Clarithromycin

Trade names: Klacid™, Mavid™, Clarithromycin-CT™, diverse generics Mavid™ tablets with 500 mg Klacid™ tablets with 250 mg Drug class: antibiotic

Manufacturer: Abbott, various other companies

Indications: prophylaxis and treatment of MAC disease. Infections of respiratory tract, ENT, and the skin.

Dose: 500 mg bid, both for primary prophylaxis and for maintenance therapy. 50 % dose reduction and good hydration if creatinine clearance is < 30 ml/min.

Side effects: mainly gastrointestinal complaints (nausea, vomiting, abdominal discomfort, rarely tenesmus, diarrhea). Allergic reactions, headache, elevated trans-aminases, alkaline phosphatase and bilirubin.

Comments/Warnings: no concurrent treatment with rifampin, carbamazepine, cisapride, terfenadine, pimozide and other macrolide antibiotics such as erythromycin or azithromycin.

Lopinavir and ritonavir increase clarithromycin levels. Clarithromycin and AZT should be taken 1-2 hours apart. Internet sources:

USA: http://hiv.net/link.php?id=73 (trade name: Biaxin) References:

1. Benson CA, Williams PL, Currier JS, et al. A prospective, randomized trial examining the efficacy and safety of clarithromycin in combination with ethambutol, rifabutin, or both for the treatment of disseminated Mycobacterium avium complex disease in persons Clin Infect Dis 2003; 37: 1234-43. http://amedeo.com/lit.php?id=14557969

2. Chaisson RE, Benson CA, Dube MP, et al. Clarithromycin therapy for bacteremic Mycobacterium avium complex disease. A randomized, double-blind, dose-ranging study in patients with AIDS. Ann Intern Med 1994, 121:905-11. http://amedeo.com/lit.php?id=7978715

3. Dunne M, Fessel J, Kumar P, et al. A randomized, double-blind trial comparing azithromycin and clarithromycin in the treatment of disseminated Mycobacterium avium infection in patients with HIV. Clin Infect Dis 2000, 31:1245-52. http://amedeo.com/lit.php?id=11073759

4. Pierce M, Crampton S, Henry D, et al. A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced AIDS. N Engl J Med 1996, 335:384-91. http://amedeo.com/lit.php?id=8663871

5. Shafran SD, Singer J, Zarowny DP, et al. A comparison of two regimens for the treatment of Mycobacterium avium complex bacteremia in AIDS: rifabutin, ethambutol, and clarithromycin versus rifampin, ethambutol, clofazimine, and ciprofloxacin. N Engl J Med 1996, 335:377-83. http://amedeo.com/lit.php?id=8676931

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