Clarithromycin instructions for use for children. Clarithromycin: instructions for use, analogues and reviews, prices in Russian pharmacies

Instructions for use:

Clarithromycin – semi-synthetic antibacterial agent, used for the treatment of infectious and inflammatory diseases caused by microorganisms sensitive to the drug.

Pharmacological action

The active ingredient Clarithromycin is bacteriostatic and bactericidal. The drug is active against:

• Gram-negative bacteria – Haemophilus influenzae, Helicobacter pylori, Haemophilus ducreyi, Bordetella pertussis, Neisseria gonorrhoeae, Moraxella catarrhalis, Neisseria meningitidis, Borrelia burgdorferi;
• Gram-positive bacteria – Corynebacterium spp., Staphylococcus spp., Listeria monocytogenes, Streptococcus spp.;
• Anaerobic bacteria – Peptococcus spp., Bacteroides melaninogenicus Eubacterium spp., Propionibacterium spp., Clostridium perfringens;
• Intracellular microorganisms – Ureaplasma urealyticum, Chlamydophila pneumoniae, Chlamydia trachomatis, Legionella pneumophila, Mycoplasma pneumoniae.

According to the instructions, Clarithromycin is also active against Mycobacterium spp. (except Mycobacterium tuberculosis) and Toxoplasma gondii.

Quite a few analogues of Clarithromycin have been registered, which have the same therapeutic effect.

Release form

Clarithromycin is available as:

• Oval biconvex light yellow tablets, coated film-coated, 250 mg and 500 mg (Clarithromycin 500). Excipients– potassium polacrilin, microcrystalline cellulose, pregelatinized starch, corn starch, talc, colloidal anhydrous silicon dioxide, magnesium stearate. 14 pieces per pack;
• Small light yellow granules for the preparation of Clarithromycin suspension for oral administration in dark glass bottles for the preparation of 60 ml (1.5 mg) and 100 ml (2.5 mg) of the finished suspension.

Indications for use of Clarithromycin

According to the instructions, Clarithromycin is used for various infectious diseases that are sensitive to the active substance:

• Tonsillopharyngitis;
• Otitis media;
• Acute sinusitis;
• Acute and chronic (in the acute phase) bronchitis,
• Bacterial and atypical pneumonia;
• Various infections of the skin and soft tissues.

Clarithromycin is also used to prevent the occurrence of mycobacterial infections in patients with AIDS.

Contraindications

The use of Clarithromycin is contraindicated in:

• Severe liver failure and hepatitis (history);
• Porphyria;
• Glucose (galactose) malabsorption syndrome, congenital fructose intolerance or deficiency of the enzyme sucrase-isomaltase;
• Hypersensitivity to clarithromycin or other macrolide antibiotics.

According to the instructions, clarithromycin is not used in the first trimester of pregnancy, childhood up to 6 months, and also simultaneously with cisapride, terfenadine, pimozide and astemizole. Use in the second and third trimesters of pregnancy is possible strictly according to indications. Children under 12 years of age or weighing up to 33 kg are contraindicated to take Clarithromycin in tablet form.

Instructions for use of Clarithromycin

When using Clarithromycin, swallow the tablets whole without breaking them with water.

Typically, children over 12 years of age and adults are prescribed 250 mg of Clarithromycin every 12 hours.

For treatment acute sinusitis and other severe infections caused by Haemophilus influenzae, 1 tablet of Clarithromycin 500 is prescribed every 12 hours. The course of treatment is one to two weeks.

For the purpose of eradicating H. pylori - 250-500 mg twice a day for a week, usually in combination with other drugs.

For the treatment and prevention of infection caused by Mycobacterium avium complex, 1 tablet of Clarithromycin 500 is prescribed every 12 hours. Treatment is usually long-term, more than six months.

Children under 12 years of age are usually prescribed a suspension, the dose of which is calculated at 15 mg per 1 kg of body weight per day, divided into two doses. After taking the suspension, it is recommended to give some liquid. The tiny granules contained in the suspension should not be chewed as they taste bitter.

Clarithromycin is administered orally using a dosing syringe containing 5 ml of suspension, which corresponds to 125 mg of clarithromycin.

The syringe must be washed after each use. The average duration of treatment is from one to two weeks.

To prepare the suspension, shake the bottle, add 1/4 of the required 42 ml of water and shake until the granules are completely dissolved. Then add the rest of the water so that the volume of the suspension reaches the mark line on the bottle, and shake again.

Side effects

According to reviews, Clarithromycin is better tolerated than erythromycin. Various problems may arise during use. side effects:

• Diarrhea, nausea, stomatitis, vomiting, abdominal pain, glossitis; much less frequently, according to reviews, Clarithromycin causes pseudomembranous colitis, increased activity of liver enzymes and cholestatic jaundice;
• Feelings of fear, dizziness, insomnia or nightmares, confusion;
• Urticaria, Stevens-Johnson syndrome, anaphylactic reactions, temporary changes in taste sensations.

Treatment with antibiotics usually changes the normal intestinal flora and, according to reviews of Clarithromycin, in some cases the development of superinfection caused by resistant microorganisms is possible.

Analogues of Clarithromycin - Aziklar, Clerimed, Clarbakt, Lekoklar, Clarimisin, Klacid and Klacid CP, Fromilid, Fromilid Uno, Klamed, Klabel, Binoclair, Klabax, Klaricar, Kleron, Klaritsid. These drugs have the same active substance and have the same therapeutic effect. The difference in names is due to different trademarks who produce these drugs.

Klacid, an analogue of Clarithromycin, is the original for this group of drugs.

Storage conditions

Clarithromycin is available with a doctor's prescription. The shelf life of film-coated tablets is 5 years, granules for preparing a suspension are 2 years.

The drug “Clarithromycin” in granules is in quite high demand among parents. It's pretty strong antibiotic, which helps cope with a number of diseases. True, it should only be used under the supervision of a specialist. Children's clarithromycin suspension is marketed under the name "Klacid". But under the name “Clarithromycin” you can find tablets in pharmacies intended for oral use. When is this drug useful?

Helpful and effective

"Clarithromycin" helps to quickly overcome pneumonia, otitis media, herpetic sore throat, that is, severe diseases, often accompanied by complications due to incorrectly chosen treatment. Only antibiotics give really good results for such pathologies, and for children, a clarithromycin suspension, sold under the name Klacid, is in quite high demand.

The medicine should be used only if there are recommendations from the attending physician with constant monitoring of the condition of the minor patient. Correct passage The course provides not only victory over the disease, but also the prevention of complications. True, it should be understood that it is possible side effects, clarithromycin suspension also has contraindications. It is important to know them; it is always possible that a sick child is included in the group of those who can use the drug only with special supervision from the treating doctor.

Features of the drug

Clarithromycin suspension for children is an effective compound that has an inhibitory effect on harmful microorganisms that cause diseases of the upper respiratory tract. When a patient takes an antibiotic, bacteria cannot multiply, so the symptoms quickly resolve.

Clarithromycin is an antimicrobial substance from the macrolide group. Clarithromycin suspension is an antibiotic with broad effectiveness, due to which it shows good results in various diseases. The composition of the drug "Klacid" (trade name of clarithromycin suspension) contains auxiliary components. This makes the therapeutic course even more effective. However, if the child is known to be intolerant to any substance used in the pharmaceutical industry, parents should carefully study the instructions for use of clarithromycin suspension for children to see if it is potentially on the list. dangerous component. If you are known to be allergic to any medication, you must inform your doctor about this at the time of writing the prescription.

How will it help?

As can be seen from the manufacturer's recommendations, clarithromycin suspension for children allows you to eliminate child's body bacteria, microbes that cause a number of diseases. The product has a strong anti-inflammatory effect. Clarithromycin suspension has an immunomodulatory effect and activates the process of sputum discharge.

This composition can be used from the age of six months. Clarithromycin suspension is sold in powder form, which must be diluted at home in accordance with the doctor's recommendations and instructions for use. The substance is mixed with clean boiled water, shaken gently and given to the sick child to drink.

Medicine is not pampering!

There is an opinion among non-specialists that the suspension is a syrup that can cure any sore. This is a misconception. A suspension is a crushed drug suspended in a liquid. That is solid crumbles into very small pieces, which are then diluted in water (but it is impossible to dilute the powder until completely dissolved), and then drunk.

But the syrup is concentrated sucrose aqueous solution, supplemented with medicinal components. The antibiotic clarithromycin is not available in this form. The price of clarithromycin in the form of a suspension under the trade name “Klacid” in pharmacies for the current year is about 300 rubles. Under the name "Clarithromycin" tablets are produced that are approved for use at the age of 12 years and older.

Clarithromycin suspension: indications

The drug is always prescribed by a doctor. The doctor determines the duration of the therapeutic course and dosage. In this case, the patient’s age, weight, general condition organism and the diagnosis. Usually "Klacid" is prescribed for acute form otitis media, open bronchitis and chronic form, for pneumonia, some types of sinusitis, pharyngitis, tonsillitis. The drug shows good efficiency at inflammatory processes, struck soft fabrics. Used in the treatment of certain skin diseases. The price of clarithromycin under the trade name “Klacid,” as already mentioned, is about 300 rubles per package of powder.

The product should not be used for kidney or liver diseases. As can be seen from the reviews, children may develop an allergy to clarithromycin suspension caused by individual intolerance. If such symptoms appear, stop treatment and seek help from a doctor.

Side effects

If the dosage of clarithromycin suspension is not observed, if the patient does not tolerate the drug well, and also due to individual characteristics side effects may occur. The manufacturer warns about the possibility of diarrhea and allergies. After taking the drug, an unpleasant bitter taste remains in the mouth for some time. With prolonged use, the likelihood of dysbiosis is high. In general, macrolides are considered the most gentle group of antibiotics, which is why they are widely used in the treatment of childhood diseases.

Medicines: compatibility, replaceability

As shown clinical trials, drugs based on clarithromycin combine well with other medications that eliminate the concomitant manifestations of those diseases for which this antibiotic is effective. You can safely combine “Klacid” and antipyretics, drugs for runny nose and cough.

Analogues of clarithromycin suspension for children are on sale in several names, but choose best option Only the attending physician can, taking into account both the diagnosis and the condition of the patient’s body. Quite often they resort to Klabax, Ecositrin, Fromilid. Usually replacement is made when an allergic reaction occurs.

“Klacid”: features of the name

The effectiveness of Klacid has been proven against infection with Helicobacteria, Corynebacterium, Staphylococcus, and Neisseria. The medication shows good effectiveness against Haemophilus influenzae. In addition to gram-negative bacteria, Klacid destroys anaerobic and atypical pathogens and effectively fights infection with protozoa. Efficiency is due to the accumulation active component in body tissues. "Klacid" shows results only when used full course in accordance with the recommendations of the manufacturer, doctor. When using the medication independently without medical supervision, there is a possibility that bacteria will develop immunity to clarithromycin.

Suspension: simple but effective

“Klatsid” is sold as a powder intended for dilution with water. The result is a liquid with a light fruity aroma. There are two dosage options: 125, 250 mg. The first option is available in a 60 ml bottle, the second - 100 ml. The packaging always contains instructions from the manufacturer. You must read it carefully before using the drug to avoid unpleasant situations.

When preparing, gently shake the bottle with the powder, add water, and shake again. The liquid can be used for 14 days. The remains are disposed of. If you need a longer course of treatment than two weeks, you must purchase a new bottle. Store the medicine at room temperature and shake thoroughly before each use. Per kilogram of live weight of a sick child, 7.5 mg of the active ingredient should be used. The drug is used twice a day.

Dosage Features

When treating children under two years of age, the dose should include 2.5 ml of solution. For patients aged two to five years, the dosage is doubled - to 5 ml. When treating a child 4-8 years of age, the dosage is 7.5 ml. For the treatment of children aged 8-12 years, the solution is given in a volume of 10 ml. In each specific case, the doctor can adjust the dosage regimen relative to the standard one, focusing on the characteristics of the case and the diagnosis.

Usually the duration of treatment is up to two weeks. As a rule, the doctor prescribes the drug and asks you to come with the child for a second appointment in a few days to monitor the effectiveness of the therapy. This allows you to determine the exact duration of the course in an individual case. With treatment for more than two weeks, additional side effects may occur, primarily dysbacteriosis.

"Klacid": specific reactions

In rare cases, taking the drug may cause insomnia, fears, anxiety. There is a possibility of temporary disorientation in space caused by the release of adrenaline into the blood. Some patients experience nausea and vomiting when taking the drug. There may be noise in the ears.

If, while taking the drug, a child complains of a headache, upset bowel movements, or dizziness, it is necessary to consult with your doctor. Usually the drug is either replaced or discontinued and the baby is treated with alternative methods.

"Klacid": restrictions on use

It was stated above that the medication combines well with drugs that eliminate associated symptoms. At the same time, there are groups of medications, simultaneously with which taking Klacid can provoke negative reactions from the body. In particular, when using a number of drugs, Klacid negatively affects the functioning of the heart and leads to rhythm disturbances. This is possible when combining the drug with Limozide, Astemizole, Terfenadine and some similar medications.

When consuming Klacid and alkaloids, there is a possibility of toxicosis. The use of Klacid reduces the effectiveness of Rifabutin. It is also necessary to change the dosage of medications when combining the described drug and Ritonavir. When taking Klacid and Triazol simultaneously, a person becomes drowsy.

What if there is too much?

When using Klacid therapy, there is a risk of overdose. This is usually accompanied by work disorder gastrointestinal tract. If you suspect an overdose, you must urgently rinse your stomach and seek qualified medical help.

Too long a course of treatment provokes a superinfection, which is characterized by the activation of pathogenic microorganisms for which clarithromycin is completely safe. During treatment, it is important to regularly take blood tests for enzymes. At the first symptoms of hepatitis, treatment is stopped.

What to replace it with: Klabaks

"Klabaks" is a fairly popular antimicrobial agent broad action. This medication is based on the same active ingredient as the previously described “Klacid”. It is sold in tablets. Under the influence of Klabaks, proteins in bacterial bodies cannot be synthesized normally, which leads to the death of harmful microorganisms. "Klabaks" shows good results both with strains that do not produce beta-lactamase and with those that are capable of producing it.

When prescribing a medication, it is necessary to take into account the fact that clarithromycin rarely shows good results against microorganisms that are not afraid of oxacillin and methicillin. In order for the result of therapy to be satisfactory, before starting treatment it is necessary to take tests and check the sensitivity of microorganisms.

When to use?

Usually "Klabaks" is prescribed for bacterial diseases, if it was possible to find out that the pathogen is sensitive to clarithromycin. In most cases, these are microorganisms that provoke diseases of the upper respiratory tract: pharyngitis, otitis media. In addition, Klabaks is effective against pneumonia and bronchitis. The drug is used for infection skin, infection of soft tissues. The product shows good effectiveness against urea, mycoplasmosis, and chlamydia. As an element complex therapy"Klabaks" is used for leprosy, toxoplasmosis, and anti-Helicobacter therapy.

How to use?

Klabax is taken orally. The dosage per day is prescribed by the doctor, focusing on the characteristics of the patient’s body and the diagnosis. Usually the daily dose is divided into two doses, the tablets are swallowed whole, without chewing, along with food. The duration of treatment is determined by the attending doctor.

For moderate illnesses, adolescents and adults are prescribed one tablet twice a day. For peptic ulcers in adolescence and adulthood, it can be used three times, the course duration is 14 days. Klabaks is usually prescribed to children, determining the dosage according to the following scheme: per kilogram of live weight - 7.5 mg of the active component. Maximum daily dose clarithromycin - 500 mg. The duration of the therapeutic course is 7-14 days.

Special cases

For kidney disease, clarithromycin is prescribed in a reduced dosage. If the creatinine clearance is 30 mg, the daily dose is no more than 250 mg, but it is possible to double it in case of severe infection. In this case, the patient must be under constant supervision of the attending physician.

"Klabaks" and other drugs

This medication cannot be used simultaneously with alkaloids, as there is a possibility of toxicosis: under the influence of Klabaks, theophylline in plasma sharply increases in concentration. Also, Klabaks may affect the plasma concentrations of some other medicinal compounds. This imposes certain restrictions on compatibility with drugs that contain cyclosporine, disopyramide, midazolam, and warfarin. Full list listed in the instructions for use. If the patient is taking any medications, it is necessary to notify the attending physician at the stage of choosing therapy to prevent negative effects.

If Klabaks is used simultaneously with drugs containing astemizole, it is necessary to regularly remove ECG indicators. When ingested simultaneously with digoxin, the drug increases the likelihood of digitalis poisoning.

Clarithromycin is a semi-synthetic antibacterial drug. Using medication to suppress various infectious pathologies associated with the respiratory organs and other systems.

It is most often used to suppress pathogenic pathogens in adults, but with the correct dose selection, Clarithromycin is effective and safe in the treatment of young patients, including pulmonary tuberculosis.

Indications for use of Clarithromycin for children

Among the main factors for using an antibacterial agent are the following:

• lower respiratory tract lesions, most often with various types bronchitis and pneumonia;
• infectious lesions of the upper respiratory tract, usually with purulent sore throats, pharyngitis and sinusitis of various origins;
• uncomplicated infectious diseases soft tissues of the skin and mucous membranes;
• ulcer duodenum , caused by the Helicobacter bacterium.

Clarithromycin is most effective against pathogenic pathogens of tuberculosis. Thanks to increased efficiency antibacterial drug It is also recommended to use it to suppress the chronic type of tuberculosis.

Many developed countries use Clarithromycin in government programs on the treatment and rehabilitation of patients with tuberculosis in childhood and adulthood. According to available data, the antibiotic increases the effectiveness of therapy up to 15%.

Contraindications for use

You should not use an antibacterial agent if you have the following problems:

• severe kidney and liver diseases, including hepatitis;
• tablets can only be used when the patient reaches weight at 33 kg or 12 years;
• porphyrias and constant intestinal disorders;
• presence of glucose malabsorption syndrome;
• intolerance active substance or other macrolides;
• intolerance to any of the components Clarithromycin.

Attention! If you ignore these requirements specified in the instructions for use, the child may experience with unpleasant consequences in the form of problems with the gastrointestinal tract, exacerbation of kidney and liver diseases, anaphylactic shock, rash and itching.

Regimen and dosage of 250 and 500 mg for tuberculosis in children under 12 years of age

Clarithromycin is not usually taken by patients under 12 years old. Despite good results, in some cases the antibiotic provokes allergic reactions and problems with the gastrointestinal tract. But thanks to the purer formula, such problems do not arise as often as with first and second generation drugs.

Photo 1. The drug Clarithromycin, 14 tablets of 500 mg from the manufacturer Darnitsa.

From the age of twelve it is recommended to take it for classical infections and tuberculosis 250 mg active substance twice a day every 12 o'clock. With more acute manifestations pathologies, the treatment regimen involves taking 500 mg Clarithromycin daily for 7-14 days. For tuberculosis, only the attending physician can determine the exact duration of treatment.

Up to 12 years The antibacterial drug is recommended, if necessary, to be taken in the form of a suspension. The dosage in this case is 15 mg active substance per kilogram. A single dose is taken morning and evening.

Reference! After taking Clarithromycin, it is recommended to drink a small amount of liquid to better absorb the active substance. The duration of therapy is selected individually.

Features of reception according to instructions

The suspension is used from six months of age. In this case, it is necessary to dilute the powder immediately before the first dose and Store the prepared liquid outside the refrigerator.

The storage duration cannot exceed seven days. When taking tablets, you should swallow them whole. Breaking a tablet should only be done as a last resort when the child cannot swallow it normally.

It is allowed to take the prescribed dosage for tuberculosis in children without taking into account food, since food has little effect on the absorption of the active substance. If you miss a dose, it is strictly forbidden to take a double dose, as this will provoke an acute allergic reaction and side effects. Usually in childhood the maximum a single dose does not exceed 125-250 mg Clarithromycin. The exact number of tablets and suspension is selected taking into account the age of the child.

Attention! Doses for tuberculosis in children are selected taking into account the condition of the kidneys and liver. If there are even minor problems with these organs, the dose is adjusted to 5-15 mg per kilogram of body. In this case, the suspension and tablets show same efficiency in suppressing a dangerous pathogen.

Clarithromycin is a third-generation antibiotic of the macrolide class, which makes it one of the most the best means treatment of infectious bacterial diseases. When treating tuberculosis, the medication is taken in combination with other drugs that will achieve the desired result. When treating children, it is imperative to begin with identify the main causative agent of tuberculosis, determine all contraindications and restrictions, taking into account which the final dose is selected.

Instructions for use:

Clarithromycin is a semi-synthetic antibacterial agent used to treat infectious and inflammatory diseases caused by microorganisms sensitive to the drug.

Pharmacological action

The active ingredient Clarithromycin is bacteriostatic and bactericidal. The drug is active against:

• Gram-negative bacteria – Haemophilus influenzae, Helicobacter pylori, Haemophilus ducreyi, Bordetella pertussis, Neisseria gonorrhoeae, Moraxella catarrhalis, Neisseria meningitidis, Borrelia burgdorferi;
• Gram-positive bacteria – Corynebacterium spp., Staphylococcus spp., Listeria monocytogenes, Streptococcus spp.;
• Anaerobic bacteria – Peptococcus spp., Bacteroides melaninogenicus Eubacterium spp., Propionibacterium spp., Clostridium perfringens;
• Intracellular microorganisms – Ureaplasma urealyticum, Chlamydophila pneumoniae, Chlamydia trachomatis, Legionella pneumophila, Mycoplasma pneumoniae.

According to the instructions, Clarithromycin is also active against Mycobacterium spp. (except Mycobacterium tuberculosis) and Toxoplasma gondii.

Quite a few analogues of Clarithromycin have been registered, which have the same therapeutic effect.

Release form

Clarithromycin is available as:

• Oval biconvex light yellow film-coated tablets, 250 mg and 500 mg (Clarithromycin 500). Excipients – potassium polacrilin, microcrystalline cellulose, pregelatinized starch, corn starch, talc, colloidal anhydrous silicon dioxide, magnesium stearate. 14 pieces per pack;
• Small light yellow granules for the preparation of Clarithromycin suspension for oral administration in dark glass bottles for the preparation of 60 ml (1.5 mg) and 100 ml (2.5 mg) of the finished suspension.

Indications for use of Clarithromycin

According to the instructions, Clarithromycin is used for various infectious diseases that are sensitive to the active substance:

• Tonsillopharyngitis;
• Otitis media;
• Acute sinusitis;
• Acute and chronic (in the acute phase) bronchitis,
• Bacterial and atypical pneumonia;
• Various infections of the skin and soft tissues.

Clarithromycin is also used to prevent the occurrence of mycobacterial infections in patients with AIDS.

Contraindications

The use of Clarithromycin is contraindicated in:

• Severe liver failure and hepatitis (history);
• Porphyria;
• Glucose (galactose) malabsorption syndrome, congenital fructose intolerance or deficiency of the enzyme sucrase-isomaltase;
• Hypersensitivity to clarithromycin or other macrolide antibiotics.

According to the instructions, clarithromycin is not used in the first trimester of pregnancy, children under 6 months of age, or simultaneously with cisapride, terfenadine, pimozide and astemizole. Use in the second and third trimesters of pregnancy is possible strictly according to indications. Children under 12 years of age or weighing up to 33 kg are contraindicated to take Clarithromycin in tablet form.

Instructions for use of Clarithromycin

When using Clarithromycin, swallow the tablets whole without breaking them with water.

Typically, children over 12 years of age and adults are prescribed 250 mg of Clarithromycin every 12 hours.

For the treatment of acute sinusitis and other severe infections caused by Haemophilus influenzae, 1 tablet of Clarithromycin 500 is prescribed every 12 hours. The course of treatment is one to two weeks.

For the purpose of eradicating H. pylori - 250-500 mg twice a day for a week, usually in combination with other drugs.

For the treatment and prevention of infection caused by Mycobacterium avium complex, 1 tablet of Clarithromycin 500 is prescribed every 12 hours. Treatment is usually long-term, more than six months.

Children under 12 years of age are usually prescribed a suspension, the dose of which is calculated at 15 mg per 1 kg of body weight per day, divided into two doses. After taking the suspension, it is recommended to give some liquid. The tiny granules contained in the suspension should not be chewed as they taste bitter.

Clarithromycin is administered orally using a dosing syringe containing 5 ml of suspension, which corresponds to 125 mg of clarithromycin.

The syringe must be washed after each use. The average duration of treatment is from one to two weeks.

To prepare the suspension, shake the bottle, add 1/4 of the required 42 ml of water and shake until the granules are completely dissolved. Then add the rest of the water so that the volume of the suspension reaches the mark line on the bottle, and shake again.

Side effects

According to reviews, Clarithromycin is better tolerated than erythromycin. Various side effects may occur when used:

• Diarrhea, nausea, stomatitis, vomiting, abdominal pain, glossitis; much less frequently, according to reviews, Clarithromycin causes pseudomembranous colitis, increased activity of liver enzymes and cholestatic jaundice;
• Feelings of fear, dizziness, insomnia or nightmares, confusion;
• Urticaria, Stevens-Johnson syndrome, anaphylactic reactions, temporary changes in taste.

Treatment with antibiotics usually changes the normal intestinal flora and, according to reviews of Clarithromycin, in some cases the development of superinfection caused by resistant microorganisms is possible.

Analogues of Clarithromycin - Aziklar, Clerimed, Clarbakt, Lekoklar, Clarimisin, Klacid and Klacid CP, Fromilid, Fromilid Uno, Klamed, Klabel, Binoclair, Klabax, Klaricar, Kleron, Klaritsid. These drugs have the same active ingredient and have the same therapeutic effect. The difference in names is due to the different brands that produce these drugs.

Klacid, an analogue of Clarithromycin, is the original for this group of drugs.

Storage conditions

Clarithromycin is available with a doctor's prescription. The shelf life of film-coated tablets is 5 years, granules for preparing a suspension are 2 years.

Name:
Clarithromycin
INN:
Clarithromycin

ATX code: J01FA09.

Pharmacotherapeutic group:

Antimicrobial drug for systemic use

Compound

for one tablet:

Active substance:

Clarithromycin 250.0 mg

Excipients:

sodium starch glycolate, microcrystalline cellulose, corn starch, purified talc, magnesium stearate, PVP K-30, polyethylene glycol 6000, propylene glycol, Tabcoatpink dye (hydroxypropyl methylcellulose, polyethylene glycol, titanium dioxide, erythrosine E 127, talc).

Pharmacological properties

Clarithromycin is a semi-synthetic derivative of erythromycin. In the cell of susceptible bacteria, clarithromycin exhibits antimicrobial activity, binding the 50S ribosomal subunit and thus inhibiting protein synthesis. The nature of the antimicrobial action of clarithromycin is predominantly bacteriostatic. Clarithromycin exhibits antibacterial activity against the following range of microorganisms:

Gram-positive bacteria: Streptococcus agalactiae, Streptococcus pyogenes, Streptococcus viridans, Streptococcus pneumoniae, Listeria monocytogenes, Staphylococcus aureus.

Gram-negative bacteria: Haemophilus influenzae, Haemophilus parainfluenzae, Neisseria gonorrheae, Legionella pneuophila, Pasteurella multocids, Helicobacter pylori, Campylobacter jejuni, Moraxella (Branthamela) catarrhalis, Bordetella pertussis.

Other microorganisms: Chlamydia pneumoniae(TWAR), Chlamydia trachomatis, Borrelia burgoferi, Mycobacterium avium complex (MAC), consisting of Mycobacterium avium, Mycobacterium intracellular, Mycobacterium leprae, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium kansasii.

Anaerobic microorganisms: Clostridium perfringes, Peptococcus niger, Propionibacterium acnes, Bacteroides melaninogenicus.

Mycoplasmas: Mycoplasma pneumoniae.

The clarithromycin metabolite 14-hydroxyclarithromycin also has therapeutically significant antimicrobial activity.

Pharmacokinetics

Clarithromycin, when taken orally, is rapidly and actively absorbed, its bioavailability is approximately 50%. The drug and its stable metabolite do not accumulate. Eating immediately before prescribing the drug slightly slows down the onset of absorption of clarithromycin, but does not affect its bioavailability and the formation of the active metabolite 14-hydroxyclarithromycin. Thus, clarithromycin can be prescribed without regard to food intake.

When prescribing the drug 2 times a day, 250 mg, the maximum equilibrium concentration (Cmax) of clarithromycin in plasma was achieved after 2-3 days and averaged 1 µg/ml for clarithromycin and 0.6 µg/ml for 14-hydroxyclarithromycin, with periods the half-life of the parent compound and its metabolite was 3-4 and 5-6 hours, respectively.

When prescribing the drug 2 times a day, 500 mg, the equilibrium Cmax of clarithromycin and its hydroxylated metabolite in plasma averaged 2.7-2.9 µg/ml and 0.88-0.83 µg/ml, respectively. The half-life of the parent compound at the 500 mg dose was 5-7 hours, while for 14-hydroxyclarithromycin it was 7-9 hours.

After the administration of higher doses of clarithromycin, a further increase in Cmax and the duration of the half-life is observed, which indicates the non-linear nature of the pharmacokinetics of clarithromycin.

With a single oral administration of 250 mg or 1200 mg of clarithromycin to adults, 37.9% of the prescribed lower dose and 46.0% of the prescribed upper dose are excreted in the urine. The excretion of clarithromycin in feces is 40.2% and 29.1% of these doses, respectively.

Clarithromycin and its 14-hydroxy metabolite are rapidly distributed throughout all tissues and body fluids. After oral administration, the concentration of clarithromycin in tissues (especially in the lungs) is several times higher than in plasma.

Indications for use

Clarithromycin is indicated for the treatment infectious diseases caused by sensitive microorganisms. These diseases include:

Lower respiratory tract infections (bronchitis, pneumonia). Infections upper section respiratory tract (pharyngitis, sinusitis). Skin and soft tissue infections (folliculitis, cellulitis, erysipelas).

Widespread or localized mycobacterial infections caused by Mycobacterium avium and Mycobacterium intracellulare. Localized infections caused by Mycobacterium chelonae, Mycobacterium fortuitum and Mycobacterium kansasii.

Clarithromycin is prescribed to prevent the spread of infection caused by Mycobacterium avium complex (MAC) in HIV-infected patients with a CD4 lymphocyte (T-helper lymphocyte) count of no more than 100 per mm 3 .

Clarithromycin is indicated for the eradication of H. pylori (only in combination therapy).

Directions for use and doses

Orally, without chewing, with a small amount of liquid. Regardless of food intake.

Adults and children over 12 years old Clarithromycin is prescribed at an average dose of 250 mg every 12 hours.
For sinusitis, severe infections and diseases caused by Haemophilus influenzae, the drug is prescribed 500 mg every 12 hours. The maximum daily dose is 2 g. The course of treatment is 8-14 days.
For eradication of Helicobacter pylori in patients with peptic ulcer duodenum or stomach Clarithromycin is prescribed at a dose of 250-500 mg 2 times a day as part of combination therapy. The course of treatment is 7 days.
Tablets should not be broken. They should be swallowed whole with a small amount of liquid.
For the treatment and prevention of common infection caused by Mycobacterium avium complex, adults and children over 12 years old The drug is prescribed at a dose of 500 mg every 12 hours. If necessary, the dose can be increased. Treatment for infection caused by Mycobacterium avium complex is long-term.
Patients with impaired renal function (creatinine clearance less than 30 ml/min or serum creatinine level more than 3.3 mg/dl) the dose should be reduced by 2 times or the interval between doses should be doubled.

No dose reduction is required for elderly people.

Side effect

The most common complaints are from the gastrointestinal tract (dyspepsia: nausea, abdominal pain, vomiting and diarrhea; pseudomembranous colitis). Other adverse reactions include headaches, changes in taste, and transient increases in liver enzymes.

There are reports of rare cases of hepatitis with increased levels of liver enzymes in the blood serum and the development of cholestasis and jaundice. These liver injuries were, in some cases, severe and usually reversible. In exceptional cases it was observed liver failure with fatal outcome. It was associated with serious underlying medical conditions and/or simultaneous administration other medicines.

When taking clarithromycin orally, allergic reactions were observed, the intensity of which varied from urticaria and skin rash to anaphylaxis and Stevens-Johnson syndrome.

There are reports of hearing loss during treatment with clarithromycin, which in most cases recovered after discontinuation of the drug. Changes in taste perception have also been reported.

There are reports of the development of glossitis, stomatitis, candidiasis of the oral mucosa and changes in the color of the tongue during treatment with clarithromycin. Changes in tooth color have also been reported in patients treated with clarithromycin. The change in tooth color was reversible in most cases.

In rare cases, hypoglycemia has been observed; in a number of these cases, hypoglycemia developed in patients who took oral hypoglycemic agents or insulin during clarithromycin treatment.

Isolated cases of thrombocytopenia have been reported.

During treatment with clarithromycin, prolongation of the QT interval, ventricular arrhythmia, including ventricular paroxysmal tachycardia and ventricular fibrillation.

During long-term treatment of patients with AIDS and other immunodeficiency states high doses of clarithromycin (1000-2000 mg/day) for infectious diseases caused by mycobacteria, the most common are nausea, vomiting, taste disturbances, abdominal pain, skin rash, diarrhea, flatulence, headache, constipation, hearing impairment, increased serum aminotransferase levels. Less frequently, patients complained of insomnia, shortness of breath and dry mouth. The frequency of adverse reactions among patients receiving doses of 1000 mg and 2000 mg was comparable, however, among patients receiving 4000 mg/day clarithromycin, these reactions occurred 3-4 times more often.

Contraindications

• Severe liver dysfunction;
• Hepatitis (history);
• Porphyria;
• I trimester of pregnancy;
• Increased sensitivity to clarithromycin and other macrolide antibiotics.
• Clarithromycin should not be administered to patients receiving terfenadine, cisapride, pimozide, or astemizole.

Pregnancy and lactation

The use of Clarithromycin in the first trimester of pregnancy is contraindicated.
The use of Clarithromycin in II and III trimesters pregnancy is possible only in cases where the expected benefit to the mother exceeds potential risk for the fetus.
If it is necessary to use the drug during lactation, breastfeeding should be stopped.

Overdose

The development of symptoms from the gastrointestinal tract (nausea, vomiting, diarrhea) is likely. In case of overdose, immediate gastric lavage and symptomatic treatment are necessary.

Hemodialysis and peritoneal dialysis do not lead to a significant change in clarithromycin serum levels.

Special instructions

When prescribing the drug, it should be taken into account that there is cross-resistance among macrolide antibiotics.
Patients with impaired liver function, mild and medium degree there is no need to reduce the dose of the drug if renal function is normal. In patients with severe renal impairment, the dose should be reduced.
Antibiotic treatment alters the normal intestinal flora, so superinfection caused by resistant microorganisms may develop.
The patient should be warned that in case of severe persistent diarrhea, which may be due to pseudomembranous colitis, he should consult a doctor.
It is recommended to measure serum concentrations of theophylline, carbamazepine, digoxin, lovastatin, simvastatin, triazolam, midazolam, phenytoin, cyclosporine, tacrolimus, and ergot alkaloids when administered concomitantly with clarithromycin.
Prothrombin time should be periodically monitored in patients receiving clarithromycin concomitantly with warfarin or other oral anticoagulants.

Impact on the ability to drive vehicles:
The drug does not affect the speed of psychomotor reactions when driving a car or operating machinery.

Interaction with others medicines

Just as when taking other antibiotics from the macrolide group, the use of clarithromycin simultaneously with drugs metabolized by the cytochrome P450 system (carbamazepine, tacrolimus, hexobarbital, alfentanil, bromocriptine, valproates, lovastatin, disopyramide, phenytoin, cyclosporine) may be accompanied by an increase in the concentration of these drugs in serum and enhancing their effects. At simultaneous use with clarithromycin, it may be necessary to monitor the serum concentrations of these drugs.

Rare cases of acute necrosis have been reported skeletal muscles, coinciding with the simultaneous administration of clarithromycin and hydroxymethylglutaryl-CoA reductase inhibitors - lovastatin and simvastatin.

There are reports of increased concentrations of digoxin in the plasma of patients receiving simultaneously digoxin and clarithromycin tablets. In such patients, it is necessary to constantly monitor the level of digoxin in the serum to avoid digitalis intoxication.

Concomitant use of clarithromycin with cisapride, pimozide, terfenadine and astemizole is contraindicated due to the possible development of life-threatening cardiac arrhythmias (see section « Contraindications").

Clarithromycin may decrease the clearance of triazolam and thus increase it pharmacological effects with the development of drowsiness and confusion.

The simultaneous use of clarithromycin and ergotamine or dihydroergotamine is associated in some patients with acute ergotamine intoxication, manifested by peripheral vasospasm and perverted sensitivity.

Concomitant administration of oral zidovudine and clarithromycin tablets to HIV-infected adults may result in decreased steady-state zidovudine concentrations. Given that clarithromycin is likely to alter the absorption of concomitantly administered orally administered zidovudine, this interaction is largely avoided by taking clarithromycin and zidovudine at different times of the day.

With the simultaneous administration of clarithromycin and ritonavir, the serum concentrations of clarithromycin increase. Dose adjustment of clarithromycin in these cases for patients with normal function no kidneys required. However, in patients with creatinine clearance from 30 to 60 ml/min, the dose of clarithromycin should be reduced by 50%. If creatinine clearance is less than 30 ml/min, the dose of clarithromycin should be reduced by 75%. During concomitant treatment with ritonavir, clarithromycin should not be prescribed in doses exceeding 1 g/day.

With the simultaneous administration of clarithromycin and omeprazole, their concentrations in plasma increase, however, dosage adjustment of these drugs is not required. Most common adverse reactions symptoms that occur during treatment with clarithromycin and omeprazole are taste disturbances, nausea and vomiting. Less than 1% of patients may experience increased serum concentrations direct bilirubin, liver transaminases and creatinine.

Storage conditions

List B. In a place protected from moisture and light at a temperature not exceeding + 25°C.

Keep out of the reach of children!

Best before date - 3 years

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