Klacid, 14 pcs., 500 mg, film-coated tablets

Antibiotic Klacid is an original drug for the treatment of bacterial infections in adults and children. Available in tablets, powder and granules for preparing a solution. Sold by prescription, the average price starts from 450 rubles per course. Due to the high cost, the presence of contraindications, dissatisfaction with the quality or effect, adverse reactions that have arisen, and defects in pharmacy organizations, buyers are interested in the question of how to replace Klacid. The selection of an analogue is carried out by a doctor; before purchasing, you should read the instructions for use.

pharmachologic effect

Klacid is an antibiotic developed by a German pharmaceutical company. Production is located all over the world: France, Italy, packaging and packing in Russia. The disadvantage is the high cost, since the drug is original and clinical trials were conducted, the frequency of adverse reactions was revealed.

The medication contains clarithromycin, which has a bactericidal and bacteriostatic effect and disrupts intracellular protein synthesis.

Indications for use of Klacid

Klacid suspension and tablets have an antibacterial effect and are used for the following diseases:

• sore throat, pharyngitis, tonsillitis;
• otitis;
• sinusitis, sinusitis;
• bronchitis, pneumonia;
• skin and soft tissue infections.

The medicine is used in complex therapy for the treatment of Helicobacter pylori, which causes gastritis and stomach ulcers. Used in conjunction with De-Nol and proton pump inhibitors (Omeprazole, Pantoprazole, Esomeprozole).

Klacid - instructions for use

Medicines and analogues based on Clarithromycin are used as prescribed by a doctor. Drink twice a day, every 12 hours. If you miss a dose, do not double the dosage.

The course of treatment depends on the disease and averages 5–7 days. The exact dosage is selected based on the patient’s personal data (child or adult, weight, old age), and the presence of a history of other diseases (liver and kidney failure).

Prescription restrictions include pregnancy and breastfeeding, severe cardiac dysfunction, and liver failure.

Drink before or after meals

The medicine Klacid, according to the instructions, can be taken regardless of meals. After use, nausea, vomiting, stomach pain, intestinal disorders (constipation, diarrhea, flatulence), and allergic reactions may occur.

To prevent unwanted effects, it is recommended to drink the antibiotic after meals with a sufficient amount of plain water.

Pharmacokinetics and pharmacodynamics

The substance clarithromycin binds well to blood proteins. The highest concentration of the drug is determined within 6 hours. The larger the dose of the drug taken by the patient, the longer the period of time it is eliminated from the body. The amount of metabolite (14-hydroxyclarithromycin) does not increase in parallel with increasing doses of clarithromycin. The larger the dose of Klacid taken, the less 14-hydroxyclarithromycin is formed in the body.

The medicine is excreted from the body through the kidneys and intestines (40% and 30% of the dose, respectively). After oral administration, clarithromycin and its metabolite are distributed throughout the tissues and fluids of the body; tissues typically contain twice as much of the drug compared to blood serum.

No dosage adjustment is required for liver diseases. In case of kidney disease, the period of elimination of clarithromycin from the body increases. Also, the elimination period of the drug increases in older people.

Klacida's analogs

If it is impossible to purchase an expensive drug, there are contraindications and adverse reactions occur, Klacid can be replaced with analogues. All medications are dispensed according to a doctor’s prescription, so it is necessary to agree with a specialist and fill out a special form for dispensing from pharmacies.

Note! The medication itself can only be replaced with analogues containing Clarithromycin. This is possible because the chemical name is written in the prescription. When selecting a substitute, you should familiarize yourself with age restrictions and administration characteristics.

List of Klacid analogues indicating the release form, prices in Moscow and country of origin

Macropen

The imported drug Macropen is an analogue from the macrolide group. Available in tablets and suspensions. It is prescribed for bacterial resistance to penicillins and their intolerance (Amoxicillin, Amoxiclav, Flemoxin, Flemoclav, Augmentin, etc.).

Vilprafen

The German or French analogue Vilprafen belongs to the group of macrolides and contains josamycin. According to indications, it can be prescribed by a doctor during pregnancy to treat bacterial infections. Available in regular tablets and suspension, soluble form. Drink 2-3 times a day.

Levofloxacin

An analogue from the fluoroquinol group is Levofloxacin. Manufactured by pharmaceutical companies under the following trade names:

• Levofloxacin;
• Levolet;
• Glevo;
• Lebel;
• Levostar;
• Levoflox;
• Remedia;
• Tavanik et al.

The advantage of Levofloxacin is single or twice daily use for 5–10 days.

Hemomycin

An analogue based on azithromycin is Hemomycin. The advantage is a wide spectrum of action and use once a day for 3–5 days in adults. In pediatric practice, a suspension is used, the dose is divided into 2 doses.

Zinnat

The drug from the second generation of cephalosporins is Zinnat. It is used in tablets and suspensions. Its analogue, Suprax, is more effective and safer.

Klacid® and analogues are cheaper

On average it costs 600-800 rubles (250 and 500 mg of active substance, respectively).
If this medicine has been prescribed, then it is advisable to take it. However, if you lack money, you can purchase a cheaper substitute (of course, after consulting your doctor first). The analogue must have a similar spectrum of antimicrobial action and, accordingly, indications.

Main drug

It is a macrolide antibiotic that is active against many pathogenic microbes:

• Gram-positive pneumococci, Staphylococcus aureus, Listeria monocytogenes and Streptococcus pyogenes.
• Gram-negative - such as Haemophilus influenzae and parainftuenzae, Neisseria, Moraxella catarrhalis.
• Anaerobes and atypical pathogens - treponema pallidum, mycoplasmas, chlamydia, mycobacteria (including those that cause leprosy).

Pseudomonas and enterobacteria that do not degrade lactose are resistant to Klacid®. Such a wide spectrum of antimicrobial activity determines the list of indications. It includes inflammation of all respiratory organs, purulent lesions of the epidermis and soft tissues, as well as disseminated and local infections caused by mycobacteria.

Contraindications are individual intolerance, periods of pregnancy and especially breastfeeding (it is permissible to use only when the therapeutic benefit is greater than the risk), renal impairment, porphyria and taking certain medications, such as cisapride, astemizole.

Mild and moderate forms of the disease are treated for 1-2 weeks with twice daily doses of 250 mg. medicine. In severe cases, the single dose is doubled. Mycobacteriosis requires antibiotic therapy for a longer period of time (up to six months), and you need to take 1 gram of the active substance twice a day.

Read further: Consequences and treatment of antibiotic overdose

Klacid SR® 500 and its analogues are long-acting medications. Due to longer absorption and excretion from the body, they are taken less frequently (once a day) for the same indications, except for infections caused by mycobacteria. Side effects occur quite rarely in the form of arrhythmia, diarrhea, abdominal pain, stomatitis, tooth discoloration (disappears with time), headache, liver dysfunction, insomnia, changes in subjective taste sensations and allergies.

Available in tablet form (regular and extended-release), as a powder and lyophilisate for the preparation of a suspension and infusion solution, respectively. The difference in cost between regular and Klacid SR® 500 mg is about 150 rubles. Foreign and Russian pharmaceutical companies offer a fairly extensive list of analogues at a lower price.

Regular acting clacid substitutes

All the drugs listed below are based on the same active ingredient - clarithromycin. Their average cost in pharmacies is lower, and their scope of application and effectiveness are almost completely similar.

Fromilid®

Produced by the famous Slovenian pharmaceutical concern KRKA, 14 pieces per package.

In a dosage of 0.25 g Fromilid® costs 320 rubles, and 0.5 – 520 rubles.

Intended for the treatment of bronchitis, tonsillopharyngitis, otitis media, sinusitis and pneumonia. It is also used for suppuration of soft tissues and skin, infections caused by mycobacteria and as part of a complex eradication of Helicobacter.

Strict contraindications include hypersensitivity to any components of the drug, the first 3 months of pregnancy, breastfeeding, a child under twelve years of age (from six months you can take the drug in granules), kidney and liver failure, hepatitis. Taken twice a day in accordance with the instructions and recommendations of the doctor.

Ecositrin®

Ecositrin® is a Russian substitute for Klacida®, a product of ABVA RUS.

14 tablets of 250 mg cost 146 rubles, and in the same quantity, but at a dosage of 500 mg - already 584. Twice daily use gives a good therapeutic effect for community-acquired pneumonia, sinusitis, tonsillitis, skin infections, mycobacteriosis.

Used in combination with other antibiotics to eradicate Helicobacter pylori. Contraindications include individual intolerance, lactation period, age under 12 years, porphyria. Use with extreme caution during pregnancy, as well as in cases of severe renal and liver failure.

Klabax® 0.5 g

Klabax® is produced in India by the pharmaceutical company Ranbaxy in the form of tablets of 14 pcs. packaged. Price – 417 rub. Effective for bacterial lesions of the respiratory tract, uncomplicated inflammation of the epidermis and subcutaneous tissue, pneumonia, stomach and duodenal ulcers caused by Helicobacter, mycobacteriosis and chlamydia.

Strictly contraindicated in case of hypersensitivity to clarithromycin, porphyria, and is prescribed with caution to pregnant and lactating women. During the treatment period, it is advisable to stop breastfeeding and express milk.

Clarithromycin-Teva®

0.5 g of active ingredient, 10 and 14 pieces per pack, are produced by the well-known Israeli company Teva®. Price – 377 and 455 rubles. respectively.

Indications are as follows: bacterial pneumonia, pharyngitis, bronchitis, sinusitis, tonsillitis, wound infection, furunculosis, ureaplasmosis, chlamydia, combined eradication of the causative agent of gastric ulcer. Contraindicated in the 1st trimester of pregnancy, while breastfeeding, before reaching 12 years of age, as well as in case of individual intolerance and porphyria.

Clarithromycin-OBL®

Products of the Russian Obolensky FP, costing 267 rubles. for 7 tablets 0.5 g. Prescribed for bronchitis, pneumonia, sinusitis, pharyngitis, folliculitis, erysipelas, odontogenic and mycobacterial infections, stomach ulcers. Not recommended for use during pregnancy and lactation, for children under 12 years of age, for persons with porphyria, renal and liver failure, or hypersensitivity to macrolides. Taken twice a day in accordance with medical recommendations and instructions.

Clarbact® 0.5 g

Medicine made in India (Ipka® company) at a price of 238 rubles for 10 pieces. Indications for its use are inflammation of the respiratory organs, soft tissues and epidermis, mycobacteriosis, chlamydia, gastric and duodenal ulcers. The list of strict contraindications includes only individual intolerance and porphyria. Treatment of pregnant women, lactating women and children is carried out according to medical prescription. In any case, it is better to temporarily stop breastfeeding and express milk.

Clarithrosin®

Produced by the Russian pharmaceutical factory "Sintez", located in the city of Kurgan, in tablet form 0.5 g, 5 pieces per package (129 rubles).

Used for the treatment of various respiratory infections of bacterial origin, purulent inflammation of the skin and subcutaneous tissue, mycobacteriosis and peptic ulcer of the duodenum and stomach. Contraindicated for pregnant women, lactating women, as well as persons with liver and kidney dysfunction, hypersensitivity.

Clarithromycin® 250 mg

Manufactured by the Russian company Vertex®, it is a capsulated drug. A package of 14 capsules costs about 220 rubles.

It is used for the same diseases as other analogues. During pregnancy - with caution and only if there is no alternative. Not recommended for nursing women or patients with heart failure taking terfenadine, astemizole or cisapride.

Clarithromycin® 500 mg

Tomsk company Pharmstandard®, costs 408 rubles per package containing 14 tablets. According to indications and contraindications, it is similar to Russian-made drugs.

Klacid or Clarithromycin - which is better?

Klacid is an original, imported drug based on clarithromycin. Available in tablets of two dosages - Klacid 250 mg and 500 mg, suspension for children. It has a wide spectrum of action and is used for diseases of the ENT organs, respiratory system, skin and soft tissues.

Clarithromycin is a cheaper analogue of Klacid. It is produced under the patent of a foreign pharmaceutical company, but has not been clinically studied; the bioavailability of the drug and the frequency of adverse reactions have not been determined. Other additional substances and technology, raw materials from another manufacturer are used. The Russian substitute is available only in tablets of 250 and 500 mg; there is also an Israeli analogue.

The Israeli drug Clarithromycin-Teva is the closest in effectiveness, the price of which is higher than the Russian one.

Klacid or Sumamed

Sumamed is a substitute for Klacid based on azithromycin, available in suspension, capsules and tablets for children and adults. For convenient use, if it is necessary to dissolve in water or dissolve, if there are difficulties in swallowing, a new form has been created - dispersible tablets. Another advantage is that the price is up to 25% lower.

Sumamed belongs to the group of macrolides and has a bactericidal and bactericidal effect. Klacid is from the same group of antibiotics. The difference is in the active substance, pricing policy, course of use. Sumamed is better for children if there is no addiction and resistance to azithromycin.

Advantages: lower price, use in children 2 times a day for 5–7 days. The course of treatment in adults is 3–5 days.

Which is stronger – Klacid or Sumamed individually. Before prescribing, it is necessary to determine the causative agent of the disease and antibiotic resistance. Sumamed is not used to treat gastritis caused by Helicobacter pylori. When used, there is an increase in liver tests and a negative effect on the intestinal microflora. When using Klacid, allergic reactions and neurological symptoms may occur. The choice of drug should be made on the basis of the analysis performed.

Klacid®

The use of the following drugs with clarithromycin is contraindicated due to the potential for serious side effects:

Cisapride, pimozide, terfenadine and astemizole

When taking clarithromycin together with cisapride, pimozide. terfenadine or astemizole have been reported to increase the concentration of the latter in the blood plasma, which can lead to prolongation of the QT interval and the appearance of cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation and torsade de pointes (see section "Contraindications").

Ergot alkaloids

Post-marketing studies show that when clarithromycin is used together with ergotamine or dihydroergotamine, the following effects associated with acute poisoning with ergotamine drugs are possible: vascular spasm, ischemia of the limbs and other tissues, including the central nervous system. The simultaneous use of clarithromycin and ergot alkaloids is contraindicated (see section "Contraindications").

Midazolam for oral use

When midazolam was coadministered with clarithromycin tablets (500 mg twice daily), midazolam AUC increased 7-fold after oral administration. Concomitant use of clarithromycin with oral midazolam is contraindicated (see section "Contraindications").

HMG-CoA reductase inhibitors (statins)

Concomitant use of clarithromycin with lovastatin or simvastatin is contraindicated (see section "Contraindications") due to the fact that these statins are largely metabolized by the CYP3A4 isoenzyme, and combined use with clarithromycin increases their serum concentrations, which leads to an increased risk of developing myopathy, including Rhabdomyolysis Cases of rhabdomyolysis have been reported in patients taking clarithromycin concomitantly with these drugs. If clarithromycin is necessary, lovastatin or simvastatin should be discontinued during therapy.

Clarithromycin should be used with caution in combination therapy with other statins. If coadministration is necessary, it is recommended to take the lowest dose of statin. It is recommended to use statins that do not depend on the metabolism of the CYP3A isoenzyme (for example, fluvastatin). The development of signs and symptoms of myopathy should be monitored.

Effect of other drugs on clarithromycin

Drugs that are inducers of the CYP3A isoenzyme (for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) can induce the metabolism of clarithromycin. This may result in subtherapeutic concentrations of clarithromycin, resulting in reduced effectiveness. In addition, it is necessary to monitor the concentration of the CYP3A inducer in the blood plasma, which may increase due to the inhibition of the CYP3A isoenzyme by clarithromycin. When rifabutin and clarithromycin were used together, an increase in plasma concentrations of rifabutin and a decrease in serum concentrations of clarithromycin were observed with an increased risk of developing uveitis.

The following drugs have a proven or suspected effect on clarithromycin plasma concentrations; if used concomitantly with clarithromycin, dosage adjustments or switching to alternative treatment may be required.

Efavirenz, nevirapine, rifampicin, rifabutin and rifapentine

Strong inducers of the cytochrome P450 system, such as efavirenz, nevirapine, rifampicin, rifabutin and rifapentine, can accelerate the metabolism of clarithromycin and, thus, reduce the concentration of clarithromycin in plasma and at the same time increase the concentration of 14-OH-clarithromycin, a metabolite that is also microbiologically active. Since the microbiological activity of clarithromycin and 14-OH-clarithromycin differs against different bacteria, the therapeutic effect may be reduced when clarithromycin is used together with enzyme inducers.

Etravirine

The concentration of clarithromycin decreases with the use of etravirine, but the concentration of the active metabolite 14-OH-clarithromycin increases. Since 14-OH-clarithromycin has low activity against infections

Mycobacterium avium complex (MAC), overall activity against these pathogens may vary, so alternative treatments should be considered for the treatment of MAC.

Fluconazole

Coadministration of fluconazole 200 mg daily and clarithromycin 500 mg twice daily in 21 healthy volunteers resulted in an increase in mean clarithromycin minimum steady-state concentration (Cmin) and AUC by 33% and 18%, respectively. However, co-administration did not significantly affect the average steady-state concentration of the active metabolite 14-OH-clarithromycin. No dose adjustment of clarithromycin is required when taking fluconazole concomitantly.

Ritonavir

A pharmacokinetic study showed that coadministration of ritonavir 200 mg every eight hours and clarithromycin 500 mg every 12 hours resulted in a marked suppression of the metabolism of clarithromycin. When co-administered with ritonavir, clarithromycin Cmax increased by 31%, Cmin increased by 182% and AUC increased by 77%. Almost complete suppression of the formation of 14-OH-clarithromycin was noted. Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with renal failure, it is advisable to consider the following dose adjustment options: with CC 30-60 ml/min, the dose of clarithromycin should be reduced by 50%; with CC less than 30 ml/min, the dose of clarithromycin should be reduced by 75%. Ritonavir should not be co-administered with clarithromycin in doses exceeding 1 g per day.

Similar dosage adjustments should be considered in patients with reduced renal function if ritonavir is used as a pharmacokinetic enhancer when using other HIV protease inhibitors, including atazanavir and saquinavir (see section "Bidirectional Drug Interactions").

Effect of clarithromycin on other drugs

Antiarrhythmic drugs (quinidine and disopyramide)

Ventricular tachycardia of the “pirouette” type may occur with the combined use of clarithromycin and quinidine or disopyramide. When clarithromycin is coadministered with these drugs, the electrocardiogram should be regularly monitored for prolongation of the QT interval, and serum concentrations of these drugs should also be monitored.

During post-marketing use, cases of hypoglycemia have been reported during co-administration of clarithromycin and disopyramide. It is necessary to monitor the concentration of glucose in the blood while using clarithromycin and disopyramide.

Oral hypoglycemic agents/insulin

When clarithromycin is used together with oral hypoglycemic agents (for example, sulfonylureas) and/or insulin, severe hypoglycemia may occur. Concomitant use of clarithromycin with certain hypoglycemic drugs (for example, nateglinide, pioglitazone, repaglinide and rosiglitazone) may lead to inhibition of the CYP3A isoenzyme by clarithromycin, which may result in hypoglycemia. Careful monitoring of glucose concentrations is recommended.

Interactions due to CYP3A isoenzyme

Co-administration of clarithromycin, which is known to inhibit the CYP3A isoenzyme, and drugs primarily metabolized by the CYP3A isoenzyme, may be associated with a mutual increase in their concentrations, which may increase or prolong both therapeutic and side effects. Clarithromycin should be used with caution in patients receiving drugs that are substrates of the CYP3 A isoenzyme, especially if these drugs have a narrow therapeutic index (for example, carbamazepine) and/or are extensively metabolized by this enzyme. If necessary, the dose of the drug taken together with clarithromycin should be adjusted. Also, whenever possible, serum concentrations of drugs primarily metabolized by the CYP3A isoenzyme should be monitored.

The following drugs/classes are metabolized by the same CYP3A isoenzyme as clarithromycin, e.g. alprazolam, carbamazepine, cilostazol, cyclosporine, disopyramide, methylprednisolone, midazolam, omeprazole, indirect anticoagulants (e.g. warfarin), atypical antipsychotics (e.g. quetiapine) , quinidine, rifabutin, sildenafil, tacrolimus, triazolam and vinblastine. Also, agonists of the CYP3A isoenzyme include the following drugs that are contraindicated for combined use with clarithromycin: astemizole, cisapride, pimozide, terfenadine, lovastatin, simvastatin and ergot alkaloids (see section “Contraindications”). Drugs that interact in a similar way through other isoenzymes within cytochrome P450 systems include phenytoin, theophylline and valproic acid.

Indirect anticoagulants

When taking warfarin and clarithromycin together, bleeding and a marked increase in INR and prothrombin time are possible. In case of combined use with warfarin or other indirect anticoagulants, it is necessary to monitor the INR and prothrombin time.

Omeprazole

Clarithromycin (500 mg every 8 hours) was studied in healthy adult volunteers in combination with omeprazole (40 mg daily). When clarithromycin and omeprazole were used together, steady-state plasma concentrations of omeprazole were increased (Cmax, AUCo-24 and T1/2 increased by 30%, 89% and 34%, respectively). The mean 24-hour gastric pH was 5.2 when omeprazole was taken alone and 5.7 when omeprazole was taken with clarithromycin.

Sildenafil, tadalafil and vardenafil

Each of these phosphodiesterase inhibitors is metabolized, at least in part, by the CYP3A isoenzyme. At the same time, the CYP3A isoenzyme can be inhibited in the presence of clarithromycin. Concomitant use of clarithromycin with sildenafil, tadalafil or vardenafil may result in increased phosphodiesterase inhibitory effects. When using these drugs together with clarithromycin, consider reducing the dose of sildenafil, tadalafil and vardenafil.

Theophylline, carbamazepine

When clarithromycin and theophylline or carbamazepine are used together, the concentration of these drugs in the systemic circulation may increase.

Tolterodine

The primary metabolism of tolterodine occurs through the 2D6 isoform of cytochrome P450 (CYP2D6). However, in part of the population lacking the CYP2D6 isoenzyme, metabolism occurs through the CYP3A isoenzyme. In this population, inhibition of CYP3A results in significantly higher serum tolterodine concentrations. In populations that are poor metabolizers of CYP2D6, a dose reduction of tolterodine may be required in the presence of CYP3A inhibitors such as clarithromycin.

Benzodiazepines (eg, alprazolam, midazolam, triazolam)

Coadministration of midazolam and clarithromycin tablets (500 mg twice daily) resulted in a 2.7-fold increase in midazolam AUC following intravenous midazolam administration. If intravenous midazolam is used concomitantly with clarithromycin, the patient's condition should be carefully monitored for possible dose adjustment. Administration of a drug through the oral mucosa, which bypasses presystemic drug elimination, is likely to result in an interaction similar to that observed with intravenous midazolam rather than with oral administration.

The same precautions should be applied to other benzodiazepines that are metabolized by CYP3A, including triazolam and alprazolam. For benzodiazepines whose elimination is not dependent on the CYP3A isoenzyme (temazepam, nitrazepam, lorazepam), a clinically significant interaction with clarithromycin is unlikely.

When clarithromycin and triazolam are used together, central nervous system (CNS) effects such as drowsiness and confusion are possible. Therefore, if coadministration occurs, it is recommended to monitor for symptoms of CNS impairment.

Interaction with other drugs

Colchicine

Colchicine is a substrate of both CYP3A and the P-glycoprotein (Pgp) transporter protein. It is known that clarithromycin and other macrolides are inhibitors of the CYP3A and Pgp isoenzymes. When clarithromycin and colchicine are taken together, inhibition of Pgp and/or CYP3A may result in increased effects of colchicine. There have been post-marketing reports of cases of colchicine poisoning when taken concomitantly with clarithromycin, most often in elderly patients. Some of the reported cases occurred in patients suffering from kidney failure. Some cases were reported to be fatal. The simultaneous use of clarithromycin and colchicine is contraindicated (see section "Contraindications").

Digoxin

Digoxin is thought to be a substrate for Pgp. Clarithromycin is known to inhibit Pgp. When clarithromycin and digoxin are co-administered, inhibition of Pgp by clarithromycin may result in increased effects of digoxin. Post-marketing studies have shown that coadministration of digoxin and clarithromycin may also result in increased serum concentrations of digoxin. Some patients have experienced clinical symptoms of digoxin toxicity, including potentially fatal arrhythmias. Serum digoxin concentrations should be carefully monitored when clarithromycin and digoxin are coadministered.

Zidovudine

Concomitant use of clarithromycin tablets and oral zidovudine in adult HIV-infected patients may result in decreased steady-state zidovudine concentrations. Because clarithromycin interferes with the oral absorption of zidovudine, the interaction can be largely avoided by taking clarithromycin and zidovudine 4 hours apart. This interaction was not observed in HIV-infected children taking clarithromycin pediatric suspension with zidovudine or dideoxyinosine. Since clarithromycin may interfere with the absorption of zidovudine when administered concomitantly orally in adult patients, such an interaction is unlikely to occur when clarithromycin is used intravenously.

Phenytoin and valproic acid

There is evidence of interactions between CYP3A inhibitors (including clarithromycin) and drugs that are not metabolized by CYP3A (phenytoin and valproic acid). For these drugs, when used together with clarithromycin, it is recommended to determine their serum concentrations, as there are reports of their increase.

Bidirectional drug interactions

Atazanavir

Clarithromycin and atazanavir are both substrates and inhibitors of the CYP3A isoenzyme. There is evidence of a bidirectional interaction between these drugs. Coadministration of clarithromycin (500 mg twice daily) and atazanavir (400 mg once daily) may result in a twofold increase in clarithromycin exposure and a 70% decrease in 14-OH-clarithromycin exposure, with a 28% increase in atazanavir AUC. Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with moderate renal failure (creatinine clearance 30-60 ml/min), the dose of clarithromycin should be reduced by 50%. In patients with CC less than 30 ml/min, the dose of clarithromycin should be reduced by 75% using the appropriate dosage form of clarithromycin. Clarithromycin in doses exceeding 1000 mg per day should not be used in conjunction with protease inhibitors.

Blockers of "slow" calcium channels

When using clarithromycin simultaneously with blockers of “slow” calcium channels that are metabolized by the CYP3A4 isoenzyme (for example, verapamil, amlodipine, diltiazem), caution should be exercised as there is a risk of arterial hypotension. Plasma concentrations of clarithromycin, as well as slow calcium channel blockers, may increase with simultaneous use. Arterial hypotension, bradyarrhythmia and lactic acidosis are possible when taking clarithromycin and verapamil simultaneously.

Itraconazole

Clarithromycin and itraconazole are substrates and inhibitors of the CYP3A isoenzyme, which determines the bidirectional interaction of the drugs. Clarithromycin may increase plasma concentrations of itraconazole, while itraconazole may increase plasma concentrations of clarithromycin. Patients taking itraconazole and clarithromycin concomitantly should be closely monitored for symptoms of increased or prolonged pharmacological effects of these drugs.

Saquinavir

Clarithromycin and saquinavir are substrates and inhibitors of the CYP3 A isoenzyme, which determines the bidirectional interaction of the drugs. Coadministration of clarithromycin (500 mg twice daily) and saquinavir (soft gelatin capsules, 1200 mg three times daily) in 12 healthy volunteers increased the AUC and Cmax of saquinavir by 177% and 187%, respectively, compared with saquinavir alone. . The AUC and Cmax values ​​of clarithromycin were approximately 40% higher than with clarithromycin monotherapy. When these two drugs are used together for a limited time at the doses/formulations indicated above, no dose adjustment is required. Results from drug interaction studies using saquinavir soft gelatin capsules may not be consistent with the effects observed with saquinavir hard gelatin capsules. The results of drug interaction studies with saquinavir monotherapy may not be consistent with the effects observed with saquinavir/ritonavir therapy. When taking saquinavir with ritonavir, consider the potential effect of ritonavir on clarithromycin.

Suprax or Klacid

Suprax is an analogue of modern cephalosporins based on cefixime. Prescribed for pharyngitis, tonsillitis and sinusitis, bronchitis, otitis media, uncomplicated forms of gonorrhea and urinary tract infections. In children's practice, it is used as prescribed by a doctor from 6 months, produced in syrup. For adults, it is sold in the form of oral or water-soluble tablets and capsules.

Suprax is used by adults once a day at the same time for 7–10 days. For children, the daily dose can be divided into two doses.

For sore throat caused by hemolytic streptococcus, it is better to choose a drug other than Suprax or Klacid 500 mg. What is more effective is individual in each therapeutic regimen; the result of treatment depends on the type of pathogen and sensitivity to antibiotics.

Contraindications

You should not take an antibiotic in the following cases:

• with high sensitivity of the body to drugs from the macrolide group;
• with porphyria ;
• during pregnancy and lactation ;
• children under 3 years of age.

The drug is prescribed with caution in cases of kidney and liver dysfunction.

You cannot take clarithromycin and the following medications at the same time : terfenadine , cisapride , dihydroergotamine , pimozide , ergotamine , and stemizole .

Klacid or Klacid SR

The medicine Klacid is an antibiotic for adults with an active substance content of 250 and 500 mg, for children. It is an original, patented form.

Another form with the extended-release CP prefix, also containing 500 mg of the active substance - clarithromycin. The difference between the analogues is in the frequency of administration: the regular one is taken twice a day, the extended Klacid CP 500 is taken once a day at the same time. This form is most convenient for adults. However, you should not break or bite the tablets.

Side effects

If Klacid is administered IV or taken orally, a number of side effects may occur. If such effects occur after intravenous administration or ingestion of tablets, you must inform your specialist.

The following manifestations are possible:

• the central nervous system: changes in taste, headaches .
• Digestive system: nausea , abdominal pain, diarrhea , vomiting , dyspepsia .
• Local reactions when injecting the solution: inflammatory processes at the injection site, phlebitis , pain during palpation.
• Laboratory indicators: increased activity of liver enzymes.

In addition to these side effects, there are possible side effects that occur less frequently:

• oral candidiasis;
• thrombocytopenia , leukopenia ;
• anaphylactic reactions;
• hypoglycemia;
• mental disorders, insomnia ;
• dizziness , convulsions ;
• myalgia;
• reversible hearing loss;
• ventricular tachycardia ;
• stomatitis , acute pancreatitis , glossitis ;
• liver dysfunction;
• hives , rash ;
• increased creatinine levels in the blood.

Klacid or Amoxiclav - which is better?

Amoxiclav is a combination drug from a series of penicillins containing a beta-lactamase inhibitor and amoxicillin. Available in powder for the preparation of a suspension for children, regular and soluble tablets for patients aged 12 years and older. Amoxiclav is often prescribed by doctors due to its affordable price.

When choosing between Klacid or Amoxicillin (Amoxiclav), you should choose the first because of its greater effectiveness.

Klabaks or Klacid

Klabax is an Indian substitute for Klacida based on clarithromycin. Available in one form - tablets containing the active substance 250 and 500 mg.

Klabax and Klacid are identical drugs with the same substance and indications and restrictions. The difference is that the analogue is cheaper, because it uses raw materials from another manufacturer, and has not been subjected to clinical trials to test the effectiveness and incidence of adverse reactions.

Substitutes for long-acting clacid

Klacid CP® 500 is taken only once a day, since the homogeneous crystalline base of the drug ensures slow absorption and gradual assimilation. Among the analogues sold in pharmacies at a lower cost are the following:

Fromilid Uno®

Slovenian medication, which is a film-coated tablet with a concentration of active substance of 500 mg. Available in 5, 7 and 14 pieces per pack at prices of 285, 356 and 480 rubles. respectively. The list of indications and contraindications is the same as for regular Fromilid. The daily dose is 0.5-1 grams.

Klabax OD® 0.5 g

The manufacturer, the Indian company Ranbaxy®, offers 7 and 14 tablets costing 304 and 525 rubles. It is prescribed in the same cases, but is also contraindicated for children under 12 years of age.

Clarithromycin SR® 500 mg

The medication is produced by the Russian company Vertex®, seven tablets per pack and costs 257 rubles. Used for antibiotic therapy of respiratory and skin diseases, stomach ulcers (as part of a complex). Not prescribed for pregnant women in the 1st trimester, lactating women, children under 18 years of age, persons with liver failure, kidney failure, porphyria and hypersensitivity.

Klacid or Augmentin

Augmentin is a substitute for Amoxiclav, with the same composition: it contains amoxicillin and clavulanic acid. Available in dispersible and soluble tablets, as well as suspension. Due to the frequent prescription of Augmentin by doctors, bacteria have developed resistance to the active substance of the drug. In these cases, the drug of choice is the original Klacid.

Which is better – Klacid or Flemoxin solutab

Flemoxin is an imported analogue of Klacida suspension for children, available in the form of soluble tablets. Contains amoxicillin. Apply 2-3 times a day for 5-10 days. Prescribed for the treatment of gastritis and stomach ulcers caused by the bacterium Helicobacter pylori.

Klacid and Flemoxin solutab are antibacterial drugs that differ in composition, indications, and features of use. Which is better depends on your medical history. Both medications are prescription medications; the choice can be made together with a specialist.

Antibiotic Klacid is available in tablets, granules and powder for suspension. Soluble forms are used in childhood and are characterized by rapid action. The selection of cheaper analogues for children and adults should be carried out by a doctor, according to the results of an analysis of bacterial resistance.

Reviews about Klacida

Reviews about Klacida are both positive and not too enthusiastic. Many patients note that the antibiotic is effective and significantly speeds up the healing process. But there are also stories that the drug provoked side effects, and as a result the doctor was forced to select a different antibiotic for treatment.

Parents who gave the drug to their children also leave different reviews of Klacid. No less important are the reviews of doctors, which indicate that experts consider this antibiotic to be effective and is often prescribed to both adults and children.