Clarithromycin
Summary
Persistence. It cannot be excluded that clarithromycin is persistent, due to lack of data.
Bioaccumulation. It cannot be excluded that clarithromycin bioaccumulates, due to lack of data.
Toxicity. It cannot be excluded that clarithromycin is toxic, due to lack of data.
Risk. Clarithromycin is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact. Further information is available in the Goodpoint report.
Environmental information is missing on fass.se (2026-07-07).
Clarithromycin is included in the European Union (EU) Priority Substances Directive for surface waters (2008/105/EC) and is subject to an environmental quality standard (EQS) and as an indicator substance in the Urban Wastewater Treatment Directive in Europe (2024/3019) applicable within the European Union.
Suggestions on how to reduce the emissions of clarithromycin
Detailed information
European Union Priority Substances Directive and indicator in the Urban Wastewater Treatment Directive
Clarithromycin is included in the Priority Substances Directive for surface waters (2008/105/EC) and is subject to an environmental quality standard (EQS) and as an indicator substance in the Urban Wastewater Treatment Directive in Europe (2024/3019) applicable within the European Union.
Low concentrations of antibiotics
Studies have shown that even low concentrations of antibiotics in the environment may contribute to antibiotic resistance and therefore measures should be taken to ensure that as little as possible ends up in our environment.
Report Goodpoint
Concentrations in Swedish wastewater treatment plants are at risk of selecting antibiotic resistance. May interact in the environment with other macrolide antiobiotics, such as azithromycin, erythromycin and roxithromycin.
Clarithromycin is included in Region Stockholm's table of pharmaceuticals with risk for negative environmental impact according to the environmental program 2017–2021. This also takes into account the risk of antibiotic resistance selection and environmental interaction between other macrolide antibiotics. Clarithromycin has been detected in treated wastewater in Region Stockholm.
The Wise list
Clarithromycin is recommended in the Wise list. (The Wise list is the drug formulary of essential medicines for common diseases in Region Stockholm from the Drug and Therapeutics Committee.) Environmental classification of pharmaceuticals is taken into consideration, sometimes with other environmental aspects, when selecting pharmaceuticals for the Wise list. When comparable pharmaceuticals are equivalent to medical effects, safety and pharmaceutical efficacy, environmental impact and price are considered.
Suggestions on how to reduce the emissions of clarithromycin
Concrete proposals on how to work to reduce emissions of environmentally harmful pharmaceuticals on the list have been developed in close cooperation with the Stockholm Drug and Therapeutics Committee's expert groups. The action proposals were developed from an environmental perspective. The patient's best always goes first and several pharmaceuticals on the list are also included in the Wise list. However, for such pharmaceuticals, there may be measures that could reduce the environmental impact.
Concrete proposal for clarithromycin
- Clarithromycin is recommended in the Wise list. Eradication of Helicobacter pylori only on strict indication.
- For antibiotics, the general rule is as restrictive use as possible without risking the patient's health. Relevant diagnostics are important in order to choose antibiotics that have a good effect with as narrow spectrum as possible.
References
- Directive 2008/105/EC of the European Parliament and of the Council.
- DIRECTIVE (EU) 2024/3019 OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL.
- Gullberg E, Cao S, Berg OG, Ilbäck C, Sandegren L, Hughes D et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathog. 2011;7:e1002158.
- Goodpoint. Prioritering av läkemedel med miljörisk inom SLL. Stockholm: Goodpoint; 2016. Rapport LS 2016–0634.
- IVL Swedish Environmental Research Institute Ltd. Fick J, Lindberg RH, Kaj L, Brorström-Lundén E. Results from the Swedish National Screening Programme 2010. Subreport 3. Pharmaceuticals.
- IVL Swedish Environmental Research Institute Ltd Fick J, Lindberg RH, Fång J, Magnér J, Kaj L, Brorström-Lundén E. Screening 2014. Analysis of pharmaceuticals and hormones in samples from WWTPs and receiving waters. Rapport C 135.
- Isidori M, Lavorgna M, Nardelli A, Pascarella L, Parrella A. Toxic and genotoxic evaluation of six antibiotics on non-target organisms. Sci Total Environ. 2005;346:87-98.
- Bengtsson-Palme J, Larsson DG. Concentrations of antibiotics predicted to select for resistant bacteria: Proposed limits for environmental regulation. Environ Int. 2016;86:140-9.
- Provtagningar av läkemedelsrester i vatten, sediment och fisk för Region Stockholm.
- Region Stockholm. Förteckning över miljöbelastande läkemedel med åtgärdsförslag framtagen inom ramen för Region Stockholms miljöprogram 2017–2021.
- Fass.se för vårdpersonal.
- Region Stockholms läkemedelskommitté. Kloka listan (the Wise list).
- Region Stockholm's Drug and Therapeutics Committee. The Wise list 2015.
Author: Health and Medical Care Administration, Region Stockholm