Clarithromycin
Classification: AATC code: A02BD06, J01FA09
Summary
Claritromycin is associated with QT-prolongation on ECG and thus a risk of potentially fatal arrhythmias of the type Torsade de pointes ventricular tacycardia. No difference in risk between men and women has been shown for clarithromycin but a known risk factor for Torsade de pointes is female sex.
A systematic review found the resistance of Helicobacter pylori to claritromycin to be higher in women.
In our opinion, the described differences do not motivate differentiated dosing or treatment in men and women.
Additional information
Pharmacokinetics and dosing
No studies with a clinically relevant sex analysis regarding pharmacokinetics or dosing of clarithromycin have been found.
Effects
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% [1].
Adverse effects
Clarithromycin has been associated with prolonged QT-interval and a risk of Torsades de pointes ventricular tachycardia [2, 3]. Among the known risk factors of drug-induced ventricular arrhythmias are female sex, hypokalemia, bradycardia, and base line QT-prolongation [4].
Reproductive health issues
Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).
Other information
Several studies report differences in Helicobacter pyloriantibiotic 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 [5].
Updated: 2019-02-26
Date of litterature search: 2015-01-27
References
- 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
- 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
- BIAXIN (clarithromycin). Summary of Product Characteristics. European Medicines Agency (EMA); 2015.
- Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-22. PubMed
- 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
- Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk
Reviewed by: Mia von Euler
Approved by: Karin Schenck-Gustafsson