clarithromycin (Biaxin)

Drug description
NIAID alert 7/27/96: clarithromycin (Biaxin) should not be used at doses over 1000 mg a day, as doses higher than that have been associated with poor survival.

Clarithromycin is an antibiotic approved for treatment of common bacterial infections in non-immunocompromised individuals. Clarithromycin is used orally for the treatment of upper and lower respiratory tract and skin and skin structure infections. Clarithromycin is approved for the treatment of MAC. It may also be useful alone, or in combination with azithromycin, for the treatment of toxoplasmosis. Clarithromycin may be an effective prophylaxis treatment for toxoplasmosis and MAC. Recent Public Health Service recommendations suggest either clarithromycin or azithromycin as the first line treatment for MAC, along with at least one other drug, usually ethambutol and one of the following: ciprofloxacin or rifabutin.

Side effects
Clarithromycin is generally well tolerated. Infrequent side effects are diarrhea, nausea, and abnormal taste. Clarithromycin may cause severe abdominal pain at high doses. There has recently been two reports of people experiencing mania as a side effect of clarithromycin. The mania went away when the drug was stopped.

Dosage
Clarithromycin comes in 250 mg and 500 mg tablets. Dosage has to be determined by a doctor for each person.

How long it may take to work
Continual use on a regular schedule for 4-6 days to treat infection is usually necessary. For streptococcal throat infections, treatment is at least 10 days. Multiple-drug treatment of MAC with clarithromycin at 500 mg to 2 g daily, ethambutol, and/or ciprofolxacin, clofazimine, amikacin or rifabutin is for at least 6 weeks. Ongoing maintenance therapy as prophylaxis for toxoplasmosis and MAC is required. Maintenance treatment means you keep taking the drug to control an infection so that you don't become ill.

Managing side effects
If diarrhea develops and continues for more than 24 hours, let your doctor know promptly.

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