Kommersiellt obunden läkemedelsinformation riktad till läkare och sjukvårdspersonal

Klaritromycin

Klassificering: A

Preparat: Clarithromycin Aurobindo, Clarithromycin HEC, Clarithromycin HEC Pharm, Clarithromycin Hexal, Clarithromycin Krka, Clarithromycin Ranbaxy, Clarithromycin Teva, Klacid, Klaritromycin Ebb, Klaritromycin STADA, Nexium® HP

ATC kod: A02BD06, J01FA09

Substanser: klaritromycin

Sammanfattning

Klaritromycin är associerat med QT-förlängning på EKG och därmed risk för allvarlig rytmrubbning av typen Torsade de Pointes kammartakykardi. Könsskillnad har inte påvisats för just klaritromycin men en känd riskfaktor för att utveckla rytmrubbningen av typ Torsade de Pointes är kvinnligt kön.

En systematisk översiktsartikel fann att resistens mot klaritromycin hos Helicobacter pylori var vanligare hos kvinnor än män.

Additional information

Pharmacokinetics and dosing

No studies with a clinically relevant sex analysis regarding pharmacokinetics or dosing of clarithromycin have been found.

Effects

Several studies report differences in Helicobacter pylori antibiotic resistance between men and women.  A systematic review of 31 studies, published worldwide 2006-2009, found that overall, primary clarithromycin resistance was more common among women than men (20.5% vs. 15.5%). Also, clarithromycin resistance rate varied widely between different populations. High resistance was reported from Spain and Japan while low resistance was found in Sweden, the Netherlands and Malaysia [1]. Similarly, in a German study analyzing positive Helicobacter pylori urease tests in 2015-2018 (929 men, 917 women, 5 unknown), female sex was associated with carrying clarithromycin-resistant H. pylori (adjusted OR 2.3, 95%CI 1.6-3.4) [2]. 

In a retrospective observational cohort study, patients (44 men, 59 women) with severe asthma or bronchiectasis were treated with clarithromycin or azithromycin in addition to their standard treatment. Men with bronchiectasis were more likely to respond (symptom score) to treatment with macrolides than women, 53% vs. 27% [3].

Adverse effects

Clarithromycin has been associated with prolonged QT-interval and a risk of Torsades de Pointes ventricular tachycardia [4, 5]. Among the known risk factors of drug-induced ventricular arrhythmias are female sex, hypokalemia, bradycardia, and base line QT-prolongation [6].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Försäljning på recept

Fler kvinnor än män hämtade ut tabletter innehållande klaritromycin (ATC-kod J01FA09) på recept i Sverige år 2020, totalt 11 036 kvinnor och 9 373 män. Det motsvarar 2,2 respektive 1,8 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 40-44 år hos kvinnor och i åldersgruppen 75-84 år och äldre hos män. I genomsnitt var tabletter innehållande klaritromycin 1,3 gånger vanligare hos kvinnor [7].

Uppdaterat: 2021-03-12

Litteratursökningsdatum: 2021-02-09

Referenser

  1. De Francesco V, Giorgio F, Hassan C, Manes G, Vannella L, Panella C et al. Worldwide H pylori antibiotic resistance: a systematic review. J Gastrointestin Liver Dis. 2010;19:409-14. PubMed
  2. Bluemel B, Goelz H, Goldmann B, Grüger J, Hamel H, Loley K et al. Antimicrobial resistance of Helicobacter pylori in Germany, 2015 to 2018. Clin Microbiol Infect. 2020;26(2):235-239. PubMed
  3. Coeman M, van Durme Y, Bauters F, Deschepper E, Demedts I, Smeets P et al. Neomacrolides in the treatment of patients with severe asthma and/or bronchiectasis: a retrospective observational study. Ther Adv Respir Dis. 2011;5:377-86. PubMed
  4. Shaffer D, Singer S, Korvick J, Honig P. Concomitant risk factors in reports of torsades de pointes associated with macrolide use: review of the United States Food and Drug Administration Adverse Event Reporting System. Clin Infect Dis. 2002;35:197-200. PubMed
  5. Clarithromycin Aurobindo (clarithromycin). Summary of Product Characteristics. Swedish Medical Products Agency. [updated 2021-11-30, cited 2021-02-09]
  6. Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-22. PubMed
  7. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2020 [cited 2021-03-10.] länk

Författare: Linnéa Karlsson Lind

Faktagranskat av: Diana Rydberg

Godkänt av: Karin Schenck-Gustafsson