Clarithromycin Dosing Guidelines

Pediatric Dosing

• The Centers for Disease Control and Prevention recommends clarithromycin dosing for children over 1 month to 12 years at 15 mg/kg/day divided into 2 doses (maximum 1 g/day) for 7-10 days 1
• Infants under 1 month should not be given clarithromycin due to unknown safety profile 1

Adult Dosing

• The Centers for Disease Control and Prevention recommends clarithromycin dosing for adults at 500 mg twice daily for 7-14 days 1, 2

Critical Safety Warnings

• The Centers for Disease Control and Prevention states that clarithromycin is absolutely contraindicated in patients with a history of hypersensitivity to any macrolide antibiotic 1, 2
• The Centers for Disease Control and Prevention warns against concomitant use of clarithromycin with astemizole, cisapride, pimozide, or terfenadine due to risk of cardiac arrhythmias including torsades de pointes 1, 2, 4
• Clarithromycin inhibits CYP3A enzymes, leading to elevated concentrations of drugs metabolized by this pathway, such as carbamazepine, cyclosporine, digoxin, theophylline, and warfarin 1

Dosage Adjustments

• The Centers for Disease Control and Prevention recommends reducing clarithromycin dose by 50% in severe renal impairment (CrCl <30 mL/min) 5
• The Centers for Disease Control and Prevention recommends reducing clarithromycin dose by 50% when co-administered with ritonavir or lopinavir-ritonavir if CrCl <60 mL/min 5