Clarithromycin

(BAN, USAN, rINN)
Clarithromycin Chemical formula
Synonyms: A-56268; Abbott-56268; Clarithromycine; Clarithromycinum; Claritromicina; Klarithromycin; Klaritromicinas; Klaritromisin; Klaritromycin; Klaritromysiini; TE-031. (2R,3S,4S,5R,6R,8R,10R,11R,12S,13R)-3-(2,6-Dideoxy-3C,3Odimethyloxy-2,4,6,8,10,12-hexamethyl-9-oxo-5-(3,4,6-trideoxy-3dimethylaminoide; 6O-Methylerythromycin.
Cyrillic synonym: Кларитромицин.

💊 Chemical information

Chemical formula: C38H69NO13 = 748.0.
CAS — 81103-11-9.
ATC — J01FA09.
ATC Vet — QJ01FA09.

Pharmacopoeias.

In Chin., Eur., Jpn, and US.

Ph. Eur. 6.2

(Clarithromycin). A white or almost white, crystalline powder. Practically insoluble in water; soluble in acetone and in dichloromethane; slightly soluble in methyl alcohol.

USP 31

(Clarithromycin). A white to off-white crystalline powder. Practically insoluble in water; slightly soluble in dehydrated alcohol, in methyl alcohol, and in acetonitrile; soluble in acetone; slightly soluble in phosphate buffer at pH values of 2 to 5. pH of a 0.2% suspension in a mixture of water and methyl alcohol (19:1) is between 8.0 and 10.0. Store in airtight containers.

💊 Adverse Effects and Precautions

As for Erythromycin. Gastrointestinal disturbances are the most frequent adverse effect but are usually mild and less frequent with clarithromycin than with erythromycin. Smell and taste disturbances, stomatitis, glossitis, tongue and tooth discoloration, and headache have occurred. There have also been reports of transient CNS effects. Other adverse effects include arthralgia, myalgia, hypoglycaemia, leucopenia, and thrombocytopenia. Interstitial nephritis and renal failure have been reported rarely. Intravenous doses may cause phlebitis and pain at the injection site. Caution is required in patients with hepatic or renal impairment and doses should be reduced in those with renal impairment (see under Uses and Administration below). It should not be used during pregnancy if possible as high doses have been associated with embryo-
toxicity in animal studies.

Effects on the blood.

Single cases of thrombocytopenia1 and thrombocytopenic purpura2,3 associated with clarithromycin have been reported. Cases of agranulocytosis have also been reported.4 A case of thrombocytopenia accompanied by interstitial nephritis, hepatitis, and elevated serum amylase levels was attributed to an allergic reaction to clarithromycin.5 Toxic epidermal necrolysis and subsequent death due to aplastic anaemia have been reported in a patient after taking clarithromycin for 3 days.6
1. Price TA, Tuazon CU. Clarithromycin-induced thrombocytopenia. Clin Infect Dis 1992; 15: 563–4
2. Oteo JA, et al. Clarithromycin-induced thrombocytopenic purpura. Clin Infect Dis 1994; 19: 1170–1
3. Alexopoulou A, et al. Thrombotic thrombocytopenic purpura in a patient treated with clarithromycin. Eur J Haematol 2002; 69: 191–2
4. Jacobs P, et al. Immune agranulocytosis and clarithromycin. Hematology 2004; 9: 291–6
5. Baylor P, Williams K. Interstitial nephritis, thrombocytopenia, hepatitis, and elevated serum amylase levels in a patient receiving clarithromycin therapy. Clin Infect Dis 1999; 29: 1350–1
6. Baz K, et al. Fatal aplastic anaemia in a patient with clarithromycin-induced toxic epidermal necrolysis. J Eur Acad Dermatol Venereol 2004; 18: 104–5.

Effects on the cardiovascular system.

QT prolongation and torsade de pointes were associated with use of clarithromycin in 2 patients.1 Renal impairment in 1 of the patients and hepatic impairment and organic heart disease in both could have increased their susceptibility to these effects. For mention of an unexpected increase in cardiovascular mortality in patients with stable coronary heart disease given clarithromycin, see Ischaemic Heart Disease, in Uses and Administration of Azithromycin, above.
1. Lee KL, et al. QT prolongation and torsades de pointes associated with clarithromycin. Am J Med 1998; 104: 395–6.

Effects on the eyes.

Corneal opacities, reversible on stopping treatment, were reported in a patient receiving oral clarithromycin as part of a regimen for disseminated Mycobacterium avium complex infection.1 Corneal subepithelial deposits have also been reported in a patient after prolonged use of clarithromycin eye drops for Mycobacterium avium complex keratitis. The deposits did not cause any ocular discomfort and resolved on stopping therapy.2
1. Dorrell L, et al. Toxicity of clarithromycin in the treatment of Mycobacterium avium complex infection in a patient with AIDS. J Antimicrob Chemother 1994; 34: 605–6
2. Tyagi AK, et al. An unreported side effect of topical clarithromycin when used successfully to treat Mycobacterium avium-intracellulare keratitis. Cornea 1999; 18: 606–7.

Effects on the gast

rointestinal tract. Pseudomembranous colitis associated with Clostridium difficile developed in a child receiving clarithromycin.1
1. Braegger CP, Nadal D. Clarithromycin and pseudomembranous enterocolitis. Lancet 1994; 343: 241–2.

Effects on the liver.

Progressive cholestatic jaundice, which subsequently proved fatal, developed in a 59-year-old woman after 3 days of clarithromycin therapy for acute maxillary sinusitis.1 Fulminant hepatic failure in another patient, which developed during clarithromycin therapy, resolved once the drug was withdrawn.2 Clarithromycin itself was considered responsible although there was the possibility that it had increased concentrations of isradipine, another known hepatotoxic drug that the patient was also receiving.
1. Fox JC, et al. Progressive cholestatic liver disease associated with clarithromycin treatment. J Clin Pharmacol 2002; 42: 676–80
2. Tietz A, et al. Fulminant liver failure associated with clarithromycin. Ann Pharmacother 2003; 37: 57–60.

Effects on the lungs.

On 2 occasions fever and pulmonary infiltration with eosinophilia occurred in a patient given clarithromycin.1 Another patient developed eosinophilic pneumonia 3 days after starting clarithromycin; symptoms improved when the drug was stopped.2
1. Terzano C, Petroianni A. Clarithromycin and pulmonary infiltration with eosinophilia. BMJ 2003; 326: 1377–8
2. Ohnishi H, et al. Clarithromycin-induced eosinophilic pneumonia. Intern Med 2004; 43: 231–5.

Effects on mental state.

Acute psychoses occurred in 2 patients receiving clarithromycin as part of prophylactic treatment for Helicobacter pylori infection and were similar to 3 previous ly reported cases in either AIDS patients or elderly subjects.1Delirium2 has also been associated with clarithromycin monotherapy in an elderly patient, and visual hallucinations have occurred in a 37-year-old woman being treated with ceftriaxone and clarithromycin for suspected pneumonia.3 A review4 of published and spontaneous reports found an association between adverse manic reactions and the use of certain antibacterials; clarithromycin was found to be the antibacterial most frequently implicated.
1. Gómez-Gil E, et al. Clarithromycin-induced acute psychoses in peptic ulcer disease. Eur J Clin Microbiol Infect Dis 1999; 18: 70–1
2. Özsoylar G, et al. Clarithromycin monotherapy-induced delirium. J Antimicrob Chemother 2007; 59: 331
3. Fernández Arenas O, et al. Alucinaciones por administración de una pauta estándar de claritromicina. Farm Hosp 2007; 31: 315–16
4. Abouesh A, et al. Antimicrobial-induced mania (antibiomania): a review of spontaneous reports. J Clin Psychopharmacol 2002; 22: 71–81.

Effects on the pancreas.

Pancreatitis has been reported in patients receiving clarithromycin.1-3
1. Liviu L, et al. Pancreatitis induced by clarithromycin. Ann Intern Med 1996; 125: 701
2. Schouwenberg BJJW, Deinum J. Acute pancreatitis after a course of clarithromycin. Neth J Med 2003; 61: 266–7
3. González Carro P, et al. Acute pancreatitis and modified-release clarithromycin. Ann Pharmacother 2004; 38: 508–509.

Hypersensitivity.

In addition to skin rashes and other hypersensitivity reactions which occasionally occur in patients receiving macrolides, leukocytoclastic vasculitis,1 Henoch-Schönlein purpura,2 and toxic epidermal necrolysis3 have been reported in patients receiving clarithromycin.
1. Gavura SR, Nusinowitz S. Leukocytoclastic vasculitis associated with clarithromycin. Ann Pharmacother 1998; 32: 543–5
2. Borrás-Blasco J, et al. Henoch-Schönlein purpura associated with clarithromycin: case report and review of literature. Int J Clin Pharmacol Ther 2003; 41: 213–16. Correction. ibid.; 420
3. Khaldi N, et al. Toxic epidermal necrolysis and clarithromycin. Can J Clin Pharmacol 2005; 12: e264–e268.

💊 Interactions

For a discussion of drug interactions of macrolide antibacterials, see Erythromycin.

Antidiabetics.

For reference to hypoglycaemia resulting from the addition of clarithromycin to glibenclamide or glipizide, see Antibacterials.

Antiretroviral drugs.

In studies in healthy subjects,1,2 the HIV-protease inhibitor ritonavir inhibited the metabolism of clarithromycin, increasing plasma concentrations and prolonging half-life. The metabolism of ritonavir was not affected significantly. The two drugs may be given together in usual doses to those with normal renal function but licensed product information for clarithromycin recommends that its dose should be reduced in patients with renal impairment receiving ritonavir and it should be noted that this is an extra reduction over and above that which may be needed for the renal impairment alone. Doses of clarithromycin should be reduced by 50% in patients with a creatinine clearance (CC) of 30 to 60 mL/minute and reduced by 75% in those with a CC below 30 mL/minute; the daily dose should not exceed 1 g. It has been suggested that other HIV-protease inhibitors and the NNRTI delavirdine may have a similar effect on clarithromycin. Use of efavirenz with clarithromycin has decreased plasma concentration of clarithromycin and increased its hydroxy metabolite. The combination has been associated with a high incidence of skin rashes. Decreases in the plasma concentration of clarithromycin have also been noted with nevirapine. Decreased concentrations of zidovudine have been reported in patients also taking clarithromycin and clarithromycin product information recommends that doses of the two drugs should be separated by 1 to 2 hours.
1. Ouellet D, et al. Assessment of the pharmacokinetic interaction between ritonavir and clarithromycin. Clin Pharmacol Ther 1996; 59: 143
2. Ouellet D, et al. Pharmacokinetic interaction between ritonavir and clarithromycin. Clin Pharmacol Ther 1998; 64: 355–62.

Colchicine.

For mention of fatal colchicine toxicity associated with concomitant use of clarithromycin, see Macrolides.

Disulfiram.

For a report of an interaction between clarithromycin and disulfiram, see Macrolides.

Fluoxetine.

For a report of delirium following use of clarithromycin with fluoxetine, see Antibacterials.

Gastrointestinal drugs.

In a study1 in healthy subjects, concentrations of clarithromycin and its active metabolite were increased in gastric tissue and mucus and, to a lesser extent, in plasma during use of omeprazole. In addition, use of clarithromycin with omeprazole resulted in higher and more prolonged plasma concentrations of omeprazole. The investigators suggest that this interaction could account for the synergistic action observed with this combination when used for eradication of Helicobacter pylori. However, licensed product information for clarithromycin states that no dosage adjustment to either drug is necessary. Although a study2 in healthy subjects suggested that some pharmacokinetic parameters of clarithromycin are altered by cimetidine, the clinical significance of such changes are unknown.
1. Gustavson LE, et al. Effect of omeprazole on concentrations of clarithromycin in plasma and gastric tissue at steady state. Antimicrob Agents Chemother 1995; 39: 2078–83
2. Amsden GW, et al. Oral cimetidine prolongs clarithromycin absorption. Antimicrob Agents Chemother 1998; 42: 1578–80.

💊 Antimicrobial Action

As for Erythromycin. Clarithromycin is reported to be more active than erythromycin against susceptible streptococci and staphylococci in vitro, as well as against some other species including Moraxella catarrhalis (Branhamella catarrhalis), Legionella spp., Chlamydia trachomatis, and Ureaplasma urealyticum. Clarithromycin is reported to be more active than erythromycin or azithromycin against some mycobacteria, including Mycobacterium avium complex and M. leprae. It is reported to have some in-vitro activity against the protozoan Toxoplasma gondii. The major metabolite, 14-hydroxyclarithromycin, is also active, and may enhance the activity of clarithromycin in vivo, notably against Haemophilus influenzae. The MICs of this metabolite are equal or twofold higher than those of the parent drug; the former is twofold more active than the latter against
H. influenzae.

Activity with other antimicrobials.

Clarithromycin has been reported to enhance the activity of a number of antimycobacterials including ethambutol, isoniazid, pyrazinamide, and rifampicin against Mycobacterium tuberculosis.1,2
1. Cavalieri SJ, et al. Synergistic activities of clarithromycin and antituberculous drugs against multi drug-resistant Mycobacterium tuberculosis. Antimicrob Agents Chemother 1995; 39: 1542–5
2. Mor N, Esfandiari A. Synergistic activities of clarithromycin and pyrazinamide against Mycobacterium tuberculosis in human macrophages. Antimicrob Agents Chemother 1997; 41: 2035–6.

Resistance.

Erythromycin-resistant isolates of Streptococcus pneumoniae are commonly cross-resistant to clarithromycin.1The incidence of resistance to clarithromycin and other macrolides is higher among penicillin-resistant strains than among penicillin-sensitive strains.2 Clarithromycin-resistant isolates of Helicobacter pylori have also emerged.3-6 Genetic mutations responsible for clarithromycin resistance have been identified in H. pylori7 and in Mycobacterium spp.8,9 Since resistance develops rapidly in M. avium during clarithromycin monotherapy, combination therapy is usually recommended. However, resistance to clarithromycin in an AIDS patient with systemic M. avium complex infection, despite combined treatment with clofazimine, has been described.10
1. Lonks JR, Medeiros AA. High rate of erythromycin and clarithromycin resistance among Streptococcus pneumoniae isolates from blood cultures from Providence, RI. Antimicrob Agents Chemother 1993; 37: 1742–5
2. Barry AL, et al. Macrolide resistance among Streptococcus pneumoniae and Streptococcus pyogenes isolates from out-patients in the USA. J Antimicrob Chemother 1997; 40: 139–40
3. López-Brea M, et al. Evolution of resistance to metronidazole and clarithromycin in Helicobacter pylori clinical isolates from Spain. J Antimicrob Chemother 1997; 40: 279–81
4. Hultén K, et al. Macrolide resistance in Helicobacter pylori: mechanism and stability in strains from clarithromycin-treated patients. Antimicrob Agents Chemother 1997; 41: 2550–3
5. Kalach N, et al. High levels of resistance to metronidazole and clarithromycin in Helicobacter pylori strains in children. J Clin Microbiol 2001; 39: 394–7
6. Grove DI, Koutsouridis G. Increasing resistance of Helicobacter pylori to clarithromycin: is the horse bolting? Pathology 2002; 34: 71–3
7. Versalovic J, et al. Mutations in 23S rRNA are associated with clarithromycin resistance in Helicobacter pylori. Antimicrob Agents Chemother 1996; 40: 477–80
8. Nash KA, Inderlied CB. Genetic basis of macrolide resistance in Mycobacterium avium isolated from patients with disseminated disease. Antimicrob Agents Chemother 1995; 39: 2625–30
9. Wallace RJ, et al. Genetic basis for clarithromycin resistance among isolates of Mycobacterium chelonae and Mycobacterium abscessus. Antimicrob Agents Chemother 1996; 40: 1676–81
10. De Wit S, et al. Acquired resistance to clarithromycin as combined therapy in Mycobacterium avium intracellulare infection. Lancet 1993; 341: 53–4.

💊 Pharmacokinetics

Clarithromycin is rapidly absorbed from the gastrointestinal tract, and undergoes first-pass metabolism; the bioavailability of the parent drug is about 55%. The extent of absorption is relatively unaffected by the presence of food. Peak plasma concentrations occur 2 to 3 hours after an oral dose. At steady state, peak plasma concentrations of clarithromycin and its principal active metabolite, 14-hydroxyclarithromycin, are about 1 and 0.6 micrograms/mL, respectively, after 250 mg orally every 12 hours as tablets. The same dose given as a suspension to fasting subjects produces steadystate plasma concentrations of about 2 micrograms/mL of clarithromycin and about 0.7 micrograms/mL of 14hydroxyclarithromycin. Steady-state concentrations are reached within 3 to 4 days. The pharmacokinetics of clarithromycin are non-linear and dose dependent; high doses may produce disproportionate increases in peak concentrations of the parent drug, due to saturation of the metabolic pathways. However, the non-linearity is slight at the recommended doses of 250 to 500 mg every 8 to 12 hours. Clarithromycin and 14-hydroxyclarithromycin are widely distributed, and tissue concentrations exceed those in serum, in part because of intracellular uptake. Plasma protein binding has been reported to be about 80%. Clarithromycin has been detected in breast milk. It is extensively metabolised in the liver, and excreted in faeces via the bile; 5 to 10% of the parent drug is recovered from the faeces. At steady state, about 20% and 30% of a 250-mg or 500-mg dose as tablets, respectively, and about 40% of a 250-mg dose as suspension, is excreted in the urine as unchanged drug. 14Hydroxyclarithromycin as well as other metabolites are also excreted in the urine, accounting for 10 to 15% of the dose. The elimination half-lives of clarithromycin and 14-hydroxyclarithromycin are about 3 to 4 and 5 to 6 hours, respectively in patients receiving 250 mg every 12 hours, and about 5 to 7 and 7 to 9 hours, respectively, in those receiving 500 mg every 8 to 12 hours. The half-life is prolonged in renal impairment.
1. Rodvold KA. Clinical pharmacokinetics of clarithromycin. Clin Pharmacokinet 1999; 37: 385–98.

💊 Uses and Administration

Clarithromycin is a macrolide derived from erythromycin with similar actions and uses. It is given in the treatment of respiratory-tract infections. It is used with pyrimethamine as an alternative regimen in the treatment of toxoplasmosis. Clarithromycin is given orally or by intravenous infusion. Some clarithromycin preparations are prepared with the aid of lactobionic acid and may be stated to contain clarithromycin lactobionate. Doses are expressed in terms of the equivalent amount of clarithromycin. Usual oral doses in adults are 250 mg twice daily, increased to 500 mg twice daily if necessary in severe infection. Modified-release tablets allowing once-daily use are available in some countries. The usual intravenous dose is 500 mg twice daily, given as an infusion over 60 minutes using a solution containing about 0.2% of clarithromycin. Intravenous treatment may continue for 2 to 5 days, but should be changed to oral clarithromycin when possible. For treatment and prophylaxis of disseminated infection due to Mycobacterium avium complex, clarithromycin may be given in an oral dose of 500 mg twice daily; for treatment, it should be given with other antimycobacterials. For leprosy, oral clarithromycin 500 mg daily has been given as part of an alternative multidrug therapy regimen. For the eradication of H. pylori associated with peptic ulcer disease, clarithromycin, usually in an oral dose of 500 mg twice daily, is given with another antibacterial and either a proton pump inhibitor or a histamine H 2 receptor antagonist, for 7 to 14 days. For details of doses in infants and children, see below. Doses may need to be reduced in patients with severe renal impairment (see below).
1. Peters DH, Clissold SP. Clarithromycin: a review of its antimicrobial activity, pharmacokinetic properties and therapeutic potential. Drugs 1992; 44: 117–64
2. Barradell LB, et al. Clarithromycin: a review of its pharmacological properties and therapeutic use in Mycobacterium avium-intracellulare complex infection in patients with acquired immune deficiency syndrome. Drugs 1993; 46: 289–312
3. Markham A, McTavish D. Clarithromycin and omeprazole: as Helicobacter pylori eradication therapy in patients with H. pylori-associated gastric disorders. Drugs 1996; 51: 161–78
4. Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc 1999; 74: 613–34
5. Zuckerman JM. Macrolides and ketolides: azithromycin, clarithromycin, telithromycin. Infect Dis Clin North Am 2004; 18: 621–49.

Administration in children.

The usual oral dose of clarithromycin for infants and children is 7.5 mg/kg twice daily; those over 12 years of age may be given the usual adult dose (see above). Although intravenous use is not licensed for children in the UK the BNFC suggests a dose of 7.5 mg/kg twice daily for those aged from 1 month to 12 years; older children may be given the adult dose (see above). For prophylaxis of disseminated infection due to Mycobacterium avium complex, clarithromycin may be given in an oral dose of 7.5 mg/kg twice daily; when used for treatment, it should be given with other antimycobacterials and the dose may be increased to 15 mg/kg (to a maximum of 500 mg) twice daily. For the eradication of Helicobacter pylori associated with peptic ulcer disease, the BNFC suggests that 7.5 mg/kg twice daily may also be given orally with another antibacterial and a proton pump inhibitor for 7 days to children aged 1 year and over.

Administration in renal impairment.

Licensed product information states that in patients with severe renal impairment (creatinine clearance of less than 30 mL/minute) dosage of clarithromycin may need to be halved or the dosing interval doubled.

Ischaemic heart disease.

For mention of studies investigating clarithromycin in the prevention of ischaemic heart disease, see under Azithromycin.

Multiple myeloma.

Clarithromycin 500 mg orally twice daily has been added1 to a regimen of lenalidomide and dexamethasone in treatment-naive patients with multiple myeloma. The regimen (BiRD) was considered effective and well tolerated, with a higher response rate at lower dexamethasone doses than had been previously reported with lenalidomide and dexamethasone alone. A regimen of clarithromycin, low-dose thalidomide, and dexamethasone (BLT-D) has also been evaluated.2
1. Niesvizky R, et al. BiRD (Biaxin [clarithromycin]/Revlimid [lenalidomide]/dexamethasone) combination therapy results in high complete- and overall-response rates in treatment-naive symptomatic multiple myeloma. Blood 2008; 111: 1101–9
2. Coleman M, et al. BLT-D (clarithromycin [Biaxin], low-dose thalidomide, and dexamethasone) for the treatment of myeloma and Waldenström’s macroglobulinemia. Leuk Lymphoma 2002; 43: 1777–82.

Respiratory disorders.

For reference to the use of clarithromycin in the management of respiratory disorders, see under Erythromycin.

💊 Preparations

USP 31: Clarithromycin Extended-Release Tablets; Clarithromycin for Oral Suspension; Clarithromycin Tablets.

Proprietary Preparations

Arg.: Aeroxina; Centromicina†; Claribiotic; Claricina; Clarimax; Clarimid; Clarovil; Clatromicin†; Corixa; Finasept; Ira; Iset; Kailasa; Klaricid; Klonacid; Macromicina; Orabiot UD†; Austral.: Clarac; Clarithro; Kalixocin; Klacid; Austria: Clararcana; Klacid; Maclar; Monocid; Belg.: Biclar; Heliclar; Maclar; Monaxin†; Braz.: Clamicin; Claricina†; Clarineo; Claritromax; Claritron†; Clatorin†; Klaricid; Klaritril†; Canad.: Biaxin; Chile: Clarimax; Clarosip; Clatic; Euromicina; Infex; Klaricid; Mus†; Pre-Clar; Cz.: Clarexid; Clarosip; Fromilid; Klabax; Klacid; Lekoklar; Zeclar†; Denm.: Klacid; Fin.: Klacid; Zeclar; Fr.: Mononaxy; Monozeclar; Naxy; Zeclar; Ger.: Biaxin; Clarithrobeta; Cyllind; Klacid; Mavid; Gr.: Arecid; Chlamydicin; Claribactron; Clarimex; Claripen; Claromycin; Derizic; Egelif; Eliben; Ezumycin; Geromycin; Glartin; Klaretop; Klaricid; Klarifar; Klarifect; Klarithrin; Klaroxin; Klazidem; Larithro; Laromin; Lyoclar; Macladin; Maxilin; Odycin; Oklaricid†; Pharlemyron; Primocid; Riclemed; Rithroprol; Ritran; Zeclaren; Hong Kong: Binoclar; Clacin; Cleron; Klacid; Klerimed; Synclar; Hung.: Cidoclar; Fromilid; Klabax; Klacid; Klamiran†; Klari†; Klarigen; Lekoklar; India: Bioclar; Clarbact; Claribid; Claricip; Clarimac; Maclar; Synclar; Indon.: Abbotic; Bicrolid; Binoklar; Clacine; Clapharma; Comtro; Hecobac; Irl.: Clarosip; Clonocid; Clorom; Klacid; Israel: Karin; Klacid; Klaridex; Ital.: Klacid; Macladin; Veclam; Jpn: Clarith; Malaysia: Binocular; Crixan; Klacid; Klerimed; Maclar; Mex.: Adel; Arlecyn-K; Clatrocin; Crolisil; Doycur; Gervaken; Klabet; Klaricid; Klarix; Klarmyn; Klarpharma; Krobicin; Mabicrol; Neo-Clarosip; Quedox; Rolicytin; Torvic; Trimeba; Vikrol; Xuclamin; Neth.: Clarosip; Klacid; Klaricid; Norw.: Klacid; NZ: Clarac; Klacid; Philipp.: Bysclas; Claranta; Clariget; Klaricid; Klarmyn; Klaz; Larizin; Maxulid; Onexid; Pol.: Fromilid; Klabax; Klabion; Klacid; Klarmin; Lekoklar; Taclar; Port.: Ciclinil; Clacina; Clarbac; Clarobiotico; Clarosip; Klacid; Zeclar; Rus.: Clarbact (Кларбакт); Fromilid (Фромилид); Klabax (Клабакс); Klacid (Клацид); Klaromin (Кларомин); Klerimed (Клеримед); S.Afr.: Clacee; ClariHexal; Klacid; Klarithran; Singapore: Clari; Claripen; Cleron; Crixan; Klacid; Klerimed; Spain: Bremon; Claritur†; Klacid; Kofron; Talicix; Swed.: Klacid; Switz.: Claromycine; Klacid; Klaciped; Thai.: Clarith; Claron; Crixan; Fascar; Klacid; Turk.: Claricide; Klacid; Klarolid; Klaromin; Klax; Laricid; Macrol; Megacid; Uniklar; UAE: Clamycin; UK: Clarosip; Klaricid; USA: Biaxin; Venez.: Binoclar; Claranta; Claritic; Claritron; Clarivax; Klaricid. Multi-ingredient: Arg.: Heliklar†; Austral.: Klacid HP 7; Losec Hp 7; Nexium Hp; Pylorid-KA; Austria: Helipac; Braz.: Anzopac†; Erradic; HBacter; Helicocid Triplice†; Helicopac; Heliklar; Omepramix; Pylorikit; Pyloripac; Pyloritrat; Canad.: Hp-Pac; Losec 1-2-3 A; Losec 1-2-3 M; Fin.: Helipak K; Ger.: ZacPac; India: OTC HP Kit; Pylokit; Malaysia: Klacid HP 7; Pylobact Combi; Mex.: Pylopac; Rezplen; Neth.: PantoPAC; NZ: Klacid HP 7†; Losec Hp 7; Philipp.: OAC Hp7; Rus.: Pylobact (Пилобакт); S.Afr.: Losec 20 Triple†; Swed.: Nexium Hp; Turk.: Helipak; UK: Heliclear†; HeliMet†; USA: Prevpac.
Published January 23, 2019.