Indications: respiratory-tract infections, mild to moderate skin and soft-tissue infections, otitis media; Lyme disease prevention of pertussis (Table Helicobacter pylori eradication.

Cautions: used with caution in patients with a predisposition to QT interval prolongation (including electrolyte disturbances and concomitant use of drugs that prolong the QT interval). Macrolides may aggravate myasthenia gravis. hepatic impairment hepatic dysfunction including jaundice reported. avoid in severe impairment (if renal impairment also present).

Renal impairment: use half normal dose if eGFR less than 30 ml/minute/1.73 m2, max. duration 14 days avoid Klacid XL or clarithromycin m/r preparations if eGFR less than 30 ml/minute/1.73 m2

Pregnancy: manufacturer advises avoid, particularly in the first trimester (unless potential benefit outweighs risk)

Breast-feeding: manufacturer advises avoid (unless potential benefit outweighs risk—present in milk)

Contra-indications: Hypersensitivity to clarithromycin, erythromycin, any of the macrolide antibiotics, or any component of the formulation. history of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin history of QT prolongation or ventricular cardiac arrhythmia (including torsade de pointes) concomitant use with cisapride, pimozide, ergotamine, dihydroergotamine, HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (eg, lovastatin, simvastatin), astemizole or terfenadine concomitant use with colchicine in patients with renal or hepatic impairment.

Side Effects: Most common : dyspepsia, taste disturbances, headache, insomnia, hyperhidrosis less commonly: gastritis, flatulence, constipation, dry mouth, stomatitis, glossitis, anorexia, chest pain, anxiety, dizziness, tremor, malaise, blood disorders (including leucopenia), myalgia, tinnitus. also reported: confusion, psychotic disorders, depression, abnormal dreams, convulsions, paraesthesia, hypoglycaemia, renal failure, interstitial nephritis, myopathy, tooth and tongue discoloration, smell disturbances.

Dose: ADULT and CHILD over 12 years 250 mg every 12 hours, increased in pneumonia or severe infections to 500 mg every 12 hours usual duration 7–14 days. CHILD body- weight under 8 kg; 7.5 mg/kg twice daily 8–11 kg; 62.5 mg twice daily 12–19 kg; 125 mg twice daily 20–29 kg;

187.5 mg twice daily 30–40 kg: 250 mg twice daily Lyme disease. ADULT and CHILD over 12 years 500 mg every 12 hours for 14–21 days.