Clarithromycin
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DRUG-CLARITHROMYCIN |
|---|---|
| Тип | Препарат |
| Синоніми | BiaxinKlabaxKlacidКларитроміцин |
| Статус | переглянуто 2026-05-18 |
| Хвороби | DIS-GASTRIC |
| Джерела | SRC-NCCN-BCELL-2025 |
Дані про препарат
| Клас | Semi-synthetic 14-membered macrolide antibiotic (Gram-positive + atypicals + Helicobacter pylori) |
|---|---|
| Механізм дії | Macrolide antibiotic that binds reversibly to the 50S ribosomal subunit near the peptidyl transferase center, blocking the translocation step of peptide elongation and producing bacteriostatic (or bactericidal at high intracellular concentrations) inhibition of protein synthesis. Spectrum: Streptococcus spp., Staphylococcus spp. (methicillin-susceptible), Haemophilus influenzae, Moraxella catarrhalis, atypicals (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella), Mycobacterium avium complex (MAC), and Helicobacter pylori (in combination therapy). Active metabolite 14-hydroxyclarithromycin contributes to H. influenzae coverage. Cancer-prevention relevance: macrolide component of H. pylori triple therapy — eradication reduces gastric cancer risk in chronic carriers (KSS §20 v0.2-A scope). |
| Типове дозування | H. pylori eradication (component of triple therapy, adult): 500 mg PO BID × 14 days, taken with PPI (omeprazole 20 mg BID) + amoxicillin 1 g BID OR metronidazole 500 mg BID (clarithromycin–metronidazole pair if penicillin-allergic). Local clarithromycin resistance >15% precludes use in triple therapy — switch to quadruple bismuth-based regimen. Other indications (CAP, sinusitis): 500 mg PO BID × 7-14 days. MAC prophylaxis: 500 mg PO BID. Renal adjustment: CrCl <30 → reduce dose by 50%. Hepatic: no adjustment in mild/moderate; caution in severe. |
| Зареєстровано в Україні | True |
| Відшкодовується НСЗУ | False |
| Остання перевірка для України | 2026-05-18 |
Застереження
- Increased risk of cardiac death — observational signal from CLARICOR trial (10-year follow-up); avoid in coronary artery disease where alternatives exist
Нотатки
STUB — v0.2 prevention-workstream authoring; pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode. Key component of H. pylori standard triple therapy (clarithromycin + PPI + amoxicillin or metronidazole) used for gastric-MALT-lymphoma treatment and gastric-cancer-prevention. WATCH: rising regional clarithromycin resistance in H. pylori (>15-20% in many European centers including Ukraine) means triple therapy is failing more often — quadruple bismuth-based therapy (PBMT) is becoming first-line in high-resistance settings. Local antibiogram or community- resistance data should drive regimen choice. Strong CYP3A4 inhibitor — drug interactions are extensive and clinically critical (esp. statins, colchicine, calcineurin inhibitors, anticoagulants). Pre-prescription medication review is mandatory. Cardiac mortality signal from CLARICOR is real but absolute risk small — avoid in CAD where alternatives exist. Ukraine: out-of-pocket pharmacy, widely available, generics affordable. Two-Co-Lead signoff queued for v0.2-A clinical review.
Де використовується
Access Pathways
AP-HP-ERADICATION-PHARMACY-OOP- H. pylori eradication (PPI + amox/clarithromycin / bismuth quadruple) — pharmacy out-of-p...
Regimens
REG-HP-PPI-CLAR-AMOX- PPI-clarithromycin-amoxicillin triple therapy — 14 days