTS OF CLARITHROMYCIN

Occasional (6%–3%): Diarrhea, nausea, altered taste, abdominal pain. Rare (2%–1%): Headache, dyspepsia.

ADVERSE EFFECTS/TOXIC OF CLARITHROMYCIN

REACTIONS

Antibiotic-associated colitis, other superinfections (abdominal cramps, severe watery diarrhoea, fever) may result from altered bacterial balance in GI tract. 

Hepatotoxicity, thrombocytopenia occur rarely.

NURSING CONSIDERATIONS OF CLARITHROMYCIN

BASELINE ASSESSMENT

Question pt for allergies to clarithromycin, erythromycins.

INTERVENTION/EVALUATION OF CLARITHROMYCIN

Monitor daily pattern of bowel activity, stool consistency. Mild GI effects may be tolerable, but increasing severity may indicate onset of antibiotic-associated colitis. Be alert for superinfection: fever, vomiting, diarrhoea, anal/genital pruritus, oral mucosal changes (ulceration, pain, erythema).

PATIENT/FAMILY TEACHING

• Continue therapy for full length of treatment.

 • Doses should be evenly spaced. 

• Biaxin may be taken without regard to food. Take Biaxin XL with food. 

• Report severe diarrhoea.