Clarithromycin
antibiotic · macrolide
Third-party optionBy the Layer Nutrition editorial team
What this medicine is for
Clarithromycine est un médicament de la catégorie « antibiotique (macrolide) ». Les antibiotiques traitent les infections dues à des bactéries. Ils se prennent en cure, sur une durée définie, jusqu'au bout de la prescription.
For Clarithromycin in practice: Treats a bacterial infection. It is used rather occasionally or as a short course, to get through an episode.
Under which brands it is found
In France, about 13 reimbursable presentations containing Clarithromycin are recorded. It comes under various trade names and in generic form.
- Clarithromycine Accord
- Clarithromycine Almus
- Clarithromycine Arrow
- Clarithromycine Arrow Lab
- Clarithromycine Biogaran
- Clarithromycine Eg
- Clarithromycine Evolugen
- Clarithromycine Hcs
- and other presentations
Original brand-name products and generics deliver the same active substance; the choice between them is made with your doctor or pharmacist.
On the plate: potassium and magnesium
Clarithromycin is not suitable when the blood is low in potassium or magnesium, because this deficit promotes cardiac rhythm disturbances. Keeping both minerals at a good level contributes to the cardiac safety of the treatment, and food remains the simplest way to look after them meal after meal.
Potassium is concentrated in vegetables and fruit: potato, sweet potato, spinach, lentils, beans, avocado, dried apricot and banana. Magnesium comes mainly from leafy green vegetables, nuts, pumpkin seeds, whole grains and dark chocolate.
Several of these foods provide both minerals at once, such as spinach, lentils, beans and pumpkin seeds. Spreading them across your meals throughout the day covers a good share of your needs, in addition to your treatment.
How clarithromycin works
Clarithromycin belongs to the macrolide family. It binds selectively to the 50S ribosomal subunit of susceptible bacteria, the part of the cellular machinery that assembles proteins. By occupying this site, it prevents the translocation of activated amino acids and blocks bacterial protein synthesis. Deprived of its proteins, the bacterium can no longer multiply normally, which gives the body's defenses time to regain the upper hand.
Its elimination half-life depends on the dose administered. It is roughly 3 to 4 hours at a dose of 250 mg every 12 hours, and lengthens to 5 to 7 hours at a dose of 500 mg every 8 to 12 hours. This non-linear pharmacokinetics explains why the doses are spread throughout the day, in order to maintain an active concentration against the bacteria.
Why it is prescribed
Clarithromycin treats bacterial infections of the upper and lower respiratory tract, for example pharyngitis, sinusitis, bronchitis or pneumonia. It is also used for certain infections of the skin and soft tissues. The physician chooses it when a bacterium susceptible to this macrolide is responsible.
It is also used, in combination, in the eradication of Helicobacter pylori during peptic ulcer disease. In this indication, it does not act alone: it is part of a regimen that combines several medicines to eliminate the bacterium from the stomach. The choice of antibiotic always depends on the targeted infection and on the patient's profile.
How to take it day to day
The clarithromycin tablet is taken with or without food: food does not change the extent of its bioavailability. You can therefore take it at whatever time suits you, which helps you not to forget a dose. Regularity matters more than the meal: respecting the interval between doses maintains an effective concentration throughout the day.
An antibiotic is taken until the planned end, even if symptoms improve beforehand. Stopping too early leaves bacteria alive and promotes both relapse and resistance. If discomfort appears or a question arises, talk to your physician or pharmacist rather than stopping the treatment on your own.
The effects to know about
The most frequent adverse effects mainly involve digestion. In the clinical trials of the tablet in adults, diarrhea (3%), nausea (3%), an abnormal taste or dysgeusia (3%), dyspepsia (2%), abdominal pain or discomfort (2%) and headache (2%) are observed. These disturbances are most often temporary and disappear when the treatment is stopped.
The European summary of product characteristics classes diarrhea, vomiting, dyspepsia, nausea and abdominal pain among the very common effects, that is at least one patient in ten. Dysgeusia, headache and insomnia appear as common, meaning at least one case in a hundred and fewer than one in ten. A metallic taste in the mouth is thus a well-known nuisance of this macrolide.
Heart and mineral balance
Clarithromycin has been associated with a prolongation of the QT interval, a feature of the electrocardiogram, and with rare cases of arrhythmia. Cases of torsades de pointes, a serious rhythm disorder, have been reported after marketing. This cardiac risk remains rare, but it guides the precautions surrounding the treatment.
For this reason, clarithromycin must not be administered in the presence of an electrolyte disturbance, that is hypokalemia or hypomagnesemia. A lack of potassium or magnesium in the blood indeed increases the risk of QT prolongation. A correct status of these two minerals therefore contributes to the cardiac safety of the treatment, which places food in the foreground.
Interactions and monitoring
Clarithromycin inhibits the liver enzyme CYP3A, which breaks down many medicines. A medicine metabolized mainly by this route can see its concentration rise, which increases or prolongs its effects, whether desired or unwanted. Its combination with lovastatin or simvastatin is contraindicated, because of the risk of myopathy and rhabdomyolysis. The combination with colchicine is also contraindicated: life-threatening, sometimes fatal, interactions have been reported.
Other combinations call for close monitoring. With warfarin, clarithromycin exposes to a risk of serious hemorrhage and to a rise in the INR and prothrombin time, which requires a check of coagulation. With oral antidiabetics or insulin, it can cause significant hypoglycemia, hence blood glucose monitoring. Always tell the physician about all the medicines you take before starting the treatment.
Sources
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What is clarithromycin used for?
Clarithromycin is an antibiotic in the macrolide family, prescribed for certain bacterial infections of the respiratory tract, the skin, or the ear, nose and throat area. Its exact indication depends on your situation: refer to the package leaflet and to your doctor or pharmacist.
What are the side effects of clarithromycin?
Among the most common effects, the package leaflet lists digestive problems (nausea, diarrhea, stomach ache), an altered sense of taste, headaches and sometimes insomnia. For any persistent or unexpected discomfort, consult the leaflet and speak with your doctor or pharmacist.
Does clarithromycin have drug interactions?
Yes, clarithromycin can interact with many other medicines, and QT interval prolongation is described in the package leaflet. Tell your doctor or pharmacist about all of your treatments, including over-the-counter ones, and refer to the leaflet.
Can you drink alcohol while taking clarithromycin?
Drinking alcohol during a course of antibiotics can worsen the digestive problems that are already common with clarithromycin. What to do depends on your situation: refer to the package leaflet and ask your doctor or pharmacist for advice.
Why can clarithromycin upset the gut flora?
Like other antibiotics, clarithromycin acts on bacteria, including part of the gut flora. Studies link this action to a temporary imbalance of the microbiome, one of the mechanisms connected to the diarrhea that occurs during antibiotic therapy.
Which probiotics should you consider to support gut flora during antibiotic treatment?
Studies link taking certain probiotic strains to a reduction in antibiotic-associated diarrhea. The yeast Saccharomyces boulardii is one of the most studied forms in this context, because it is not affected by antibacterial antibiotics. The choice of strain and the timing of the dose should be discussed with your doctor or pharmacist.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.