Clarithromycin Long tablets p/o with modified release 500 mg No. 5x2

pharmachologic effect

Manufacturer: OZON LLC, Russian Federation
Release form: film-coated tablets

Active ingredient: clarithromycin

Synonyms: Klabaks, Fromilid, Klarbakt, Clarithromycin Ecositrin, Klacid

Clarithromycin is an antibiotic belonging to the macrolide group. The substance inhibits protein bonds in bacterial cells, thereby inhibiting their growth and reproduction.

The medication is active against parasites, gram-positive and gram-negative microbes, such as staphylococci, streptococci, chlamydia, Helicobacter pylori, mycobacteria and others.

Analogues of Clarithromycin

For the treatment of infectious and inflammatory diseases, analogues and synonyms of Clarithromycin are used. Medicines differ in composition, action, indications, and release form.

List of Clarithromycin analogues with prices

If the question is what can replace Clarithromycin for a bacterial infection, then you should consult a doctor for tests and a prescription.

Clarithromycin or Klacid - which is better, what is the difference

Manufacturer: EbbVi, Italy
Release form: granules for suspension, tablets

Active ingredient: clarithromycin

Synonyms: Klabaks, Fromilid

Klacid is an analogue of Clarithromycin in terms of the active substance. The drug is original and produced by a foreign pharmaceutical company.

The active substance Klacida exhibits antimicrobial action and activity against many pathogenic bacteria. The medication is used in adults and children from birth for the following infections:

• acute and chronic otitis media;
• bronchitis, pneumonia, bronchiolitis;
• rhinosinusitis, tracheitis, laryngitis;
• primary and secondary infections of the skin and soft tissues.

Klacid is used as part of the complex treatment of gastrointestinal ulcers caused by Helicobacter pylori.

For adults, the drug is prescribed 250–500 mg twice a day for 7–14 days. In pediatrics, the dosage is set based on the child's weight.

The main advantages of Klacid are:

• preclinical and clinical studies;
• variety of dosage forms;
• convenient dosing in pediatrics.

Both medications have positive reviews, have the same effect and indications.

Publications in the media

Clarithromycin (Klabax, Klatsid, Fromilid), granules for the preparation of an oral suspension, capsules, lyophilisate for the preparation of a solution for infusion, powder for the preparation of an oral suspension, film-coated tablets, film-coated tablets with extended release

Pharmaceutical group - macrolide antibiotic.

Pharmaceutical action. Semi-synthetic broad-spectrum macrolide antibiotic. Disturbs the protein synthesis of microorganisms (binds to the 50S subunit of the ribosomal membrane of the microbial cell). Acts on extra- and intracellularly located pathogens. Active against: Staphylococcus spp., Streptococcus agalactiae (Streptococcus pyogenes, Streptococcus viridans, Streptococcus pneumoniae), Haemophilus influenzae (Haemophilus parainfluenzae), Haemophilus ducreyi, Neisseria gonorrhoeae, Neisseria meningitidis, Listeria monocytogenes, Legionella pneumophila, Mycoplasma pneumonia e, Helicobacter pylori (Campylobacter ), Campylobacter jejuni, Chlamydia pneumoniae, Moraxella catarrhalis, Bordetella pertussis, Propionibacterium acne, Mycobacterium avium, Mycobacterium leprae, Mycobacterium cansasii, Mycobacterium marinom, Staphylococcus aureus, Ureaplasma urealyticum, Toxoplasma gondii, Corynebacterium spp., Borrelia burgdorferi, Pasteur ella multocida, some anaerobes (Eubacter spp., Peptococcus spp., Propionibacterium spp., Clostridium perfringens, Bacteroides melaninogenicus), less active against Mycobacterium tuberculosis.

Pharmacokinetics. Absorption is fast. Food slows absorption without significantly affecting bioavailability. The bioavailability of clarithromycin in suspension form is equivalent to or slightly higher than when taken in tablet form. Communication with plasma proteins is more than 90%. After a single dose, 2 Cmax peaks are recorded. The second peak is due to the ability of the drug to concentrate in the gallbladder, followed by gradual or rapid entry into the intestine and absorption. TCmax when taken orally 250 mg - 1-3 hours. After oral administration, 20% of the dose taken is quickly hydroxylated in the liver by cytochrome enzymes CYP3A4, CYP3A5 and CYP3A7 with the formation of the main metabolite - 14-hydroxyclarithromycin, which has pronounced antimicrobial activity against Haemophilus influenzae. It is an inhibitor of the isoenzymes CYP3A4, CYP3A5 and CYP3A7. With regular intake of 250 mg/day, Css of the unchanged drug and its main metabolite is 1 and 0.6 μg/ml, respectively; T1/2 - 3-4 and 5-6 hours, respectively. When the dose is increased to 500 mg/day, Css of the unchanged drug and its metabolite in plasma is 2.7-2.9 and 0.83-0.88 mcg/ml, respectively; T1/2 - 4.8-5 and 6.9-8.7 hours, respectively. At therapeutic concentrations it accumulates in the lungs, skin and soft tissues (concentrations there are 10 times higher than the level in blood serum). It is excreted by the kidneys and in feces (20-30% in unchanged form, the rest in the form of metabolites). With a single dose of 250 and 1200 mg, 37.9 and 46% are excreted by the kidneys, and 40.2 and 29.1% are excreted in the feces, respectively.

Indications. Lower respiratory tract infections (including bronchitis, pneumonia). Infections of the upper respiratory tract (including pharyngitis, sinusitis). Infections of the skin and soft tissues (including folliculitis, erysipelas). Mycobacterial infections caused by Mycobacterium avium and Mycobacterium intracellulare. Localized infections caused by Mycobacterium fortuitum and Mycobacterium kansasii. Prevention of the spread of infection caused by Mycobacterium avium complex (MAC infection) in HIV-infected patients with a CD4 lymphocyte count of no more than 100/μl. Eradication of Helicobacter pylori to reduce the frequency of relapses of duodenal ulcer. Odontogenic infections. For long-acting dosage forms: lower respiratory tract infections (including bronchitis, pneumonia), upper respiratory tract infections (including pharyngitis, sinusitis), skin and soft tissue infections (including folliculitis, erysipelas ).

Contraindications. Hypersensitivity, porphyria, pregnancy (first trimester), lactation, simultaneous use of cisapride, pimozide, terfenadine. Carefully. Renal and/or liver failure.

Dosing. Orally, adults and children over 12 years old - 250-500 mg 2 times a day. Duration of treatment is 6-14 days. In case of severe infections or in case of difficulty in oral administration, it is prescribed in the form of intravenous injections at a dose of 500 mg/day for 2-5 days, with further transfer to oral administration of 500 mg/day. The total duration of treatment is 10 days. When treating infections caused by Mycobacterium avium, 500 mg is prescribed orally 2 times a day. Duration of treatment is 6 months or more. Children are prescribed as a suspension at a dose of 7.5 mg/kg every 12 hours. The maximum daily dose is 500 mg. The duration of treatment is 7-10 days. In patients with chronic renal failure (creatinine clearance less than 30 ml/min or serum creatinine concentration more than 3.3 mg/100 ml) - 250 mg/day (once), for severe infections - 250 mg 2 times a day. The maximum duration of treatment for patients in this group is 14 days.

Side effect . From the nervous system: headache, dizziness, anxiety, fear, insomnia, nightmares; rarely - disorientation, hallucinations, psychosis, depersonalization, confusion. From the digestive system: nausea, vomiting, gastralgia, diarrhea, stomatitis, glossitis, increased activity of liver transaminases, cholestatic jaundice, rarely - pseudomembranous enterocolitis. From the senses: tinnitus, change in taste (dysgeusia); in isolated cases, hearing loss occurs after discontinuation of the drug. From the hematopoietic organs and hemostasis system: rarely - thrombocytopenia (unusual bleeding, hemorrhage). Allergic reactions: skin rash, itching, malignant exudative erythema (Stevens-Johnson syndrome), anaphylactoid reactions. Other: development of resistance of microorganisms.

Overdose. Symptoms: dysfunction of the gastrointestinal tract, headache, confusion. Treatment: gastric lavage, symptomatic therapy. Interaction. Simultaneous use with cisapride, pimozide, terfenadine is not allowed. When taken simultaneously, it increases the concentration in the blood of drugs metabolized in the liver with the help of cytochrome P450 enzymes - indirect anticoagulants, carbamazepine, theophylline, astemizole, cisapride, terfenadine (2-3 times), triazolam, midazolam, cyclosporine, disopyramide, phenytoin, rifabutin , lovastatin, digoxin, ergot alkaloids, etc. Reduces the absorption of zidovudine (an interval of at least 4 hours is required between the use of drugs). Cross-resistance may develop between clarithromycin, lincomycin and clindamycin.

Special instructions . In the presence of chronic liver diseases, it is necessary to regularly monitor serum enzymes. Prescribe with caution against the background of drugs metabolized by the liver (it is recommended to measure their concentration in the blood). In case of co-administration with warfarin or other indirect anticoagulants, it is necessary to monitor the prothrombin time.

Clarithromycin or Azithromycin - which is better and stronger for pneumonia, what is the difference

Manufacturer: ABVA RUS JSC, Russian Federation
Release form: powder for suspension, film-coated tablets, capsules

Active ingredient: azithromycin

Synonyms: Azitrox, Sumamed, Zitrolide, Hemomycin

Azithromycin is an analogue of Clarithromycin in tablets and suspension. Medicines belong to the same group - macrolides and have a similar mechanism of action. Azithromycin inhibits the reproduction and development of pathogenic microorganisms. It is used for ENT infections, infectious and inflammatory diseases of the skin, soft tissues, and genitourinary system.

Comparison of drugs is shown in the table

Which medication is optimal depends on the condition, symptoms, and age of the patient.

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

Pharmacodynamics

Clarithromycin is a second-generation bacteriostatic antibiotic from the group of broad-spectrum macrolides. Disturbs the protein synthesis of microorganisms (binds to the 50S subunit of the ribosomal membrane of the microbial cell). Acts on extra- and intracellularly located pathogens. Active regarding:

Streptococcus agalactiae (Streptococcus pyogenes, Streptococcus viridans, Streptococcus pneumoniae), Haemophilus influenzae (parainfluenzae), Haemophilus ducreyi, Neisseria gonorrhoeae, Neisseria meningitidis, Listeria monocytogenes, Legionella pneumophila, Mycoplasma pneumoniae, Helicobacter pylori (Campilobacter), Campi lobacter jejuni, Chlamydia pneumoniae, Moraxella catarrhalis, Bordetella pertussis, Propionibacterium acne, Mycobacterium avium, Mycobacterium leprae, Mycobacterium kansasii, Mycobacterium marinom, Staphylococcus aureus, Ureaplasma urealyticum, Toxoplasma gondii, Corynebacterium spp., Borrelia burgdorferi, Pasteurella multocida, some anaerobes (Eubacterium spp. ., Peptococcus spp., Propionibacterium spp., Clostridium perfringens, Bacteroides melaninogenicus), is less active against Mycobacterium tuberculosis.

Pharmacokinetics

Absorption is fast. Food slows absorption without significantly affecting bioavailability. Communication with plasma proteins is more than 90%. After a single dose, 2 peaks of the maximum concentration of the drug in the blood plasma are recorded. The second peak is due to the ability of the drug to concentrate in the gallbladder, followed by gradual or rapid entry into the intestine and absorption. The time to reach the maximum concentration of the drug in the blood plasma after oral administration of 250 mg is 1-3 hours.

After oral administration, 20% of the dose taken is quickly hydroxylated in the liver by cytochrome enzymes CYP3A4, CYP3A5 and CYP3A7 to form the main metabolite -14-hydroxyclarithromycin, which has pronounced antimicrobial activity against Haemophilus influenzae. It is an inhibitor of the isoenzymes CYP3A4, CYP3A5 and CYP3A7.

When taken regularly at 250 mg/day, the equilibrium concentrations of the unchanged drug and its main metabolite are 1 and 0.6 μg/ml, respectively; The half-life is 3-4 hours and 5-6 hours, respectively. When the dose is increased to 500 mg/day, the equilibrium concentration of the unchanged drug and its metabolite in plasma is 2.7-2.9 and 0.83-0.88 μg/ml, respectively; half-life is 4.8-5 hours and 6.9-8.7 hours, respectively. At therapeutic concentrations it accumulates in the lungs, skin and soft tissues (concentrations there are 10 times higher than the level in blood serum).

It is excreted by the kidneys and intestines (20-30% in unchanged form, the rest in the form of metabolites). With a single dose of 250 mg and 1200 mg, 37.9 and 46% are excreted by the kidneys, and 40.2 and 29.1% by the intestines, respectively.

Clarithromycin or Amoxicillin - which is better?

Manufacturer: Hemofarm, Serbia
Release form: tablets, capsules, granules

Active ingredient: amoxicillin

Synonyms: Flemoxin Solutab, Amosin

Amoxicillin is an analogue of Clarithromycin 500 mg, which is cheaper than the others. The drug belongs to the group of semisynthetic penicillins. The substance destroys pathogenic microflora in the body. Amoxicillin has a wide spectrum of action and is used for:

• sinusitis, sinusitis, nasopharyngitis, laryngitis and other upper respiratory tract infections;
• bronchitis, community-acquired pneumonia;
• bacterial infections of the kidneys, bladder and urethra;
• sexually transmitted infections;
• infectious lesions of the gastrointestinal tract;
• general intoxications;
• sepsis.

The analogue is used to treat children from birth and adults. The dosage of the drug is determined individually.

The combined use of Clarithromycin and Amoxicillin is used to kill Helicobacter pylori.

Amoxicillin and Clarithromycin are broad-spectrum antimicrobial agents. Which drug is better depends on the patient's condition and accompanying symptoms.

Clarithromycin Long tablets p/o with modified release 500 mg No. 5x2

Name

Clarithromycin long

Description

Oval, blue-coated tablets with a biconvex surface.

Main active ingredient

Clarithromycin

Release form

5 or 10 tablets in a blister pack made of polyvinyl chloride film and aluminum foil. 2.4 blister packs of 5 tablets each or 1.2 blister packs of 10 tablets each, together with an insert, are placed in a cardboard pack (No. 5x2, No. 5x4, No. 10x1, No. 10x2).

Dosage

500 mg

special instructions

pharmachologic effect

Pharmacodynamics

Clarithromycin is a semisynthetic macrolide antibiotic. The antibacterial effect of clarithromycin is determined by its binding to the 5OS ribosomal subunit of sensitive bacteria and inhibition of protein biosynthesis. Modified-release tablets are a homogeneous crystalline base that, when passing through the gastrointestinal tract, provides a sustained release of the active substance. The drug is highly effective in vitro against a wide range of aerobic and anaerobic gram-positive and gram-negative microorganisms, including hospital strains. The minimum inhibitory concentrations (MICs) of clarithromycin are usually two times lower than the MICs of erythromycin. Clarithromycin is highly effective in vitro against Legionella pneumophila and Mycoplasma pneumonie. In vitro studies have shown that strains of Enterobacteriaceae and Pseudomonas, as well as gram-negative bacteria that do not produce lactose, are insensitive to clarithromycin. Microbiology Clarithromycin is active in vitro and in clinical practice against most strains of the following microorganisms. Aerobic gram-positive microorganisms: Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Listeria monocytogenes. Aerobic gram-negative microorganisms: Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Legionella pneumophila. Other microorganisms: Mycoplasma pneumoniae, Chlamydia pneumoniae (TWAR). Mycobacteria: Mycobacterium leprae, Mycobacterium kansasii, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium avium complex (MAC), which includes Mycobacterium avium, Mycobacterium intracellulare. Beta-lactamases of microorganisms do not affect the effectiveness of clarithromycin. Most methicillin- and oxacillin-resistant strains of staphylococci are insensitive to clarithromycin. Clarithromycin is active in vitro against most strains of such microorganisms, but the clinical effectiveness and safety of its use have not been established. Aerobic gram-positive microorganisms: Streptococcus agalactiae, Streptococci (groups C,F,G), Viridans group streptococci. Aerobic gram-negative microorganisms: Bordetella pertussis, Pasteurella multocida. Other microorganisms: Chlamydia trachomatis. Anaerobic gram-positive microorganisms: Clostridium perfringens, Peptococcus niger, Propionibacterium acnes. Anaerobic gram-negative microorganisms: Bacteriodes melaninogenicus. Spirochetes: Borrelia burgdorferi, Treponema pallidum. Campylobacter: Campylobacter jejuni. Clarithromycin has a bactericidal effect against several strains of bacteria: Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Moraxella (Branhamella) catarrhalis, Neisseria gonorrhoeae, Helicobacter pylori, Campylobacter spp. The main metabolite of clarithromycin in the human body is the microbiologically active 14-OH-clarithromycin. For most microorganisms, the microbiological activity of the metabolite is equal to or 1-2 times weaker than that of the parent substance, with the exception of Helicobacter influenzae, for which the effectiveness of the metabolite is 2 times higher. Under in vitro and in vivo conditions, the parent substance and its major metabolite exhibit either an additive or synergistic effect against Helicobacter influenzae, depending on the strain of the microorganism.

Pharmacokinetics

The kinetics of clarithromycin modified-release tablets were compared with those of immediate-release 250 and 500 mg tablets. The magnitude of absorption was equivalent when equivalent doses were used. Absolute bioavailability is about 50%. With repeated administration of the drug, no accumulation was detected and the nature of metabolism in the human body does not change. Healthy subjects Following administration of clarithromycin modified-release tablets, 500 mg per day orally after meals, the steady-state maximum plasma concentrations (Cmax) of clarithromycin and 14-OH-clarithromycin were 1.3 and 0.48 mcg/mL, respectively. The half-lives of the drug and its metabolite were 5.3 and 7.7 hours, respectively. After taking 1000 mg of clarithromycin per day (2 tablets of 500 mg), the steady-state maximum concentrations of clarithromycin and 14-OH-clarithromycin averaged 2.4 mcg/ml and 0.67 mcg/ml, respectively. The half-lives of the parent substance and its main metabolite are 5.8 and 8.9 hours, respectively. Tmax when taking 500 mg and 1000 mg per day was achieved after 6 hours. Equilibrium concentrations of 14-OH-clarithromycin do not increase in proportion to the dose of clarithromycin, and the half-lives of clarithromycin and its main metabolite increase with increasing dose. The nonlinear nature of the pharmacokinetics of clarithromycin is associated with a decrease in the formation of 14-hydroxylated and N-demethylated metabolites when using higher doses. About 40% of the clarithromycin dose is excreted in the urine, and 30% through the intestines. Patients Clarithromycin and its 14-OH metabolite are widely distributed in tissues and body fluids. After oral administration, the content of clarithromycin in the cerebrospinal fluid remains low (1-2% of the serum level with a normal blood-brain barrier). The concentration of clarithromycin in tissues is usually several times higher than in serum. Liver dysfunction. In patients with moderate or severe hepatic impairment but with preserved renal function, no dose adjustment of clarithromycin is required. Renal dysfunction. If renal function is impaired, the minimum and maximum plasma concentrations, half-life and area under the concentration/time curve of clarithromycin and 14-OH-clarithromycin increase. The elimination constant and urinary excretion decrease. The degree of change in these indicators depends on the degree of renal dysfunction - the more severe the impairment, the more pronounced the changes in indicators. Elderly patients. In elderly patients, blood levels of clarithromycin and 14-OH-clarithromycin were higher and elimination was slower compared with those in younger adults. Changes in pharmacokinetics in the elderly are primarily associated with impaired renal function rather than with the patient's age.

Indications for use

Treatment of infections caused by microorganisms sensitive to clarithromycin: - lower respiratory tract infections (bronchitis, pneumonia, etc.); — upper respiratory tract infections (sinusitis, pharyngitis, etc.); - infections of the skin and soft tissues (folliculitis, erysipelas, etc.).

Directions for use and doses

The recommended dose of clarithromycin for adults and children over 12 years of age is 500 mg once daily with meals. For more severe infections, the dose can be increased to 1000 mg once a day (2 tablets of 500 mg). The usual duration of treatment is from 5 to 14 days, with the exception of treatment of community-acquired pneumonia and sinusitis, which require 6-14 days of therapy. The tablets should be swallowed whole without chewing. Use in patients with renal failure: Clarithromycin Long 500 mg should not be used in patients with severe renal failure (creatinine clearance less than 30 ml/min), since in this situation a dose reduction of 50% is required, which is not possible for this form of release of the drug. Clarithromycin immediate-release tablets can be used (see section "Contraindications"). The dose of clarithromycin should be reduced by half, that is, 250 mg once a day, or 250 mg twice a day in more severe cases. Treatment of these patients should not last more than 14 days. If it is necessary to reduce the dose in patients with moderate renal impairment (creatinine clearance 30 to 60 ml/min) to 50% of the original dose, the maximum dose will be one clarithromycin immediate-release 500 mg tablet per day (see also Interactions with Others). medicines"). Doses of other drugs may need to be adjusted when used concomitantly with clarithromycin due to drug-drug interactions (see Interactions with Other Drugs section).

Use during pregnancy and lactation

The safety of clarithromycin during pregnancy and lactation has not been established. The drug should not be used during pregnancy and breastfeeding without a thorough assessment of the benefit/risk ratio. Clarithromycin is excreted into breast milk.

Precautionary measures

Cardiovascular adverse reactions When using macrolides, including clarithromycin, prolongation of the repolarization phase and QT interval was identified, which are a risk of developing cardiac arrhythmia and torsades de pointes. Since the following conditions may increase the risk of developing ventricular arrhythmias (including torsades de pointes), clarithromycin should be used with caution: - in patients with coronary artery disease, severe heart failure, conduction disturbances and clinically significant bradycardia; - in patients with electrolyte imbalance such as hypomagnesemia. Clarithromycin should not be given to patients with hypokalemia; - with simultaneous use of other drugs with an established risk of prolongation of the QT interval; - simultaneous use of clarithromycin with the drugs astemizole, cisapride, pimozide and terfenadine is contraindicated; - Clarithromycin should not be used in patients with a history of congenital or acquired QT prolongation or ventricular arrhythmia. Epidemiological studies assessing the risk of cardiovascular adverse outcomes have shown variable results. Some observational studies have identified a risk of arrhythmia, myocardial infarction, and cardiovascular mortality associated with the use of macrolides, including clarithromycin. When using clarithromycin, the information received must be taken into account. Long-term or repeated use of antibiotics can cause overgrowth of non-susceptible bacteria and fungi. If superinfection occurs, clarithromycin should be discontinued and appropriate therapy should be initiated. The drug should be used with caution in patients with severe renal failure. Liver dysfunction, including elevated liver enzymes, and hepatocellular and/or cholestatic hepatitis with or without jaundice have been reported with clarithromycin use. This liver dysfunction can be severe and is usually reversible. In some cases, fatal liver failure has been reported, which was mainly associated with serious underlying diseases and/or concomitant drug treatment. You should immediately stop using clarithromycin if signs and symptoms of hepatitis such as anorexia, jaundice, dark urine, itching or pain in the abdomen occur. Mild to fatal diarrhea due to Clostridium difficile (CDAD) has been reported with almost all antibacterial drugs, including clarithromycin. The possibility of developing Clostridium difficile diarrhea should always be kept in mind in all patients with diarrhea after antibiotic use. In addition, a careful history must be taken as diarrhea caused by Clostridium difficile has been reported 2 months after the use of antibacterial drugs. Increased symptoms of myasthenia gravis have been reported in patients receiving clarithromycin. The drug is excreted by the liver and kidneys. Caution should be exercised when using the drug in patients with impaired liver function or moderate or severe renal impairment. Colchicine toxicity (including fatal outcomes) has been reported with the combined use of clarithromycin and colchicine, especially in elderly patients, including those with renal failure. Clarithromycin and triazolbenzodiazepines, for example, triazolam, midazolam, should be used with caution (see “Interaction with other drugs”). Pneumonia Because Streptococcus pneumoniae may be resistant to macrolides, it is important to perform susceptibility testing when prescribing clarithromycin for the treatment of community-acquired pneumonia. For hospital-acquired pneumonia, clarithromycin should be used in combination with other appropriate antibiotics. Mild to moderate skin and soft tissue infections These infections are most often caused by Staphylococcus aureus and Streptococcus pyogenes, both of which may be resistant to macrolides. Therefore, it is important to conduct a sensitivity test. In cases where beta-lactam antibiotics cannot be used (for example, allergies), other antibiotics, such as clindamycin, may be used as first choice. Currently, macrolides only play a role in the treatment of certain skin and soft tissue infections, for example: infections caused by Corynebacterium minutissimum (erythrasma), acne vulgaris, erysipelas; and in situations where penicillin treatment cannot be used. Hypersensitivity. If severe acute hypersensitivity reactions develop, such as anaphylaxis, severe skin reactions (eg, acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with rash, eosinophilia, and systemic symptoms (DRESS syndrome) , it is necessary to immediately stop taking clarithromycin and promptly begin appropriate treatment.Clarithromycin should be used with caution when co-administered with inducers of the cytochrome CYP3A4 enzyme (see "Interaction with other drugs"). Attention should be paid to the possibility of cross-resistance between clarithromycin and other macrolides, as well as lincomycin and clindamycin. The use of any antimicrobial therapy, including clarithromycin, for the treatment of Helicobacter pylori infection can lead to the development of microbial resistance. The drug contains lactose, so patients with rare hereditary forms of galactose intolerance, lactase deficiency or glucose syndrome galactose malabsorption should not use the drug. Oral hypoglycemic agents/insulin The combined use of clarithromycin and oral hypoglycemic agents and/or insulin may cause severe hypoglycemia. When used concomitantly with hypoglycemic agents such as nateglinide, pioglitazone, repaglinide and rosiglitazone, clarithromycin may inhibit the CYP3A enzyme, which may cause hypoglycemia. Close monitoring of glucose levels is recommended. Oral anticoagulants When clarithromycin is used concomitantly with warfarin, there is a risk of serious bleeding, a significant increase in INR (international normalized ratio) and prothrombin time. As long as patients are taking clarithromycin and oral anticoagulants concomitantly, MHO and prothrombin time should be monitored frequently. HMG-CoA reductase inhibitors The combined use of clarithromycin with lovastatin or simvastatin is contraindicated (see “Contraindications”). Like other macrolides, clarithromycin led to increased concentrations of HMG-CoA reductase inhibitors. Rarely, rhabdomyolysis has been reported in patients using these drugs together. Monitor patients for signs and symptoms of myopathy. Rarely, rhabdomyolysis has been reported in patients when clarithromycin was co-administered with atorvastatin or rosuvastatin. In case of simultaneous use, the dose of atorvastatin or rosuvastatin should be reduced as much as possible. Appropriate decisions should be made regarding statin dose adjustments or use of a statin that is not dependent on CYP3A metabolism (eg, fluvastatin or pravastatin). Clarithromycin tablets have not been studied in children under 12 years of age. Children of this age can use the drug in the form of a suspension. No impact data available. However, before operating vehicles and other mechanisms, it is necessary to take into account the possibility of adverse reactions from the nervous system, such as convulsions, dizziness, vertigo, hallucinations, confusion, disorientation, etc.

Interaction with other drugs

The use of the following drugs is strictly contraindicated due to the possible development of severe interaction effects Cisapride, pimozide, terfernadine, astemizole Increased serum levels of cisapride, pimozide and terfenadine were observed when they were used together with clarithromycin, which can lead to prolongation of the QT interval and the appearance of arrhythmias, in including ventricular tachycardia, ventricular fibrillation and torsade de pointes. Similar effects were observed with the combined use of astemizole and other macrolides. Ergotamine/dihydroergotamine Concomitant use of clarithromycin and ergotamine or dihydroergotamine has been associated with signs of acute ergotism, characterized by vasospasm and ischemia of the extremities and other tissues, including the central nervous system. HMG-CoA reductase inhibitors (statins) Concomitant use of clarithromycin with lovastatin or simvastatin is contraindicated (see section "Contraindications"), since these statins are significantly metabolized by CYP3A and simultaneous use with clarithromycin increases their concentration in the blood plasma, which, in turn, turn, increases the risk of myopathy, including rhabdomyolysis. There have been reports of rhabdomyolysis in patients treated concomitantly with clarithromycin and these statins. If treatment with clarithromycin cannot be avoided, therapy with lovastatin or simvastatin should be discontinued for the duration of treatment. Caution should be exercised when clarithromycin is administered concomitantly with statins. In situations where concomitant use of clarithromycin with statins cannot be avoided, it is recommended to prescribe the lowest registered dose of the statin. It is possible to use a statin that is not dependent on CYP3A metabolism (for example, fluvastatin). Monitor for signs and symptoms of myopathy. Ticagrelor Concomitant use of clarithromycin increases the concentration of ticagrelor by reducing its metabolism in the liver and reducing the concentration of the active metabolite. Oral midazolam When midazolam was coadministered with clarithromycin tablets (500 mg twice daily), the AUC of midazolam increased 7-fold after oral administration of midazolam. The simultaneous administration of oral midazolam and clarithromycin is contraindicated (see section "Contraindications"). Quetiapine Significant increase in quetiapine concentrations with risk of overdose. Colchicine Colchicine is a substrate of both the CYP3A isoenzyme and the transport protein P-glycoprotein (Pgp). It is known that clarithromycin and other macrolides are inhibitors of the CYP3A and Pgp isoenzymes. When clarithromycin and colchicine are coadministered, inhibition of Pgp and/or CYP3A may result in increased colchicine exposure. The simultaneous use of clarithromycin and colchicine is contraindicated (see sections "Contraindications" and "Precautions"). Effect of other drugs on the pharmacokinetics of the drug Drugs that are inducers of CYP3A (for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) can induce the metabolism of clarithromycin. This may result in subtherapeutic levels of clarithromycin and reduced effectiveness. In addition, it may be necessary to monitor plasma levels of the CYP3A inducer, which may be increased due to the inhibition of CYP3A by clarithromycin (see also the prescribing information for the corresponding CYP3A4 inducer). Concomitant use of rifabutin and clarithromycin resulted in increased rifabutin levels and decreased clarithromycin serum levels, while increasing the risk of uveitis. The following drugs have known or suspected effects on clarithromycin blood concentrations, so dose adjustments or alternative therapy may be necessary. Efavirenz, nevirapine, rifampicin, rifabutin and rifapentine Potent inducers of cytochrome P450 enzymes, such as efavirenz, nevirapine, rifampicin, rifabutin and rifapentine, can accelerate the metabolism of clarithromycin, reducing its concentration in the blood plasma, but increasing the concentration of 14-OH-clarithromycin, a microbiologically active metabolite. . Since the microbiological activity of clarithromycin and 14-OH-clarithromycin is different in relation to different bacteria, the expected therapeutic effect may be reduced due to the combined use of clarithromycin and inducers of cytochrome P450 enzymes. Etravirine The effect of clarithromycin was attenuated by etravirine; however, concentrations of the active metabolite 14-OH-clarithromycin were increased. Because 14-OH-clarithromycin has reduced activity against Mycobacterium avium complex (MAC), overall activity against this pathogen may be affected. Therefore, alternative drugs to clarithromycin should be considered for the treatment of MAC. Fluconazole Steady-state concentrations of the active metabolite 14-OH-clarithromycin did not change significantly when administered concomitantly with fluconazole. No clarithromycin dose change is required. Ritonavir The use of ritonavir and clarithromycin led to a significant inhibition of the metabolism of clarithromycin. Clarithromycin Cmax increased by 31%, Cmin by 182% and AUC by 77%. There was complete inhibition of the formation of 14-OH-clarithromycin. Due to the large therapeutic window, a dose reduction of clarithromycin is not required in patients with normal renal function. In patients with renal failure, dose adjustment is necessary: ​​with a CLCR of 30-60 ml/min, the dose of clarithromycin should be reduced by 50% to a maximum dose of 1 modified-release tablet per day; at CLCR

Contraindications

Hypersensitivity to the active substance, other macrolide antibiotics or to any of the excipients listed in the “Composition” section. Concomitant use of clarithromycin with any of the following drugs: astemizole, cisapride, pimozide and terfenadine, as they can induce cardiac arrhythmias (QT prolongation, ventricular tachycardia, ventricular fibrillation and torsades de pointes) (see section "Interactions with Others") medicines"). Concomitant use of clarithromycin with quetiapine, ticagrelor or ranolazine. Concomitant use of ergot alkaloids (ergotamine or dihydroergotamine) and clarthyromycin, because this may lead to ergotoxicity (see section "Interactions with other drugs"). Concomitant use of clarithromycin and oral midazolam (see section “Interactions with other drugs”). Clarithromycin is contraindicated in patients with a history of prolonged QT interval (prolongation of the QT interval, congenital or acquired, documented) or ventricular arrhythmia, including torsades de pointes (see sections "Precautions" and "Interactions with other drugs"). Concomitant use of clarithromycin with an HMC-CoA reductase inhibitor (statins), which are extensively metabolized by CYP3A4 (lovastatin or simvastatin), due to an increased risk of myopathy, including rhabdomyolysis (see section "Interactions with other drugs"). Clarithromycin is contraindicated in patients with hypokalemia (risk of QT prolongation). Clarithromycin is contraindicated in patients suffering from severe liver failure accompanied by impaired renal function. Like other strong inhibitors of CYP3A4 enzymes, clarithromycin should not be used in combination with colchicine (see Precautions and Drug Interactions). Clarithromycin Long tablets 500 mg are contraindicated in patients with severe renal impairment (creatinine clearance less than 30 ml/min), since the release form does not allow reducing the dose below 500 mg per day. History of cholestatic jaundice and/or hepatic dysfunction associated with clarithromycin use.

Compound

One tablet contains: active ingredient: clarithromycin – 500 mg; excipients: citric acid, sodium alginate, povidone, talc, stearic acid, magnesium stearate, lactose monohydrate, opadry II (including polyvinyl alcohol, partially hydrolyzed; talc; macrogol 3350 (polyethylene glycol 3350); titanium dioxide E 171; aluminum varnish based on indigo carmine E 132; aluminum varnish based on yellow quinoline E 104).

Overdose

Existing reports indicate that overdose of clarithromycin may cause gastrointestinal symptoms. One patient with a history of bipolar psychosis who took 8 grams of clarithromycin developed mental status disturbance, paranoid behavior, hypokalemia, and hypoxemia. Adverse reactions accompanying an overdose should be treated with gastric lavage and symptomatic therapy. As with other macrolides, hemodialysis or peritoneal dialysis is unlikely to significantly alter ur levels.

Clarithromycin or Levofloxacin - which is better for pneumonia

Manufacturer: JSC Dalkhimfarm, Russian Federation
Release form: film-coated tablets

Active ingredient: levofloxacin hemihydrate

Synonyms: Tavanik, Remedia, Levolet R, Eleflox, Flexid

Levofloxacin is a substitute for Clarithromycin. The substance included in the drug exhibits a bactericidal effect. The analogue is active against enterococci, staphylococci, streptococci, clostridia, chlamydia and other pathogenic bacteria. Levofloxacin is used for infectious diseases of the lower respiratory tract, genitourinary system, and skin. The drug has proven itself especially well for bronchitis, pneumonia and acute bacterial sinusitis, chronic prostatitis.

The medication is prescribed for adults, 1 tablet 1-2 times a day. The duration of treatment is 5–7 days.

Which remedy depends more on the patient’s condition and the course of the disease.

Clarithromycin or Amoxiclav - which is better and stronger for pneumonia

Manufacturer: Lek D.D., Slovenia
Release form: powder for suspension, tablets

Active ingredient: clavulanic acid, amoxicillin

Synonyms: Flemoclav Solutab, Augmentin, Ecoclave

Amoxiclav is a combined imported analogue of Clarithromycin. The drug contains two substances. Amoxicillin kills pathogenic bacteria in the body. Clavulanic acid enhances the effect of the main substance, protecting it from destruction. Amoxiclav is used in pediatrics, ENT practice, gynecology, urology, and dentistry.

The main advantages of the analogue are:

• Possibility of use in pregnant women, premature babies and newborns;
• low rate of adverse reactions;
• average cost;
• variety of forms and dosages.

The medications have similar indications, but for respiratory tract infections, preference is given to the analogue.

Clarithromycin or Suprax - which is better?

Manufacturer: Facta Pharmaceutici S.P.A., Italy
Release form: granules for suspension, tablets

Active ingredient: cefixime

Synonyms: Pancef, Cefixime Express

An imported analogue of the drug Clarithromycin is Suprax. The drug belongs to the group of 3rd generation cephalosporin antibiotics. The substitute disrupts protein synthesis in bacterial cells, which causes their death. Suprax is prescribed to children from 6 months and adults with the following pathologies:

• acute tonsillitis, pharyngitis, sinusitis;
• acute and subacute otitis media;
• lower respiratory tract infections;
• pyelonephritis, urethritis, cystitis;
• dysentery;
• genital bacterial infections.

The analogue is used in the recommended dosage once a day. The duration of treatment is 5–7 days.

Among the advantages of the drug are:

• high efficiency;
• use from 6 months;
• no adverse reactions.

Suprax and Clarithromycin exhibit a similar effect, however, for uncomplicated infections, preference is given to the analogue.

Clarithromycin or Sumamed

Manufacturer: Pliva Hrvatska, Croatia
Release form: tablets, capsules, powder for suspension

Active ingredient: azithromycin dihydrate

Synonyms: Azithromycin ecomed, Zi-factor, Zitrolide, Hemomycin, Azithrus

Sumamed is a foreign analogue. The antibacterial drug belongs to the group of macrolides and exhibits a bacteriostatic effect. Sumamed is used in the treatment of adults and children over 6 months of age for infectious diseases caused by bacteria sensitive to the substance.

A comparison of the analogue and Clarithromycin is shown in the table

Lopinavir and ritonavir

A combination of antiviral drugs called kaletra is used to treat HIV. According to WHO, the use of the drug in combination with other medications is effective in the fight against coronavirus. At the end of January, the Ministry of Health included lopinavir with ritovinar in the list of drugs recommended for COVID-19 as antiviral therapy. As a result, the demand and sales of kaletra increased tenfold. Experts warn that uncontrolled use of the drug without a doctor's prescription can cause harm to health, including diarrhea and liver damage.

Chinese scientists have found that lopinavir and ritonavir are not effective in treating mild to moderate COVID-19. Taking medications does not improve the clinical picture; moreover, it may cause side effects. The experiment involved 86 patients, of which 34 people took a combination of lopinavir and ritonavir, and 17 patients did not receive any drugs. After two weeks, both groups showed similar results, but those taking the medications experienced side effects.

Clubax OD

Manufacturer: Ranbaxy, India
Release form: extended-release film-coated tablets

Active ingredient: clarithromycin

Klabaks OD is a foreign analogue in the composition of the drug Clarithromycin. Medicines belong to the same pharmaceutical group, have the same composition and mechanism of action. Klabax OD is used in children over 12 years of age and adults for bacterial infections caused by microorganisms sensitive to the substance.

The main advantage of the drug is its prolonged action.

Ribavirin

It is quite difficult to assess the effectiveness and safety of ribavirin. On the one hand, this drug inhibits the reproduction of the vast majority of viruses, on the other, the mechanism of action of ribavirin is not fully understood. At the end of January, the Ministry of Health recommended the use of this antiviral drug to treat coronavirus. It is prescribed to children for respiratory syncytial infection (a rare type of acute respiratory viral infection), which causes severe lung damage. The drug is used for severe influenza, for measles in children with immunodeficiency, and in combination with interferon ribavirin to treat viral hepatitis C.

However, Academician of the Russian Academy of Sciences Alexander Chuchalin criticized the recommendations of the Ministry of Health. When prescribing the drug to adults, it is necessary to take into account its teratogenicity (threat of disruption of embryonic development), therefore ribavirin is strictly contraindicated during pregnancy. Despite the fact that the drug inhibits the reproduction of many viruses, it is very toxic and causes many side effects.

At the end of March, the Ministry of Health excluded ribavirin from the list of recommended drugs for the treatment of COVID-19.