Clarithromycin Dosing and Administration Guidelines

Standard Adult Dosing by Indication

The Centers for Disease Control and Prevention recommends clarithromycin 1 g per day divided into two 500 mg doses for 7 days for the treatment of pertussis 1
For the treatment of Mycobacterium avium complex (MAC), the American Thoracic Society recommends clarithromycin 500 mg twice daily in combination with ethambutol 15 mg/kg daily 2, 3, 4

The American Geriatrics Society suggests considering reducing clarithromycin to 250-500 mg/day in patients <50 kg or >70 years due to increased risk of gastrointestinal intolerance 2, 3, 4
In patients with severe renal impairment (CrCl <30 mL/min), the National Kidney Foundation recommends reducing the clarithromycin dose by 50% 5

The American College of Clinical Pharmacy recommends reducing clarithromycin dose by 50% when used with ritonavir or lopinavir-ritonavir if CrCl <60 mL/min; reduce by 75% if CrCl <30 mL/min 5
The Infectious Diseases Society of America notes that clarithromycin efficacy may be reduced by 35-39% when used with efavirenz or nevirapine; monitor closely for treatment failure 5

The American Journal of Respiratory and Critical Care Medicine reports that gastrointestinal symptoms (metallic taste, nausea, vomiting) are dose-related and most common adverse effects of clarithromycin 2, 3, 4
The Centers for Disease Control and Prevention advises that doses >1000 mg/day are poorly tolerated in most adults and should be avoided 2, 3, 4

The American Thoracic Society recommends a dosage of 1000 mg three times a week in combination with rifampin 600 mg and ethambutol 25 mg/kg for nodular/bronchiectatic pulmonary Mycobacterium avium complex (MAC) disease 6, 7
For pulmonary MAC disease with fibrocavitary or severe disease, the recommended dosage is 500-1000 mg daily in combination with rifampin 600 mg and ethambutol 15 mg/kg 6, 7
The American Thoracic Society recommends a dosage of 1000 mg per day in combination with ethambutol 15 mg/kg/day for disseminated MAC disease 6, 7
For MAC prophylaxis in AIDS patients with CD4 <50 cells/μL, the recommended dosage is 1000 mg per day 6, 7
The American Thoracic Society recommends a dosage of 1000 mg per day as part of a multidrug regimen for pulmonary M. abscessus disease, although no regimen has proven efficacy 6, 7

The Infectious Diseases Society of America recommends a dosage of 15 mg/kg/day divided into 2 doses for community-acquired pneumonia caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae in children 8, 9, 10, 11
The oral dose should not exceed the adult dose 8, 9, 10, 11

The American Thoracic Society recommends dosing clarithromycin at 500 mg twice daily for 7-14 days for community-acquired pneumonia, or alternatively 1000 mg once daily using the extended-release formulation 12
The American Academy of Family Physicians recommends dosing clarithromycin at 250 mg twice daily for 10 days for group A streptococcal pharyngitis 13

The Centers for Disease Control and Prevention recommends reducing the clarithromycin dose by 50% in patients with moderate renal impairment (CrCl 30-60 mL/min) and concomitant ritonavir or atazanavir, and by 75% in patients with severe renal impairment (CrCl <30 mL/min) and concomitant ritonavir or atazanavir 14
The Centers for Disease Control and Prevention also recommends reducing the clarithromycin dose by 50% when used with ritonavir or lopinavir-ritonavir in patients with CrCl <60 mL/min, and by 75% when used with ritonavir or lopinavir-ritonavir in patients with CrCl <30 mL/min 14

The Centers for Disease Control and Prevention notes that clarithromycin AUC decreases by 39% when used with efavirenz, and by 35% when used with nevirapine, requiring close monitoring for treatment failure 14

The American Academy of Family Physicians notes that macrolide resistance in Streptococcus pneumoniae and Staphylococcus aureus is well-documented and varies geographically 13

The Centers for Disease Control and Prevention recommends clarithromycin administration at 500 mg twice daily (every 12 hours) for standard immediate-release formulations, or 1000 mg once daily for extended-release formulations in adults 15, 16
For children over 1 month, the recommended dose is 15 mg/kg per day divided into 2 doses (maximum 1 g per day) for 7 days 15, 16
Infants under 1 month should not be given clarithromycin due to the unknown association with infantile hypertrophic pyloric stenosis (IHPS) 15

For pertussis treatment in adults, the recommended dose is 1 g per day in two 500 mg doses for 7 days 15
For pertussis treatment in children over 1 month, the recommended dose is 15 mg/kg per day in 2 divided doses for 7 days 15
For Mycobacterium avium Complex (MAC) treatment, the recommended dose is 500 mg twice daily with ethambutol 15 mg/kg daily 17
For pediatric MAC treatment, the recommended dose is 7.5 mg/kg twice daily (maximum 500 mg per dose) 17

In patients with severe renal impairment (CrCl <30 mL/min), the dose should be reduced by 50% while maintaining twice-daily frequency 15
The maximum daily dose for children should not exceed 1 g per day, regardless of weight-based calculation 15
Infants under 1 month should not be given clarithromycin due to the potential risk of IHPS 15

For treatment of Mycobacterium avium complex (MAC), clarithromycin 500 mg twice daily should be given in combination with ethambutol 15 mg/kg once daily. [18][19]
For MAC prophylaxis in patients with advanced immunosuppression (e.g., CD4 < 50 cells/µL), clarithromycin 500 mg twice daily is recommended. 19

For skin and soft‑tissue infections, clarithromycin 250 mg administered four times daily is an effective regimen. 20

Immediate‑release clarithromycin tablets may be taken with or without food; the standard dose is 500 mg twice daily. 18

Gastro‑intestinal symptoms (metallic taste, nausea, vomiting, diarrhea) are dose‑related and represent the most common adverse effects of clarithromycin. 18
Baseline electrocardiogram (ECG) and a repeat ECG at 2 weeks are advised for patients at risk of QT‑interval prolongation. 18
Baseline audiometry, with follow‑up if auditory symptoms appear, is recommended because long‑term clarithromycin use can cause hearing loss and tinnitus. 18
Routine laboratory monitoring—including complete blood count and renal and hepatic function tests—should be performed during prolonged clarithromycin therapy. 18