Treatment of AOM caused by H. influenzae, M. catarrhalis, or S. pneumoniae.
Not a drug of first choice; considered an alternative for patients with a history of type I penicillinhypersensitivity. May not be effective for AOM that fails to respond to amoxicillin since S. pneumoniae resistant to amoxicillin also may be resistant to clarithromycin.
Pharyngitis and Tonsillitis
Treatment of pharyngitis or tonsillitis caused by susceptible Streptococcus pyogenes (group A β-hemolytic streptococci). Generally effective in eradicating S. pyogenes from the nasopharynx, but efficacy in the prevention of subsequent rheumatic fever has not been established to date.
CDC, AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice; oral cephalosporins and oral macrolides considered alternatives. Amoxicillin sometimes used instead of penicillin V, especially for young children.
Consider that strains of S. pyogenes resistant to macrolides are common in some areas of the world (e.g., Japan, Finland) and clarithromycin-resistant strains have been reported in the US. (See Selection and Use of Anti-infectives under Cautions.)
Respiratory Tract Infections
Treatment of acute maxillary sinusitis caused by Haemophilus influenzae, Moraxella catarrhalis, or S. pneumoniae.
Treatment of acute bacterial exacerbations of chronic bronchitis caused by H. influenzae, H. parainfluenzae, M. catarrhalis, or S. pneumoniae.
Treatment of mild to moderate community-acquired pneumonia (CAP) caused by H. influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae (Chlamydia pneumoniae), S. pneumoniae, H. parainfluenzae, or M. catarrhalis.
Treatment of Legionnaires’ disease† caused by Legionella pneumophila. Drugs of choice are macrolides (usually azithromycin) or fluoroquinolones with or without rifampin.
Treatment of pertussis† caused by Bordetella pertussis. Erythromycin traditionally has been drug of choice for treatment and postexposure prophylaxis of pertussis, but other macrolides (azithromycin, clarithromycin) appear to be as effective and may be associated with better compliance because they are better tolerated.
Skin and Skin Structure Infections
Treatment of uncomplicated skin or skin structure infections caused by Staphylococcus aureus or S. pyogenes.
Helicobacter pylori Infection and Duodenal Ulcer Disease
Treatment of Helicobacter pylori infection and duodenal ulcer disease (active or 1-year history of duodenal ulcer); eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence.
Used in a multidrug regimen that includes amoxicillin, clarithromycin, and either lansoprazole or omeprazole (triple therapy). Also used with omeprazole (dual therapy) or ranitidine bismuth citrate (dual therapy).
Cat scratch disease generally self-limited in immunocompetent individuals and may resolve spontaneously in 2–4 months; some clinicians suggest that anti-infectives be considered for acutely or severely ill patients with systemic symptoms, particularly those with hepatosplenomegaly or painful lymphadenopathy, and such therapy probably is indicated in immunocompromised patients.
Anti-infectives also indicated in patients with B. henselae infections who develop bacillary angiomatosis, neuroretinitis, or Parinaud’s oculoglandular syndrome.
Optimum regimens have not been identified; some clinicians recommend azithromycin, clarithromycin, ciprofloxacin, erythromycin, doxycycline, rifampin, co-trimoxazole, gentamicin, or third generation cephalosporins.
Cryptosporidiosis
May decrease incidence of cryptosporidiosis† in HIV-infected adults. Anti-infectives may suppress the infection, but none has been found to reliably eradicate Cryptosporidium. CDC, NIH, IDSA, and others state that the most appropriate treatment for cryptosporidiosis in HIV-infected individuals is the use of potent antiretroviral agents (to restore immune function) and symptomatic treatment of diarrhea.
Lyme Disease
Alternate for treatment of early Lyme disease†. IDSA, AAP, and others recommend doxycycline, amoxicillin, or cefuroxime; macrolides may be less effective than these first-line agents.
Mycobacterial Infections
Primary prevention (primary prophylaxis) of Mycobacterium avium complex (MAC) bacteremia or disseminated infections in adults, adolescents, and children with advanced HIV infection. Recommended by USPHS/IDSA as a drug of choice for primary prevention of MAC in HIV-infected patients.
Treatment of disseminated MAC infection in HIV-infected adults, adolescents, and children. ATS, CDC, NIH, IDSA, and others recommend a regimen of clarithromycin (or azithromycin) and ethambutol and state that consideration may be given to adding a third drug (preferably rifabutin). Clarithromycin usually the preferred macrolide for initial treatment; azithromycin can be substituted if clarithromycin cannot be used because of drug interactions or intolerance and is preferred in pregnant women.
Prevention of recurrence (secondary prophylaxis) of disseminated MAC infection in HIV-infected adults, adolescents, and children. USPHS/IDSA, CDC, NIH, IDSA, and others recommend a macrolide (clarithromycin or azithromycin) given with ethambutol (with or without rifabutin). Azithromycin usually the preferred macrolide for use in conjunction with ethambutol for secondary prophylaxis in pregnant women.
Treatment of pulmonary MAC infections in HIV-negative patients†. A multiple-drug regimen of clarithromycin (or azithromycin), ethambutol, and either rifabutin or rifampin usually recommended.
Treatment of M. kansasii infections†; an alternative agent.
Treatment of cutaneous infections caused by M. abscessus or Mycobacterium chelonae†.
Treatment of cutaneous M. marinum infection†.
Toxoplasmosis
Has been used in conjunction with pyrimethamine for treatment of encephalitis caused by Toxoplasma gondii† in HIV-infected patients; not a preferred or alternative agent. CDC, NIH, IDSA, and others usually recommend pyrimethamine in conjunction with sulfadiazine and leucovorin for treatment of toxoplasmosis in adults and children, especially immunocompromised patients (e.g., HIV-infected individuals).
Prevention of Bacterial Endocarditis
Alternative for prevention of α-hemolytic (viridans group) streptococcal endocarditis† in penicillin-allergic patients undergoing certain dental, oral, respiratory tract, or esophageal procedures who have cardiac conditions that put them at high or moderate risk.
Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.
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