Treatment with clarithromycin. Taking Clarithromycin while breastfeeding. Professional medical publications concerning the use of clarithromycin in the eradication of Helicobacter pylori

Gross formula

Pharmacological group of the substance Clarithromycin

Nosological classification (ICD-10)

CAS code

Characteristics of the substance Clarithromycin

Semi-synthetic macrolide antibiotic.

White or almost white crystalline powder, soluble in acetone, slightly soluble in methanol, ethanol, acetonitrile and practically insoluble in water. Molecular weight 747.96.

Pharmacology

It binds to the 50S ribosomal subunit of the microbial cell and inhibits protein synthesis.

When taken orally, it is rapidly absorbed from the gastrointestinal tract, bioavailability in healthy volunteers is approximately 50%. Food slows absorption without significantly affecting bioavailability. In adults, the bioavailability of oral suspension and tablets is similar. In healthy volunteers, T max when taken orally on an empty stomach is achieved within 2-3 hours. It binds to plasma proteins. About 20% taken dose immediately oxidized in the liver with the formation of the main metabolite 14-hydroxyclarithromycin (14-OH clarithromycin), which has a pronounced antimicrobial activity against haemophilus influenzae. Biotransformation is catalyzed by enzymes of the P450 cytochrome complex. Steady-state concentrations of clarithromycin and its major metabolite are reached within 2-3 days. When taking 250 mg of clarithromycin every 12 hours, C max clarithromycin in the equilibrium state is approximately 1-2 μg / ml, C max 14-OH clarithromycin is 0.6-0.7 μg / ml; when taking 500 mg every 12 hours C max clarithromycin - 2-3 mcg / ml, every 8 hours - 3-4 mcg / ml, for 14-OH clarithromycin C max when taking 500 mg every 8-12 hours - up to 1 mcg / ml. Clarithromycin and 14-OH clarithromycin penetrate well into body fluids and tissues, incl. into lungs, skin, soft tissues, creating concentrations 10 times higher than the level in the blood serum. The volume of distribution is 243-266 liters. T 1/2 clarithromycin when taking 250 mg every 12 hours - 3-4 hours, 14-OH clarithromycin - 5-6 hours; when taking 500 mg every 8-12 hours, the T 1 / 2 values ​​\u200b\u200bof clarithromycin and its main metabolite increase to 5-7 hours and 7-9 hours, respectively. It is excreted by the kidneys and with feces. When excreted in the urine: unchanged - 20-30% (when taking tablets 250 and 500 mg 2 times a day) or 40% (when taking 250 mg as a suspension 2 times a day); 14-OH clarithromycin accounts for 10% and 15% of the 250 and 500 mg twice daily doses excreted in the urine, respectively. Approximately 4% of a 250 mg dose is excreted in the faeces.

Elderly age. In elderly patients (65-81 years) who received 500 mg of clarithromycin every 12 hours, at steady state, C max and AUC of clarithromycin and 14-OH clarithromycin were increased compared with those in healthy volunteers young age. No dose adjustment of clarithromycin is required when used in the elderly, except in cases of severe renal insufficiency.

Impaired liver function. In hepatic dysfunction, steady-state concentrations of clarithromycin did not differ from those in patients with normal liver function, while steady-state concentrations of 14-OH clarithromycin in patients with impaired liver function were significantly lower. In case of impaired liver function, a decrease in the excretion of drugs in the form of 14-OH clarithromycin is partially offset by an increase in the excretion of clarithromycin by the kidneys, as a result of which the equilibrium concentration of clarithromycin changes slightly and dose adjustment is not required.

Impaired kidney function. In patients with impaired renal function, plasma concentrations of clarithromycin, T 1/2 , C max and C min , AUC of clarithromycin and 14-OH clarithromycin are increased. In patients with severe renal impairment (with Cl creatinine less than 30 ml / min), dose adjustment may be required.

Active against many microorganisms, incl. intracellular (Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia trachomatis and Chlamydia pneumoniae, Ureaplasma urealyticum), gram-positive - Staphylococcus spp., Streptococcus spp.(incl. Streptococcus pyogenes, Streptococcus pneumoniae), Listeria monocytogenes, Corynebacterium spp., and Gram-negative bacteria (Haemophilus influenzae, Haemophilus parainfluenzae, Haemophilus ducreyi, Moraxella catarrhalis, Bordetella pertussis, Neisseria meningitidis, Borrelia burgdorferi, Pasteurella multocida, Campylobacter spp., Helicobacter pylori), some anaerobes ( Eubacterium spp., Peptococcus spp., Propionibacterium spp., Clostridium perfringens, Bacteroides melaninogenicus), Toxoplasma gondii, Mycoplasma pneumoniae, mycobacteria ( Mycobacterium avium complex, including Mycobacterium avium and Mycobacterium intracellulare).

When administered to animals, hepatotoxicity was noted (including in rats and monkeys at doses 2 times the maximum daily dose for humans, calculated in mg / m 2, and in dogs at doses comparable to it). Renal tubular degeneration has occurred in rats, monkeys and dogs at doses (calculated in mg/m 2 ) greater than 2, 8, and 12 times the MRDF, respectively. Testicular atrophy has been observed in rats at doses (in mg/m2) 7 times the MRDH, 3 times the MRDA in dogs, and 8 times the MRDA in monkeys. Corneal opacity has been observed at doses (in mg/m 2 ) above the MRHD by 12 times in monkeys and 8 times in dogs. Lymphoid depletion has been reported in dogs at doses (mg/m2) of 3 times the MRHD and 2 times in monkeys.

These adverse effects were not observed during clinical trials clarithromycin.

No mutagenic effect of clarithromycin was detected in a number of tests in vitro(mammalian salmonella/microsome test, dominant lethal test in mice, micronucleus test in mice, etc.). When conducting in vitro test for chromosome aberrations in one case, a weak positive result, in the other it is negative. The Ames test with clarithromycin metabolites was negative.

In experiments on male and female rats treated daily with clarithromycin at doses up to 160 mg / kg / day (1.3 times higher than the MRH, in mg / m 2), no adverse effects on the estrous cycle, fertility, childbirth, number and offspring viability. Plasma levels in rats after doses of 150 mg/kg/day were 2 times higher serum level in a person.

Studies in monkeys have shown that at doses of 150 mg / kg / day, plasma concentrations are 3 times higher than those observed in humans. Ingestion of clarithromycin at doses of 150 mg/kg/day (2.4 times higher than the MRDH, in mg/m 2) marked the death of embryos, which is explained by the pronounced toxic effect of this high dose of clarithromycin on the body of females.

In rabbits, with intravenous administration of clarithromycin at a dose of 33 mg / m 2 (17 times higher than the MRDC), intrauterine fetal death was noted.

No long-term animal studies have been conducted to assess the potential carcinogenicity of clarithromycin.

In four studies of teratogenicity in rats (three with oral clarithromycin, one with intravenous doses up to 160 mg/kg/day during major organ development) and two studies in rabbits with oral doses up to 125 mg/day kg / day (approximately 2 times higher than the MRDC, in mg / m 2) or / in the introduction at doses of 30 mg / kg / day from the 6th to the 18th day of pregnancy, the teratogenic effect of clarithromycin was not detected. Two additional studies in a different strain of rats treated with oral clarithromycin at approximately the same doses and under similar conditions demonstrated a low incidence of malformations. of cardio-vascular system at doses of 150 mg / kg / day, received in the period from the 6th to the 15th day of pregnancy. Plasma levels following a 150 mg/kg/day dose of clarithromycin were 2-fold higher than those observed in humans. The development of the cleft palate was observed when administered to rats at doses of 500-1000 mg / kg / day in the period from the 6th to the 15th day of pregnancy. In monkeys, oral clarithromycin at a dose of 70 mg/kg/day (approximately equal to the MRHD in mg/m 2 ) showed a delay in fetal development (with plasma levels 2 times higher than those in humans).

Application of the substance Clarithromycin

Bacterial infections caused by susceptible microorganisms: infections of the upper respiratory tract (laryngitis, pharyngitis, tonsillitis, sinusitis), lower divisions respiratory tract (bronchitis, including exacerbation chronic bronchitis, pneumonia, SARS), skin and soft tissues (folliculitis, furunculosis, impetigo, wound infection), otitis media; peptic ulcer and duodenum(eradication Helicobacter pylori as part of combination therapy), mycobacteriosis (including atypical, in combination with ethambutol and rifabutin), chlamydia.

Contraindications

Hypersensitivity (including to erythromycin and other macrolides), porphyria, simultaneous reception cisapride, pimozide, astemizole, terfenadine (see "Interaction").

Application restrictions

Renal and / or liver failure, newborns and children under 6 months (safety has not been established).

Use during pregnancy and lactation

During pregnancy, it is possible only in cases where the expected effect of therapy outweighs the potential risk to the fetus in the absence of an alternative suitable therapy(Adequate and well-controlled studies of the safety of use in pregnant women have not been conducted). If pregnancy occurs during treatment with clarithromycin, the patient should be warned of the possible risk to the fetus.

At the time of treatment, breastfeeding should be discontinued (clarithromycin and its active metabolite pass into breast milk, the safety of use during breastfeeding has not been established).

Side effects of Clarithromycin

From the nervous system and sensory organs: headache, dizziness, anxiety, fear, insomnia, nightmares, tinnitus, taste change; rarely - disorientation, hallucinations, psychosis, depersonalization, confusion; in isolated cases - hearing loss, passing after the abolition of drugs; there are reports of rare cases paresthesia.

From the digestive tract: dysfunction of the gastrointestinal tract (nausea, vomiting, gastralgia / abdominal discomfort, diarrhea), stomatitis, glossitis, transient increase in liver transaminases, cholestatic jaundice; rarely - pseudomembranous enterocolitis; there are reports of rare cases of hepatitis; in exceptional cases liver failure was observed.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): rarely - thrombocytopenia (unusual bleeding, hemorrhage), leukopenia; extremely rare - prolongation of the interval QT, ventricular arrhythmia, incl. ventricular paroxysmal tachycardia, flutter/flicker of the ventricles.

From the genitourinary system: there are reports of rare cases of an increase in serum creatinine concentration, the development of interstitial nephritis, and renal failure.

Allergic reactions: skin rash, itching, malignant exudative erythema(Stevens-Johnson syndrome), anaphylactoid reactions.

Others: development of resistance of microorganisms; in rare cases, hypoglycemia (against the background of treatment with oral hypoglycemic agents and insulin).

Interaction

When taken simultaneously with cisapride, pimozide, astemizole, terfenadine, the interval may be lengthened QT, the development of cardiac arrhythmias (ventricular paroxysmal tachycardia, fibrillation, ventricular flutter / flicker). The simultaneous use of clarithromycin and ergotamine or dihydroergotamine caused acute ergotamine intoxication in some patients, manifested by peripheral vasospasm and dysesthesia. Clarithromycin increases the blood concentration (enhances the effects) of drugs metabolized in the liver with the participation of cytochrome P450 enzymes: warfarin and other indirect anticoagulants (there are separate post-marketing reports that, in the case of combination with oral anticoagulants, clarithromycin can potentiate their effect, in case of joint use it is necessary to carefully monitor the PT), carbamazepine, theophylline, astemizole, cisapride, triazolam, midazolam, cyclosporine, digoxin, phenytoin, ergot alkaloids, etc. (with simultaneous use, it is recommended to measure their concentration in the blood). With simultaneous administration of HMG-CoA reductase inhibitors (lovastatin, simvastatin), acute necrosis of skeletal muscles is possible. Clarithromycin reduces the clearance of triazolam (increases its pharmacological effects with the development of drowsiness and confusion).

With the simultaneous use of oral clarithromycin and zidovudine in HIV-infected adult patients, the equilibrium concentrations of zidovudine decreased. When taking 500 mg of clarithromycin twice a day, the AUC of zidovudine at steady state decreased by an average of 12% (n=4). Individual values ​​ranged from a 34% decrease to a 14% increase. Limited data from 24 patients who took clarithromycin 2-4 hours prior to oral zidovudine suggest that steady-state zidovudine concentration (C max ) was approximately 2-fold increased, with no change in AUC. The simultaneous use of clarithromycin and didanosine in 12 HIV-infected patients did not lead to statistically significant changes pharmacokinetics of didanosine.

Co-administration of clarithromycin and ritonavir (n=22) increased the AUC of clarithromycin (by 77%) and decreased the AUC of 14-OH clarithromycin (by 100%). In this regard, clarithromycin can be used in usual doses(but not higher than 1 g/day) in patients with normal renal function receiving ritonavir. However, in patients with renal insufficiency, the dose of clarithromycin is reduced at Cl creatinine 30-60 ml / min by 50%, less than 30 ml / min - by 75%.

The simultaneous use of 200 mg of fluconazole daily and 500 mg of clarithromycin 2 times a day in 21 healthy volunteers caused an increase in the equilibrium C min and AUC of clarithromycin by 33 and 18%, respectively, while the equilibrium concentration of 14-OH clarithromycin did not change.

Perhaps the development of cross-resistance between clarithromycin and other antibiotics from the group of macrolides, as well as lincosamides (lincomycin and clindamycin).

With daily intake of 500 mg of clarithromycin every 8 hours in combination with omeprazole 40 mg in healthy volunteers, the values ​​of the pharmacokinetic parameters of omeprazole in the equilibrium state increased: plasma concentration (C max ) - by 30%, AUC 0-24 - by 89%, T 1 / 2 - by 34%. The pH value in the stomach for 24 hours was 5.2 when taking omeprazole alone and 5.5 when taking omeprazole with clarithromycin together. When taken together, plasma levels of clarithromycin and its active metabolite increased - for clarithromycin: C max - by 10%, C min - by 27%, AUC 0-8 - by 15%, for 14-OH clarithromycin: C max - by 45% , C min - by 57%, AUC 0-8 - by 45%; concentrations of clarithromycin in the tissues and gastric mucosa were also increased when taken simultaneously.

The combined use of clarithromycin and ranitidine bismuth citrate led to an increase plasma concentration ranitidine (by 57%), bismuth (by 48%) and 14-OH clarithromycin (by 31%), these effects were not clinically significant.

Overdose

Symptoms: dysfunction of the gastrointestinal tract (nausea, vomiting, diarrhea, abdominal pain), headache, confusion.

Treatment: gastric lavage, symptomatic therapy. Hemodialysis and peritoneal dialysis are not effective.

Precautions Substance Clarithromycin

It is prescribed with caution against the background of drugs metabolized in the liver (it is recommended to measure their concentration in the blood).

Clarithromycin modified release is contraindicated in patients with severe renal insufficiency (creatinine clearance less than 30 ml / min), such patients are prescribed clarithromycin rapid release tablets.

Consideration should be given to the possibility of cross-resistance between clarithromycin and other macrolide antibiotics, lincomycin and clindamycin. With prolonged or repeated use of the drug, superinfection may develop (growth of insensitive bacteria and fungi). In case of severe, prolonged diarrhea, which may indicate the development of pseudomembranous colitis, it is necessary to stop taking the drug and consult a doctor.

Interactions with other active substances

Trade names

Clarithromycin 500 and 250 mg is a new generation antibiotic. Its action is based on the destruction of several types of anaerobic microorganisms at once. Unlike other types of drugs in this area, it is absolutely safe, has a minimum of contraindications and does not cause harm even when long-term use. But you can achieve high results only if you use Clarithromycin 500 mg according to the instructions for use and following the recommendations of the doctor who prescribed it.

Composition and medicinal properties of Clarithromycin tablets 500 mg

This antibiotic belongs to the group of macrolides - drugs with an extensive, but sparing therapeutic effect for the body. They are often prescribed in combination with antibiotics of other types, but in the course of clinical trials their individual ability to suppress the activity of both gram-positive and gram-negative microorganisms has been proven, to have a destructive effect even on those that develop inside tissue cells and in the intercellular space.

The main active ingredient of the drug is clarithromycin. It is derived from, but is more resistant to decomposition under the influence of salts, is able to penetrate deep into the structure of all types of body tissues and linger there. As excipients, Clarithromycin 500 mg tablets include

• Povidone;
• magnesium stearate;
• Starch;
• Aerosil;
• Talc.

The drug is hypoallergenic, it can be taken by patients who do not tolerate antibiotics from a number of penicillins. Before starting treatment, samples of the patient's biomaterials are taken to determine the type of infectious or viral lesion.

Indications and contraindications for the use of Clarithromycin

The instructions for use of Clarithromycin 500 tablets list almost all types of diseases, that is, its spectrum of action is much wider than that of other types of antibiotics:

• HIV infections and tuberculosis;
• Inflammatory and infectious diseases of the upper respiratory tract;
• Dentistry, including exposure to dental tissues;
• Urogenital diseases;
• Pneumonia, including atypical;
• infections skin;
• Diseases of the gastrointestinal tract.

High efficiency, positive reviews About Clarithromycin 500mg for both patients and medical practitioners makes it a sought after treatment for many diseases. A decrease in the intensity of the manifestation of symptoms of the disease is noted after 2-3 days of using the drug. But before starting a course of taking this antibiotic, it is necessary to exclude the presence of the following contraindications in the patient:

1. Hepatitis;
2. Liver failure;
3. Allergy to the active substance or one of the excipients;
4. Pregnancy or breastfeeding period;
5. Porfiry.

During treatment with the drug, side effects may also appear - a change in the taste of food, hearing or vision impairment, tinnitus, dizziness, anxiety, confusion, candidiasis or stomatitis, colitis, arrhythmia.

If at least one of the listed symptoms appears, the patient should notify the attending physician, who will decide whether to reduce the dosage or completely cancel the drug.

How to take the drug

Dosage and duration of course treatment with Clarithromycin 500 mg - according to the instructions for use. In some cases, it may be higher or lower than indicated by the manufacturer, but such decisions can only be made by the attending physician, based on an analysis of the patient's biomaterials and the overall picture of the disease.

High doses are prescribed for severe course illness, and only short period– from 2 to 5 days. After analyzing the patient's condition, a decision is made to change the intensity of treatment. The standard dosage recommended in the instructions for use of Clarithromycin 500 is 3 tablets per day for 7-14 days.

When prescribing the drug, the doctor must warn the patient that Clarithromycin 500 mg should be taken after meals. It is better to exclude dairy products and alcohol from the diet. In the first case, the effectiveness of the drug may decrease, and in the second, there is a high risk of serious side effects, malfunctions in the gastrointestinal tract, dizziness and convulsions, and psychosis.

Despite the fact that the drug is able to complement other types of antibiotics, there are a number of drugs with which it cannot be combined. These are Astemizol, Cisapride, Pimozide, Terfenadine. They suppress each other's action and can exacerbate the disease.

Acceptance of it medicinal product should be accompanied by supervision medical specialist, clinical and biochemical control of blood, urine. In the treatment of certain diseases of the gastrointestinal tract, the work of the intestine, its reaction to the drug, is monitored.

How much is Clarithromycin 500mg

The cost of the drug depends on its brand. The price of Clarithromycin 500 mg Teva ranges from 100 to 300 rubles, depending on the number of tablets in the package. The cost of analogues from other manufacturers is identical.

The low price makes the drug affordable for patients from any social category and with any income.

Clarithromycin 500 mg - reviews of patients and physicians

Medical specialists in their reviews of Clarithromycin 500 mg note it high efficiency in the treatment of urogenital diseases and infections transmitted through unprotected intercourse. According to practitioners, the result is always positive, and among the side effects, disorders in the gastrointestinal tract most often occur.

Most patients treated with Clarithromycin complain of the same side effect of nausea, diarrhea, and lack of appetite. But the results of treatment justify these short-term inconveniences. Side effects disappeared immediately after the addition of the course of treatment with auxiliary drugs that control the work of the gastrointestinal tract, sometimes it was required to reduce the dosage of Clarithromycin.

Like other antibiotics, Clarithromycin 500 mg should be taken only as prescribed by a doctor, after a detailed and in-depth study of the causes and intensity of the disease, analysis of the patient's biomaterials, in accordance with the individual characteristics of his body and the presence chronic problems with health. Self-medication with antibiotics is unacceptable, even if they are inexpensive and freely available.

When prescribing the drug, the doctor will definitely explain why Clarithromycin is needed. Instructions for use for it indicate the possibility of various side effects, but it is not always clear at first reading which of them really threaten many, and which are extremely rare. Consider the reviews and official information to figure out how dangerous the antibiotic is, what to expect from it.

Negative aspects: general information

Side effects of Clarithromycin (500 mg and other dosage forms) include anxiety, sleep disturbances, and bad dreams. Some note that while taking the drug, the head was ill and dizzy, and disorientation was occasionally disturbing. Manufacturers specify that the drug can provoke psychosis and various visions. There is a risk of depersonalization.

Quite often, as clinical practice has shown, side effects occur when taking Clarithromycin: bitterness in the mouth, nausea and vomiting, and pain in the abdomen. Against the background of taking an antibiotic, an inflammatory process may develop in the oral cavity (on the buccal mucosa, tongue). Occasionally laboratory tests show increased activity of liver enzymes. There is a risk of jaundice. In rare cases, the drug provokes pseudomembranous enterocolitis.

It is known that against the background of the use of the drug increases the likelihood of developing superinfection. Pathological microflora can develop resistance to the active component of the drug.

What to fear?

Confirm the side effects indicated in the instructions for the use of Clarithromycin, reviews of people who used this antibiotic. Since the drug is affordable, proven and effective, it is prescribed quite often, so there are many responses about taking it. The product is known to cause tinnitus, with some patients reporting that this side effect worried for some time after the completion of therapy. It is known that in isolated cases, tablets can cause deafness. The phenomenon is reversible, hearing is restored as soon as the medication is canceled.

Quite rare in the background drug course thrombocytopenia occurs malignant erythema. There is a risk of skin rashes and individual itchy areas. The drug can cause an anaphylactoid response of the body.

FDA studies suggest that additional side effects of Clarithromycin are associated with a long therapeutic course. The use of an antibiotic for a long time against the background of diseases of the heart and blood vessels probably creates mortal risks, increases the likelihood of complications. The fact of the unsafety of the drug is confirmed by one decade of monitoring of patients suffering from ischemia of the heart. It was revealed that among the people of this group who used Clarithromycin for two weeks or more, for an inexplicable reason, the percentage deaths. Probably, increased risk mortality persists for one year from the end of the antibiotic.

When to apply?

Of course, you are more likely to experience the side effects of Clarithromycin if you use it for other purposes. To avoid such a mistake, the drug is used only under the supervision of a doctor. The medication in question is prescribed if the patient has a bacterial infection, and laboratory research confirm the sensitivity of microflora to the agent in question.

"Clarithromycin" is prescribed for inflammation in the respiratory system. The drug is effective in processes both in the upper respiratory tract and in the lower ones. Its effectiveness has been proven in laryngitis, tonsillitis, various forms of the common cold, pulmonary inflammation (including atypical) and bronchial, tonsillitis.

Clarithromycin is prescribed for folliculitis, boils, infection of wounds and impetigo.

The drug has shown its effectiveness in otitis media and ulcers in the stomach and intestines.

It is used for infection with chlamydia, mycobacterium. However, with any diagnosis, before prescribing, you should first evaluate the obvious benefit to the patient, analyze possible side effects, contraindications of Clarithromycin (all of them are given in the accompanying documentation for the tablets).

Theory and practice: how does the drug work?

The persons who took the remedy in question in their reviews side effects"Clarithromycin" traditionally pays considerable attention - indeed, many face negative phenomena, and in a certain percentage of cases they are quite significant. It is noted that the drug is effective against the underlying disease, which, according to some, fully justifies the adverse effects. At the same time, it is clear that some negative phenomena disturb not only during the course, but also after.

Quite often, people who used pills in their reviews of the side effects of Clarithromycin mention bitterness in the mouth. Presumably, this is the most common of the pronounced and unpleasant effects of the composition. Bitterness cannot be washed down, seized. The phenomenon worries even with strict adherence to the instructions and careful swallowing of the drug, without violating the integrity of the shell. It is noted that unpleasant feeling in the mouth most actively a quarter of an hour after taking the medication. Some pointed out that they sought to alleviate the condition with caramel.

Nuances and troubles: what else is possible

Should I take Clarithromycin? Reviews of doctors who regularly prescribe this drug to patients in their clinical practice agree on its effectiveness. Indeed, the antibiotic quickly gives a pronounced and positive effect. It is extremely rare that his course is ineffective against microflora. At the same time, it is noted that the use of tablets in a number of patients leads to severe pain in the stomach. For some, the pain is so pronounced that you have to completely abandon the therapeutic course.

One of the disadvantages of the composition in question is its effect on the liver. "Clarithromycin" for this reason causes strong bitterness in the mouth. The phenomenon worries not only during the course of treatment, but also after it. It is noted that, on average, the side effect completely disappears only a month after taking the last pill (for some, later). Of course, the manufacturer in the accompanying instructions indicates the possibility of this phenomenon, however, this knowledge does not make it easier for patients, which is confirmed by various responses.

Combine and combine: is it possible?

Sometimes doctors prescribe a complex course: both Amoxicillin and Clarithromycin. Side effects in this case can be quite unpleasant. In general, the drug in question is very poorly combined with others, so its use as an element complex therapy practiced infrequently. Simultaneous use with "Amoxicillin" has proven to be a good approach to the treatment of severe infectious diseases, but this practice is associated with a number of dangers.

Often, before prescribing a comprehensive course, the doctor clarifies how well the patient tolerates antimicrobial drugs in general. This is due to the nuances of the influence of "Clarithromycin" on the body: it is he who most often provokes undesirable responses, activating, among other things, Negative influence"Amoxicillin". People who took this combination of drugs noted that they were worried not only by bitterness in the mouth, which could not be overcome by any means. Side effects of Clarithromycin in children and adults included severe dizziness and rapid heartbeat. In responses, some patients indicate hallucinations that came at night, disturbed sleep and did not allow them to fully rest.

Features of influence and practice

Side effects of "Clarithromycin" are often observed in women using the drug due to gynecological diseases. It is known that with such diagnoses, the remedy is prescribed quite often. In addition, the practice of a preventive course is widespread, when tablets are prescribed even without indications that are mandatory for their use. As you can see from the responses, this is not for everyone. Side effects are of great concern to those who start taking Clarithromycin at their own discretion, without consulting a doctor at all.

From the responses it can be seen that the most typical side effects of Clarithromycin in women are pain in the lower abdomen, thrush, sleep disturbance, changes in psycho-emotional status, tearfulness. It is noted that against the background of taking the tablets there were severe pain on the right under the ribs, the chair was broken, he vomited. Some women who took the drug complained of panic attacks.

Official Instructions: Unwanted Effects

It is not always easy for a specialist to decide whether or not to prescribe Clarithromycin to a child. Reviews of doctors testify: the drug is effective, effective, but the price of this is quite high, since many are faced with negative effects. Perversion of taste, disturbances in the functioning of the gastrointestinal tract are the most typical phenomena.

On the other hand, all the negative consequences mentioned in the instructions for use are also characteristic of other macrolides - a group of antibiotics to which Clarithromycin belongs. These effects are not something fundamentally abnormal, so they will not be a reason to cancel the composition, although in some cases the doctor may recommend stopping treatment. This is possible if negative effects very very strong. You should not interrupt the program on your own: you need to consult a doctor. The specialist will determine how to replace Clarithromycin or how to smooth out negative phenomena in order to complete the antimicrobial course completely.

Clinical trials on the side effects of Clarithromycin showed that they do not depend on the presence of mycobacteria in the pathological microflora. Of particular interest are post-marketing studies on different schemes and options for drug use. A large-scale collection of information regarding the activity of all existing forms release.

Clarified and confirmed: the dangers indicated in the instructions

Among the side effects of Clarithromycin, the likelihood of cellulite is mentioned. The therapeutic course can cause gastroenteritis, vaginal infection, erysipelas, erythrasma. It is known that the drug can provoke neutro-, thrombocyto-, leukopenia, cause agranulocytosis or eosinophilia. Cases of thrombocythemia have been reported. The drug may cause a reaction hypersensitivity, intolerance, anaphylactic response. The frequency of such negative effects has not yet been established. Some patients experience weight loss and loss of appetite. A possible consequence of treatment is hypoglycemia.

Many patients are concerned about the side effects of Clarithromycin on the central nervous system. The drug disrupts sleep and makes a person anxious and nervous. There are many cases when, against the background of a therapeutic course, unpredictable screams were characteristic of patients. It was not possible to establish the frequency of psychosis and depersonalization, confusion and depressed psycho-emotional status. It is known that "Clarithromycin" can cause nightmares, mania, loss of orientation in space, visions. For some, it provokes malfunctions of the auditory system and vestibular apparatus.

Dangers lie in wait: rare, but extremely unpleasant

"Clarithromycin" can cause dyskinesia, dysgeusia, ano-, parosmia, convulsions, ageusia, tremor. Sometimes, against the background of a therapeutic course, you feel sleepy, dizzy and have a headache. Episodes of unconsciousness are possible. There is a risk of cardiac arrest and atrial fibrillation, increased speed and rhythm disturbances in the contraction of the heart muscle, including tachycardia according to the "pirouette" principle. There is a possibility of an increase in the duration of the QT interval, extrasystole. It was determined that the drug in question can cause hemorrhage, vasodilation. For the first, the frequency is not specified, the second is observed in 10% of patients or more often.

While taking Clarithromycin, there is a risk of developing asthma, nosebleeds, and pulmonary vascular embolism. The drug can provoke esophagitis and reflux, gastritis, increased gas formation, bloating. Some are observed liquid stool, others have constipation. There is a risk of belching, dry mouth. It was not possible to find out with what frequency "Clarithromycin" provokes pancreatitis, a change in the shade of teeth and tongue, but it is known for sure that there is a risk of such side effects.

Unwanted responses: variety is great

Sometimes "Clarithromycin" provokes cholestasis or liver failure. It can cause urticaria, bullous dermatitis, hyperhidrosis, necrolysis, acne. Some patients experienced uncontrolled muscle spasms, rigidity of the muscles that support the skeleton, rhabdomyolysis. Possible myopathy. AT circulatory system may increase creatinine concentration, urea content. There is a possibility of interstitial nephritis. Some patients have a fever, others have chest pains. Against the background of tablets, chronic fatigue, general malaise and weakness, chills are possible.

Laboratory studies can reveal a change in the ratio of globulin and albumin, an increase in alkaline phosphatase and lactate dehydrogenase. There is a possibility of an increase in prothrombin time. In some patients, the color of the urine changed. Several reports of uveitis have been received. Such a side effect is more likely when combining Clarithromycin and Rifabutin. As a rule, the phenomenon is reversible. In old age, with insufficient kidney function, when combined with colchicine, the likelihood of poisoning the body increases, which can cause the death of the patient.

And what to replace?

Against the background of all of the above, a fair question arises: are there more safe analogues drug Clarithromycin? On sale are following pills with the same composition:

• "Clabax".
• Aziklar.
• "Clarbact".
• "Clarith".

However, they can also cause undesirable consequences for the body. To minimize such phenomena, drugs should be used strictly under the supervision of a doctor. It is forbidden to take the drug on its own, without evidence for this. It is impossible to use the composition for a short-term course, to refuse it only because of an improvement in the condition, without completing the program completely. It is possible to replace Clarithromycin with any other antibiotic only after agreement with the doctor, otherwise the drug program is likely to be ineffective.

Is it possible or not?

To minimize the likelihood of a negative response, before taking the drug, you should study the accompanying documentation, paying special attention to the contraindications section. Side effects of Clarithromycin, if the remedy is used against the background of contraindications, will be more pronounced and stronger.

It is necessary to refrain from taking the drug in case of hypersensitivity to its components or any other macrolides. The drug is not taken during the course of midazolam. It cannot be used if there was a torsades de pointes, ventricular arrhythmia, QT interval prolongation in the past. The remedy is contraindicated in case of a lack of potassium in the body, a severe form of insufficiency of the liver and kidneys.

Especially responsibly it is necessary to take the selection of a therapeutic course if a person is forced to use any medications. "Clarithromycin" is not combined with astemizole, carob alkaloids, statins, terfenadine. Do not use an antibiotic in combination with pimozide, cisapride, colchicine, ranolazine, ticagrelor.

How to use correctly?

For patients older than twelve years of age, "Clarithromycin" is recommended to use 250 mg every 12 hours. If the infection is severe, double the dose. Course duration - 6-14 days. The drug is used regardless of the meal, since food does not correct the bioavailability of the active compound.

With odontogenic infections, five days in a row, twice a day with twelve-hour breaks, take 250 mg each. In case of mycobacterial invasion, the agent is first used at a dose of 0.5 g twice a day for 3-4 weeks. If the program does not give the desired result, the dose can be doubled.

In case of disseminated MAC infection on the background of AIDS, the duration of the course is as long as the agent shows effectiveness, confirmed by analyzes. It is allowed to combine the drug and some other antibiotics.

Diagnoses and nuances

If the indication for the appointment of "Clarithromycin" is the eradication of Helicobacter pylori, the localization of the ulcer is the intestine, a triple course may be prescribed. Its duration is 7-10 days. The drug is taken twice a day, 0.5 g in combination with twice the dose of Amoxicillin. In addition, 20 mg of Omeprazole is taken once a day.

An alternative ten-day program involves combining the described composition, taking it twice a day at 0.5 g in combination with 20 mg of Lansoprazole. Also twice a day use "Amoxicillin" (1 g).

For two weeks, a combination of Clarithromycin and Omeprazole may be prescribed. During the day, the first drug is used three times at 0.5 g, the second - once 40 mg. After the first two weeks, the program is continued only with Omeprazole, using it at 20-40 mg once a day for another two weeks.

Similarly, you can combine the described tool and Lansoprazole. The antibiotic is taken every day three times at 0.5 g, and the second drug is taken once at 60 g. In the future, it may be necessary to use medications to control production of hydrochloric acid to alleviate the symptoms of the ulcerative process.

Clarithromycin inhibits protein synthesis by a microbial cell by binding to its 50S subunit of the ribosome. After oral administration, clarithromycin is rapidly absorbed from the gastrointestinal tract, with a bioavailability of approximately 50% in healthy volunteers. Food inhibits absorption, but does not significantly affect bioavailability. Bioavailability in adults when using tablets and suspensions for oral administration is the same. After oral administration on an empty stomach in healthy volunteers, the maximum concentration was reached after 2-3 hours. Clarithromycin binds to plasma proteins. Approximately 20% of the dose taken is immediately oxidized in the liver to form the main metabolite 14-hydroxyclarithromycin, which has a pronounced antimicrobial activity against Haemophilus influenzae. Biotransformation is catalyzed by the action of enzymes of the cytochrome P450 complex. Within 2 to 3 days, stable concentrations of clarithromycin with its main metabolite are reached. After taking 250 mg of clarithromycin every 12 hours, its maximum concentration is approximately 1–2 μg / ml, and the main metabolite is 0.6–0.7 μg / ml; when taken every 12 hours 500 mg of the drug, its maximum concentration is 2-3 mcg / ml, every 8 hours - 3-4 mcg / ml, for the main metabolite when taking 500 mg every 8-12 hours, the maximum concentration is not more than 1 mcg / ml ml. Clarithromycin with metabolites pass well into the tissues and body fluids, including the lungs, soft tissues, skin, while the concentration of the drug there is 10 times higher than in the blood. Distribution volumes are 243-266 liters. The half-life when taken every 12 hours at 250 mg of clarithromycin is 3-4 hours, 14-OH clarithromycin is 5-6 hours; when taken every 8-12 hours, 500 mg of the drug, the half-life of clarithromycin and its main metabolite, respectively, increase to 5-7 hours and 7-9 hours.
Clarithromycin is excreted by the kidneys and intestines. Excretion with urine: unchanged - after taking 250 or 500 mg 2 times a day - 20-30%, after taking 250 mg suspension 2 times a day - 40%; 14-OH clarithromycin - 15 and 10% after taking 500 and 250 mg, respectively, 2 times a day. About 4% when taking 250 mg of the drug is excreted by the intestines. In elderly patients (65-81 years) who received the drug every 12 hours at 500 mg, the maximum concentration and AUC were higher than in healthy young volunteers, but dose adjustment of clarithromycin is not required when used in elderly patients (except in cases of severe renal impairment). insufficiency).
In hepatic impairment, steady-state concentrations of clarithromycin were the same as in patients with normal work liver, but the equilibrium concentrations of 14-OH clarithromycin were significantly lower. In case of violations of the liver, a decrease in the excretion of the drug in the form of 14-OH clarithromycin is somewhat offset by an increase in the excretion of clarithromycin by the kidneys, this leads to a slight change in the equilibrium concentration of clarithromycin, but dose adjustment is not required. In case of impaired renal function, plasma clarithromycin content, AUC, maximum and minimum concentrations, half-life of 14-OH clarithromycin and clarithromycin increase. In patients with severe renal impairment (Cl creatinine less than 30 ml / min), dose adjustment may be required.
Clarithromycin is active against many microorganisms, including intracellular (Legionella pneumophila, Mycoplasma pneumoniae, Ureaplasma urealyticum, Chlamydia pneumoniae and Chlamydia trachomatis), gram-positive Streptococcus spp. (including Streptococcus pneumoniae, Streptococcus pyogenes) Helicobacter pylori, Campylobacter spp.), some anaerobes (Peptococcus spp., Eubacterium spp., Propionibacterium spp., Bacteroides melaninogenicus, Clostridium perfringens), Mycoplasma pneumoniae, Toxoplasma gondii, mycobacteria (Mycobacterium avium complex, including Mycobacterium intracellulare and Myavcobacterium).
When using clarithromycin in animals, hepatotoxicity, renal tubular degeneration, testicular atrophy, clouding of the cornea of ​​the eye, lymphoid depletion were noted (but in studies using doses exceeding the maximum daily human dose, calculated in mg / m 2, by 2 to 12 times). These effects have not been obtained in clinical trials. Mutagenic and carcinogenic effects of clarithromycin have not been identified. In experiments on female and male rats, no adverse effect clarithromycin on fertility, estrous cycle, childbirth, viability and offspring. In experiments on monkeys, it was shown that when using 150 mg / kg / day (2.4 times the MRDH, in mg / m 2), embryonic death is noted due to the toxic effects of a high dose of clarithromycin. In rabbits, intravenous 33 mg/m 2 clarithromycin (17 times the MRDH) was associated with intrauterine fetal death. In a teratogenicity study (4 studies in rats, 2 studies in rabbits), no teratogenic effects of clarithromycin were obtained. However, in two additional studies (another line of rats) under the same conditions and doses of the drug, a low incidence of heart defects was obtained.

Indications

Bacterial infections caused by susceptible microorganisms: infections of the upper and lower respiratory tract (pharyngitis, laryngitis, sinusitis, tonsillitis, pneumonia, bronchitis, atypical pneumonia), otitis media, soft tissue and skin infections (folliculitis, impetigo, furunculosis, wound infection); mycobacteriosis (including atypical, clarithromycin is used together with rifabutin and ethambutol); peptic ulcer (Helicobacter pylori eradication, as part of a combined treatment); chlamydia.

Method of administration of clarithromycin and dosage

Clarithromycin is used intravenously and orally (regardless of food intake). The dosage regimen and the duration of the course of therapy are set individually, taking into account the indications, the sensitivity of the pathogen, the severity of the course of the disease. Inside, patients over 12 years old - 2 times a day for 250-500 mg; duration of therapy - 6-14 days. In the treatment of sinusitis and diseases caused by Mycobacterium avium, as well as severe infections, including Haemophilus influenzae, - 2 times a day, 500-1000 mg; the maximum daily dose of clarithromycin is 2 g. Patients under 12 years of age - every 12 hours at the rate of 7.5 mg / kg of body weight; the maximum daily dose is 0.5 g. In patients with renal insufficiency (Cl creatinine less than 30 ml / min or serum creatinine content greater than 3.3 mg / 100 ml), the dose should be reduced by 2 times. Maximum duration therapy in patients of this group - no more than 14 days. Intravenous drip, 1000 mg / day for 2 injections.
If you miss the next dose of clarithromycin, do it as you remember, the next dose should be taken after the set time from the last use.
Caution when using clarithromycin while taking drugs that are metabolized in the liver (it is recommended to measure their levels in the blood). Modified release clarithromycin should not be taken in patients with severe renal insufficiency (creatinine clearance less than 30 ml/min), these patients are prescribed clarithromycin rapid release tablets. It is worth considering the possibility of development between clarithromycin and other antibiotics from the macrolide group, clindamycin and lincomycin cross-resistance. With prolonged or repeated use of the drug, superinfection may occur (growth of insensitive fungi and bacteria). In case of severe, prolonged diarrhea, which may indicate the appearance of pseudomembranous colitis, you should consult a doctor and stop taking the drug.

Contraindications for use

Hypersensitivity (including to erythromycin and other macrolides), porphyria, co-administration of cisapride, astemizole, pimozide, terfenadine.

Application restrictions

Hepatic and / and renal failure, children under 6 months (safety of use has not been established).

Use during pregnancy and lactation

Clarithromycin can be used during pregnancy only when the expected benefit of the treatment outweighs the possible risk to the fetus, and also in the absence of an alternative suitable treatment (strictly controlled and adequate studies of the safety of use in women during pregnancy have not been conducted). If pregnancy occurs during clarithromycin therapy, the patient should be informed of potential risk for the fetus. At the time of therapy, it is necessary to stop breastfeeding (clarithromycin and its metabolites pass into breast milk, the safety of using clarithromycin during breastfeeding has not been established).

Side effects of clarithromycin

Nervous system and sense organs: headache, anxiety, dizziness, fear, nightmares, insomnia, tinnitus, disorientation, taste changes, hallucinations, depersonalization, psychosis, confusion, hearing loss that resolves after drug withdrawal, paresthesia;
digestive system: disruption of work gastrointestinal tract(nausea, gastralgia / abdominal discomfort, vomiting, diarrhea), glossitis, stomatitis, transient increase in liver transaminase activity, cholestatic jaundice, pseudomembranous enterocolitis, hepatitis, liver failure;
blood and circulatory system: thrombocytopenia, leukopenia; prolongation of the QT interval, ventricular arrhythmia, including ventricular paroxysmal tachycardia, flutter / ventricular fibrillation;
selection system: an increase in serum creatinine, interstitial nephritis, renal failure;
allergic reactions: itching, skin rash, malignant exudative erythema, anaphylactoid reactions;
others: development of resistance of microorganisms, hypoglycemia.

Interaction of clarithromycin with other substances

With the combined use of clarithromycin with cisapride, astemizole, pimozide, terfenadine, the development of cardiac arrhythmias (fibrillation, ventricular paroxysmal tachycardia, ventricular fibrillation / flutter), an increase in the QT interval is possible. The combined use of clarithromycin and dihydroergotamine or ergotamine caused acute ergotamine intoxication in some patients, which was manifested by dysesthesia and peripheral vasospasm. Clarithromycin increases blood levels and enhances the effects of drugs that are metabolized in the liver with the participation of cytochrome P450 enzymes: warfarin and others indirect anticoagulants, carbamazepine, theophylline, astemizole, cisapride, triazolam, midazolam, cyclosporine, digoxin, phenytoin, ergot alkaloids and others (when used together, it is recommended to measure the blood concentration of the above drugs). With the joint administration of clarithromycin and HMG-CoA reductase inhibitors (simvastatin, lovastatin), acute necrosis of skeletal muscles may develop. Clarithromycin reduces the clearance of triazolam (increases its effects with the development of confusion and drowsiness). With the joint administration of clarithromycin and zidovudine, the equilibrium concentrations of zidovudine decrease. The combined use of clarithromycin and ritonavir increases the AUC of clarithromycin and decreases the AUC of 14-OH clarithromycin. Perhaps the development of cross-resistance when taking clarithromycin and other antibiotics of the macrolide group, as well as lincosamides (clindamycin and lincomycin).

Overdose

With an overdose of clarithromycin, there is a violation of the gastrointestinal tract (nausea, diarrhea, vomiting, abdominal pain), confusion, headache. It is necessary to wash the stomach, symptomatic treatment. Peritoneal dialysis and hemodialysis are not effective.

Trade names of drugs with the active substance clarithromycin

Clarithromycin is a combination drug
Clarithromycin* + Lansoprazole* + Amoxicillin*

Clarithromycin (also Clarithromycin SR) is a macrolide antibiotic with a wide range applications. The drug has antibacterial properties, affecting a variety of harmful microorganisms.

The active ingredients of this medication come into contact with the bacterial structure, inhibiting protein synthesis in it, which inevitably leads to its destruction.

Clarithromycin acts on bacteria such as moraxella, Helicobacter pylori, Staphylococcus aureus, Haemophilus influenzae, mycobacteria, etc. Based on this, indications for the use of this medication can be noted: respiratory diseases - pneumonia, bronchitis, etc., pharyngitis, otitis and sinusitis, infectious processes localized on the skin, mycobacterial infections, burns, general therapy for duodenal ulcers.

An important area of ​​​​use is the treatment of diseases such as tonsillitis and pneumonia. The drug is a second-line drug and is used when the patient is contraindicated in the use of first-line drugs - Amoxicillin and other similar drugs.

In addition, Clarithromycin is used in the field of venereology, is used in the treatment of mycoplasmosis and urogenital chlamydia.

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The regimen should be prescribed by the attending physician, after conducting all the necessary laboratory tests. Diagnosis also affects dosage, frequency, and duration. drug therapy, so you should not take Clarithromycin on your own, without a visit to the doctor.

The drug is available in several forms:

• Capsules of 250 and 500 mg.
• Tablets. The content of the active active ingredient is 250 and 500 mg.
• Special powder for suspension preparation.
• Solution for infusion.

If we evaluate the effectiveness of these funds, then the tablets are no different from the capsules. As for the powder, it is used to prepare a suspension for children under 12 years old.

Adult patients and children over 12 years of age are prescribed from 250 to 500 mg of the drug twice a day. A dose of 500 mg is stored in the body for about 12 hours, therefore, the drug is taken twice.

You can drink tablets or capsules with plain water or other liquids, but not with milk, as it can lead to improper absorption.

How to take with a bacterial infection, before or after a meal?

The antibiotic Clarithromycin is widely used in the treatment of gastroenterological diseases. The scheme of application includes taking capsules or tablets twice a day. The daily dose is 500 mg.

Reception is carried out after a meal. The duration of therapy varies from one to two weeks. Only the attending physician decides how many days to take the drug.

Taking the drug by pregnant women and children

Any antibiotic is quite aggressive on the body, so most of them are not prescribed to women during pregnancy and young children. Clarithromycin is widely used in the treatment various diseases not only in adults, but also in children.

However, there is one small nuance. The drug in the form of capsules and tablets is prescribed only for those children whose age exceeds 12 years.

The dosage for children over 12 years old will be identical to the dosage regimen for adults, i.e. from 250 to 500 mg twice a day. Young children are given from 7.5 to 15 mg per kilogram of weight. They are shown the drug in the form of a powder, with which a suspension is prepared. The suspension is administered orally with a dosing syringe containing 5 ml of the drug, which corresponds to 125 mg of Clarithromycin.

The expediency of taking this particular drug is determined by the pediatrician. The average duration of treatment is 6 to 14 days.

As for pregnant women, the question is ambiguous.

When taking Clarithromycin in the first and second trimester appears real danger the occurrence of intrauterine pathologies in the unborn child.

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The average size dosage is 500 mg of the drug per day. This dose is provided for both adults and children over 12 years of age. AT this case we are talking about taking it orally, but if the patient for some reason cannot take this medicine inside, he is prescribed the administration of the substance intravenously using droppers. In this case, the dosage is also 500 mg per day. Intravenous administration continues for 2-5 days, after which the patient is transferred to tablets or capsules.

In the treatment of diseases caused by various mycobacteria, the maximum daily dose may be increased to 1 gram per day. If the disease is severe, maximum dose increases exactly twice - up to 2 grams. With this scheme, treatment can last up to six months.

If the patient is diagnosed with chronic renal failure, then the dosage of Clarithromycin should be no more than 250 mg. Accordingly, the drug is taken once.

Important! The maximum daily dose for children over 12 years of age should be no more than 1 gram.

Dosage for tuberculosis

Clarithromycin is a macrolide, which means it can be used in the treatment of tuberculosis. It is used only in complex therapy, together with first-line drugs - Isoniazid, Ethambutol, Rifampin, etc.

Photo 1. Packing of the drug Isoniazid in the form of tablets with a dosage of 300 mg. Producer "Moskhimfarmpreparaty".

The dosage is 1 gram twice a day. The average duration of such therapy is six months.

There is a certain dependence of the dosage on the weight and age of a particular patient. For adult patients over 18 years of age, the dosage in the first 8 weeks is 25 mg per 1 kg of body weight. Then the course changes a little, and the dosage will be 35 mg per 1 kg of weight.

Dosage for children - 15 mg per 1 kg of body weight.

Main contraindications

Despite the indisputable effectiveness, this drug can not be used in all cases. The main contraindications include:

• First and second trimester of pregnancy.
• lactation period.
• Individual intolerance to the substances included in the composition.
• Hepatitis.
• Cholestatic jaundice.
• Liver failure in an acute form, occurring simultaneously with renal failure.
• Allergy to lactose in a patient.
• potassium deficiency.
• Ventricular arrhythmia.

If you have any liver disease, there is a possibility of complications. That is why it is necessary to strictly follow the prescriptions established by the doctor.

Clarithromycin cannot be used in the treatment of angina and otitis media in children.

It is also worth noting that the drug interacts with other drugs.

Medications that exclude concomitant use with this drug:

• Heart preparations made on the basis of ergot.
• Ticagrelor, i.e., a blood thinner.
• Atorvastatin, Rosuvastatin and other cholesterol-lowering drugs.
• Terfenadine, pimozide and cisapride.

Simultaneous use with these drugs can cause a significant deterioration in the condition and many side effects.

Attention! Clarithromycin belongs to the category of antibiotics, so it is forbidden to drink alcohol with it.

The fact is that alcohol significantly weakens the effect of the drug on the body, as a result of which the patient does not receive necessary treatment.

The antibiotic acts on the body quite aggressively. It has a negative effect not only on microorganisms and bacteria, but also on healthy cells. If we add to this the use of alcoholic beverages, then the body will be doubly loaded. The load on the internal organs, including the liver, is very high. If the organ is healthy, it will cope with all the loads, and if there are certain problems, then complications may arise.

Side effects

Individual characteristics and non-compliance with the dosage can cause backlash on the part of the body to receive Clarithromycin. The main side effects can be identified:

• Panic attacks.
• Sleep disturbance.
• Pain in the head.
• Dizziness.
• Constant feeling of anxiety.
• Hallucinations (rare).
• Vomiting and diarrhea.
• Change in taste.
• Noise in ears. In very rare cases, there may be a partial loss of auditory activity after discontinuation of the drug.
• Various allergic reactions on the skin, a feeling of itching.
• Anaphylactic reaction.

Reference. In some cases (about 0.1%), there may be a change in the composition of the blood. Fixed cases of change heart rate.

When taking the drug, an exacerbation of chronic diseases of the liver and kidneys is possible. People with these problems should be treated with extreme caution. As for the complex therapy of tuberculosis, the side effects are not much different from the usual cases. The most common are dizziness, ringing in the ears and partial hearing loss, which recovers quickly. But it's still worth following official instructions to reduce the likelihood of their occurrence.

Conclusion

If we talk about the specifics of taking Clarithromycin, then we can note several nuances.

The frequency of administration, dosage and duration of therapy is determined only by the attending physician. The dosage and duration of the drug will vary and depend on many factors; great importance has a specific disease, the patient has chronic ailments and other pathologies.

Photo 2. Packaging of the drug Clarithromycin in the form of tablets with a dosage of 500 mg. Producer "Rapharma".

This drug should be used with extreme caution during pregnancy. Doctors allow you to do this only in the third trimester of pregnancy, but the gynecologist makes the final decision on the advisability of taking it.

Women who are breastfeeding should stop breastfeeding if they start taking this medicine. The fact is that the active components of the drugs penetrate into the mother's milk, which can adversely affect the health of the baby.

The maximum daily dose should not exceed 2 grams, but this amount is shown only in some, the most severe cases. The drug belongs to the group of antibiotics, so it can adversely affect the functioning of the heart, liver, kidneys and digestive system if the dose is exceeded.

With regard to use in the treatment of tuberculosis, Clarithromycin is perceived as a 2-line drug, i.e., it can only be used as an adjuvant. As a rule, the drug is taken together with Ethambutol or Rifabutin. With this method of therapy, the daily dose of the drug is 1 gram - 500 mg twice a day. Depending on the specific clinical picture of the disease, treatment can last no more than six months, but there are cases when therapy continues throughout the patient's life.

In this video you will find useful information about the antibiotic Clarithromycin: its properties, indications for use, contraindications, side effects.

no-tuberculosis.ru

Clarithromycin: instructions for use of tablets

Clarithromycin is an antibiotic belonging to the group of macrolides. It is mainly prescribed as an etiotropic therapy for sinusitis, otitis media, sinusitis, infectious diseases. respiratory system, with angina and bacterial inflammation maxillofacial region. Also, the drug helps in the fight against infections caused by Mycobacterium intracellulare and Mycobacterium avium. Instructions for use, analogues, reviews, side effects of the drug, contraindications and indications for its use, as well as whether it can be used for children and during breastfeeding and pregnancy - all the information presented in the article is provided by doctors.

The original drug is called Klacid. On him, on this moment there are about 40 copies - generics. It is not difficult to write out a prescription for Clarithromycin in Latin. On the Latin it looks like this:

• Rep.: Tab. Clarithromycini 0.25
• D.t.d: No. 10
• S.: Take one tablet twice daily for five days.

It refers to antibacterial agents with a bacteriostatic effect. Has a wide spectrum of activity.

Compound

Which group a drug belongs to depends on its pharmacological properties. The composition of the drug includes 250 or 500 mg of the active substance.

Clarithromycin is not available in ampoules, and as a suspension, suppositories, ointment or capsule. The release form is only Opadry II coated tablets, while one pill can contain 250 and 500 mg per active ingredient. The use of the drug inside is shown.

The auxiliary substances of the drug include:

• potato starch;
• povidone;
• sodium lauryl sulfate;
• aerosil;
• pregelatinized starch;
• magnesium stearate.

In the Russian Federation, it is produced packed in a blister containing 5 pieces of tablets. One carton box contains from one to two blisters.

What is the price?

How much does Clarithromycin cost? Its cost is much cheaper than that of analogues. What is the difference then? The difference in the degree of purification of the drug and the manufacturer. The original drug, Klacin, has the highest cost. Generics are cheaper.

The price of one package for 10 tablets of Clarithromycin is 200-300 rubles. The medicine can be bought at a pharmacy according to the photo and description.

Indications for use Clarithromycin

Indication for use is the carriage and diseases that cause the whole spectrum of infectious agents on the body. For what or from what does it help, what is it treated for? How to behave when taking the medicine and the method of administration, when it is excreted from the body and the pharmacological treatment regimen.

This active semi-synthetic antibacterial drug accepted at:

• infectious processes caused by Mycobacterium, chlamydia and other sexually transmitted pathogens;
• purulent and unspecified otitis media and acute sinusitis;
• sharp and chronic pharyngitis, tonsillitis, laryngitis, tracheitis, sinusitis;
• pneumonia without specifying the pathogen;
• bronchitis, whether acute or chronic;
• skin abscess, furuncle, carbuncle;
• folliculitis.

Analogues

As a treatment for infection, Nolpaza, Metronidazole, Amoxiclav, Azithromycin, Fromilid, Vilprafen, Zentiva, Amoxicillin, Klacid and other synonyms of names can also be used. antibacterial agents. Which antibiotic will be best for a particular patient is largely determined by the sensitivity of the pathogen to it. All these drugs are not the same. And doctors should choose the right treatment in the case of a particular patient.

For example, the drug of the same group, Erythromycin, has a higher minimum inhibitory concentration (MIC) compared to Clarithromycin (twice as much Erythromycin is required to suppress bacterial growth).

How is Clarithromycin Teva different?

Clarithromycin Teva is a semi-synthetic macrolide derivative of erythromycin. Has a wide spectrum of action. Its mechanism of action is that the drug inhibits protein synthesis due to binding to the 50s subunit of bacterial ribosomes. It kills and inhibits the growth of both aerobic and anaerobic Gram-positive and Gram-negative organisms.

A stable concentration of Clarithromycin in the blood is maintained for 12 hours. Clarithromycin Teva contains 250 mg of the active ingredient. What treats - the same as the simple form of Clarithromycin.

Clarithromycin: instructions for use

Clarithromycin as a substance is activated after passing through the liver. Its 14-hydroxy metabolite has antimicrobial activity. Based on this action, it is important to know how to organize the correct intake of the medicine in order to achieve its greater effectiveness.

Before meals or after taking pills?

It is advisable not to take the drug at the same time as others before meals. This significantly reduces the bioavailability and reduces the absorption of the drug and its concentration. And the effect that food brings and the treatment of diseases are not compatible.

Application and ureaplasma, sinusitis, gastritis, chlamydia dosage

The drug Clarithromycin is used for ureaplasma, prostatitis, cystitis, chlamydia and other infections of the urinary system. It is a specific drug against chlamydia, as it can penetrate and act intracellularly.

Maximum dosage: 500 mg twice a day for adults over 18 years of age. The duration of admission is from 7 to 10 days, depending on the activity of the infection.

It is advisable to combine Clarithromycin with the use of alkaline waters to reduce toxic effect drug for the kidneys.

During pregnancy, breastfeeding

The drug is not prescribed in the first trimester of pregnancy. And if a woman who has given birth is breastfeeding a baby and is being treated with an antibacterial agent, breastfeeding is contraindicated for her. Feeding should be avoided for the period of five days when Clarithromycin is taken and plus a day for its complete elimination from the body.

Contraindications

The drug is contraindicated for people with chronic diseases liver and kidneys, i.e. kidney and/or liver failure.

Absolute contraindications are:

• hypersensitivity to any of the additional substances of the drug;
• porphyria;
• first trimester of pregnancy;
• breastfeeding period.

It is impossible to take Cisapride, Pimozide, Terfenadine simultaneously with Clarithromycin.

Side effects

To prevent side effects of the drug on previously damaged mucous membranes in gastritis, peptic ulcer stomach and duodenum simultaneously with Clarithromycin take Omeprazole (a proton pump inhibitor), you can drink DeNol at the same time or replace it with it. Omez and Omeprazole are trade names the same active substance, the differences between the two drugs are minimal.

Also, people who are allergic to any component of the drug that was used to prepare it should not take Clarithromycin. Side effects include hepato- and nephrotoxicity.

Amoxicillin and Clarithromycin at the same time?

Both Amoxiclav and Clarithromycin are representatives of a group of antibacterial agents. They have similar side effects. Therefore, the joint use of these two drugs does not improve them. antibacterial action, but potentiates the number of adverse reactions. You can take them at the same time, but this should be done with extreme caution. This may cause bitterness in the mouth. What to do about it? So this is to remove the extra antibiotic.

Alcohol compatibility

As with any antibiotic, Clarithromycin should not be taken with alcohol. Since at the same time metabolized ethanol significantly affects liver function. And since the entire drug passes through the hepatocytes, an excessive alcohol load leads to the accumulation of the substance and its toxic effect. Do not use alcohol and check for compatibility with drugs. Then this remedy (alcohol) will not affect the active period of the drug, which he has a day.

promedicine.ru

Clarithromycin - instructions for use

What is the drug clarithromycin?

Clarithromycin is a semi-synthetic macrolide antibiotic. Clarithromycin is available in tablet and capsule form. One tablet or capsule contains from two hundred and fifty to five hundred milligrams of the active ingredient - clarithromycin. It must be said that the demand for clarithromycin in the world is quite large. Therefore, many pharmaceutical companies produce this drug under their own original titles. Moreover, the form of the drug can be different. It can be both a liquid for injection and granules for making a suspension. At the same time, the dosage and purpose of all these drugs remain the same. If you see that the main active ingredient in the drug is clarithromycin, then you can safely apply this instruction to it. http://www.tiensmed.ru/news/makrolinus-wikit/What to take?

Clarithromycin is prescribed in the presence of infectious and inflammatory diseases of the respiratory system, ears, nose and throat, as well as pneumonia. In addition, clarithromycin is also effective in the treatment of infected skin lesions. Clarithromycin is prescribed for mycobacteria, Helicobacter pylori.

How much to take?

The average dose of clarithromycin is two hundred and fifty milligrams of the drug in the morning and evening. In more severe cases, the dosage is adjusted to five hundred milligrams. And if you need to fight mycobacteria, then even up to one gram twice a day.

You ask: "how long should I take clarithromycin?".

The duration of the course is very individual. With ordinary infections of the ENT organs, this can be only five days. But in severe mycobacterial diseases, taking clarithromycin can take several months. Children can also take clarithromycin. But if your baby is not yet six months old, you should not treat him with this drug. In the future, the dosage for children is fifteen milligrams per kilogram of the patient's body weight per day. This dose should be divided into two dachas. Special dosage prescribed to those patients who suffer from poor kidney function. In such cases, the start of treatment is carried out using "shock" doses of clarithromycin. Then they are reduced gradually, constantly conducting laboratory studies of the liquid media of the patient's body.

Can clarithromycin cause side effects?

Compared to other antibiotics, the side effects of this drug are much less. But they still exist. Therefore, if you are taking clarithromycin, be prepared for the fact that your digestion may be upset, headaches may be observed, sleep and general condition may worsen. Sometimes the use of clarithromycin also provokes allergic reactions of the external plan. These are usually some kind of rash.

Who should not take clarithromycin?

If you suffer from kidney or liver disease, then clarithromycin is contraindicated for you. Also, in no case should clarithromycin be used to treat pregnant women in the first three months of pregnancy. In the second and third months, clarithromycin can be used only on prescription and under strict control. The use of clarithromycin during lactation is completely prohibited.

Clarithromycin interacts with a host of drugs. To protect your health, use this medicine only as directed by your doctor. Maintain your body healthy lifestyle life and clarithromycin you will not need.

Before use, you should consult with a specialist.