The best analogue of "Klacid": comparison of drugs and reviews about them. Official instructions for use

In this article you can find instructions for use medicinal product Klacid. Feedback from site visitors - consumers - is presented of this medicine, as well as the opinions of specialist doctors on the use of Klacid in their practice. We kindly ask you to actively add your reviews about the drug: whether the medicine helped or did not help get rid of the disease, what complications were observed and side effects, perhaps not stated by the manufacturer in the annotation. Analogues of Klacid in the presence of existing structural analogues. Use for the treatment of infections in adults, children, as well as during pregnancy and breastfeeding.

Klacid- semisynthetic antibiotic of the macrolide group. Renders antibacterial effect, interacting with the 50S ribosomal subunit of bacteria and suppressing protein synthesis in the microbial cell.

Clarithromycin ( active substance drug Klacid) demonstrated high activity in vitro against standard and isolated bacterial cultures. Highly effective against many aerobic and anaerobic gram-positive and gram-negative microorganisms. In vitro studies confirm high efficiency clarithromycin against Legionella pneumophila, Mycoplasma pneumoniae and Helicobacter (Campylobacter) pylori.

Enterobacteriaceae, Pseudomonas spp., as well as other gram-negative bacteria that do not degrade lactose are insensitive to clarithromycin.

The production of beta-lactamases does not affect the activity of clarithromycin. Most strains of staphylococci resistant to methicillin and oxacillin are also resistant to clarithromycin.

Clarithromycin is effective in vitro against most strains of the following microorganisms (however, the safety and effectiveness of clarithromycin in clinical practice not confirmed clinical studies And practical significance remains unclear): aerobic gram-positive microorganisms: Streptococcus agalactiae, streptococci (groups C, F, G), streptococci of the Viridans group; aerobic gram-negative microorganisms: Bordetella pertussis, Pasteurella multocida; anaerobic gram-positive microorganisms: Clostridium perfringens, Peptococcus niger, Propionibacterium acnes; anaerobic gram-negative microorganisms: Bacteroides melaninogenicus; Borrelia burgdorferi, Treponema pallidum, Campylobacter jejuni.

Pharmacokinetics

With a single dose in adults, the bioavailability of the suspension was equivalent to the bioavailability of tablets (at the same doses) or slightly higher. Eating slightly delayed the absorption of Klacida suspension, but did not affect the overall bioavailability of the drug. Clarithromycin is metabolized in the liver under the action of the CYP3A isoenzyme to form the microbiologically active metabolite 14-hydroxyclarithromycin. Clarithromycin and its metabolite are well distributed in tissues and body fluids. Tissue concentrations are usually several times higher than serum concentrations. Approximately 40% of ingested clarithromycin is excreted by the kidneys; through the intestines - approximately 30%.

Indications

• infections lower sections respiratory tract(bronchitis, pneumonia);
• infections upper sections respiratory tract (pharyngitis, sinusitis);
• otitis;
• infections of the skin and soft tissues (folliculitis, cellulitis, erysipelas);
• common mycobacterial infections caused by Mycobacterium avium and Mycobacterium intracellulare;
• localized mycobacterial infections caused by Mycobacterium chelonae, Mycobacterium fortuitum and Mycobacterium kansasii;
• eradication of Helicobacter pylori and reduction in the frequency of relapses of duodenal ulcers;
• prevention of the spread of infection caused by Mycobacterium avium complex (MAC) in HIV-infected patients;
• odontogenic infections.

Release forms

Film-coated tablets 250 mg and 500 mg (CP or extended release form of Klacida).

Powder for the preparation of suspension for oral administration 125 mg and 250 mg.

Lyophilisate for the preparation of solution for infusion (injections in ampoules).

Instructions for use and dosage regimen

Pills

The drug is taken orally regardless of food intake.

Usually adults are prescribed 250 mg 2 times a day. In more severe cases, the dose is increased to 500 mg 2 times a day. Usually the duration of treatment is from 5-6 to 14 days.

For mycobacterial infections, 500 mg is prescribed 2 times a day.

For common MAC infections in patients with AIDS, treatment should be continued as long as there is clinical and microbiological evidence of benefit. Clarithromycin should be prescribed in combination with other antimicrobial drugs.

At infectious diseases caused by mycobacteria, except tuberculosis, the duration of treatment is determined by the doctor.

For the prevention of infections caused by MAC, the recommended dose of clarithromycin for adults is 500 mg 2 times a day.

For odontogenic infections, the dose of clarithromycin is 250 mg 2 times a day for 5 days.

For eradication of Helicobacter pylori

Combined treatment with three drugs:

• clarithromycin 500 mg 2 times a day + lansoprazole 30 mg 2 times a day + amoxicillin 1000 mg 2 times a day for 10 days;
• clarithromycin 500 mg 2 times a day + omeprazole 20 mg per day + amoxicillin 1000 mg 2 times a day for 7-10 days.

Combined treatment with two drugs:

• clarithromycin 500 mg 3 times a day + omeprazole 40 mg per day for 14 days with the appointment of omeprazole at a dose of 20-40 mg per day over the next 14 days;
• clarithromycin 500 mg 3 times a day + lansoprazole 60 mg per day for 14 days. For complete healing of the ulcer, additional reduction in the acidity of gastric juice may be required.

Powder for suspension for oral administration

The prepared suspension should be taken orally regardless of food intake (with milk).

To prepare the suspension, water is gradually added to the bottle with granules up to the mark, then the bottle is shaken. The prepared suspension can be stored for 14 days at room temperature.

Suspension 60 ml: 5 ml - 125 mg of clarithromycin; suspension 100 ml: 5 ml - 250 mg of clarithromycin.

Recommended daily dose clarithromycin suspension for non-mycobacterial infections in children is 7.5 mg/kg 2 Maximum dose- 500 mg 2 The usual duration of treatment is 5-7 days, depending on the pathogen and the severity of the patient’s condition. Before each use, shake the bottle of the drug well.

There are no data on the dosage of Klacid in ampoules for children.

Intramuscular and bolus administration of the drug is prohibited.

In patients with impaired renal function and creatinine clearance less than 30 ml/min, the dose of clarithromycin should be reduced by half the normal recommended dose.

Rules for preparing the solution

1) Add 10 ml of sterile water for injection to a vial with 500 mg of lyophilisate. It is recommended to use only sterile water for injection, as any other solvent may cause sedimentation. Do not use solvents containing preservatives or inorganic salts.

The reconstituted solution of the drug obtained by the method described above contains sufficient quantity preservative and has a concentration of 50 mg/ml clarithromycin. The solution is stable for 48 hours at 5°C or 24 hours at 25°C. The reconstituted solution of the drug should be used immediately after its preparation. If the drug is not used immediately after receiving its reconstituted solution, it is recommended to store it for no more than 24 hours at a temperature of 2°C to 8°C under aseptic conditions.

2) Before administration, the prepared solution of the drug (500 mg in 10 ml of water for injection) must be added to at least 250 ml of one of the following solvents for intravenous administration: 5% glucose solution in lactated Ringer's solution, 5% glucose solution , lactated Ringer's solution, 5% glucose dextrose solution in 0.3% sodium chloride solution, Normosol-M solution in 5% glucose solution, Normosol-R solution in 5% glucose solution, 5% glucose solution in 0.45% sodium chloride solution, 0.9% sodium chloride solution.

The physical and chemical parameters of the solution do not change during storage for 48 hours at a temperature of 5°C or 6 hours at a temperature of 25°C. However, it is recommended to use the resulting drug solution immediately after its preparation. If the resulting solution cannot be used immediately, it should be stored under aseptic conditions. The drug solution remains stable during 24 hours of storage at temperatures from 2° to 5°C. After this period, further preservation and use of clarithromycin IV solution is not recommended.

Do not mix the solution with any medicines or solvents, unless their physical or chemical compatibility with IV clarithromycin has been first established.

Side effect

• diarrhea;
• nausea, vomiting;
• abdominal pain;
• pseudomembranous enterocolitis;
• glossitis;
• stomatitis;
• oral thrush;
• change in tongue color;
• changes in tooth color (these changes are usually reversible and can be corrected by your dentist);
• pancreatitis;
• dizziness;
• anxiety;
• insomnia;
• nightmares;
• noise in ears;
• confusion;
• disorientation;
• hallucinations;
• psychosis;
• prolongation of the QT interval;
• ventricular tachycardia;
• ventricular tachycardia of the "pirouette" type;
• hearing loss (after cessation of treatment, hearing was usually restored);
• impaired sense of smell, usually combined with perversion of taste;
• leukopenia, thrombocytopenia;
• hives;
• rash;
• anaphylaxis;
• Stevens-Johnson syndrome;
• Lyell's syndrome.

Contraindications

• severe liver dysfunction;
• severe renal dysfunction (CK<30 мл/мин);
• porphyria;
• simultaneous use with astemizole, cisapride, pimozide, terfenadine, ergotamine, dihydroergotamine;
• pregnancy;
• lactation period (breastfeeding);
• children under 3 years of age (for the dosage form in the form of tablets);
• hypersensitivity to macrolide antibiotics.

Use during pregnancy and breastfeeding

The safety of clarithromycin during pregnancy and lactation has not been studied.

Clarithromycin is known to be excreted in breast milk.

Therefore, Klacid should be used during pregnancy and lactation only in cases where there is no safer alternative, and the risk associated with the disease itself outweighs the possible harm to the mother and fetus.

special instructions

Clarithromycin is eliminated primarily by the liver. In this regard, caution should be exercised when prescribing Klacid to patients with impaired liver function.

In the presence of chronic liver diseases, it is necessary to regularly monitor serum enzymes.

Caution should be observed when treating patients with moderate and severe renal failure with Klacid.

In clinical practice, cases of toxicity of colchicine when combined with clarithromycin have been described, especially in elderly people. Some of them were observed in patients with renal failure; Several deaths have been reported in similar patients.

The possibility of cross-resistance between clarithromycin and other macrolide drugs, as well as lincomycin and clindamycin, must be considered.

Prescribe with caution against drugs metabolized by the liver.

In case of co-administration with warfarin or other indirect anticoagulants, it is necessary to monitor the prothrombin time.

Drug interactions

In clinical studies, when combining theophylline or carbamazepine with clarithromycin, there was a small but statistically significant (p<0.05) повышение уровней теофиллина и карбамазепина в сыворотке крови.

When Klacid was used simultaneously with HMG-CoA reductase inhibitors (lovastatin, simvastatin), rhabdomyolysis developed in rare cases.

With simultaneous use of clarithromycin with cisapride, an increase in the levels of the latter was observed. This may lead to prolongation of the QT interval and the development of cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation, and torsade de pointes (TdP). Similar effects have been reported in patients receiving clarithromycin with pimozide.

Macrolides cause disruption of the metabolism of terfenadine, which leads to an increase in its plasma levels and is sometimes associated with the development of arrhythmias, incl. prolongation of the QT interval, ventricular tachycardia, ventricular fibrillation and torsade de pointes. In one study of 14 healthy volunteers, the combined use of clarithromycin tablets and terfenadine resulted in a 2- to 3-fold increase in serum levels of the acid metabolite terfenadine and a prolongation of the QT interval, which was not associated with any clinical effects.

In clinical practice, cases of ventricular tachycardia of the “pirouette” type have been reported when clarithromycin is combined with quinidine or disopyramide. Serum levels of these drugs should be monitored during treatment with clarithromycin.

In clinical practice, when clarithromycin was combined with ergotamine or dihydroergotamine, cases of acute toxicity of the latter, which is characterized by vasospasm, ischemia of the limbs and other tissues, including the central nervous system, were recorded.

In patients receiving clarithromycin tablets in combination with digoxin, an increase in serum concentrations of the latter was observed. Monitoring serum digoxin levels is advisable.

Colchicine is a substrate for CYP3A and P-glycoprotein. Clarithromycin and other macrolides are inhibitors of CYP3A and P-glycoprotein. When colchicine and clarithromycin are coadministered, inhibition of P-glycoprotein and/or CYP3A may result in increased effects of colchicine. Patients should be closely monitored for symptoms of colchicine toxicity.

Concomitant oral use of Klacid tablets with zidovudine in HIV-infected adult patients may result in decreased steady-state zidovudine concentrations. This interaction was not observed in HIV-infected children taking clarithromycin suspension with zidovudine or dideoxyinosine.

Analogues of the drug Klacid

Structural analogues of the active substance:

• Arvicin;
• Arvicin retard;
• Binoculars;
• Zimbaktar;
• Kispar;
• Clubax;
• Clarbuckt;
• Clarithromycin;
• Clarithrosin;
• Claricin;
• Claricite;
• Claromine;
• Klasine;
• Klacid SR;
• Clerimed;
• Coater;
• Crixan;
• Seydon-Sanovel;
• CP-Klaren;
• Fromilid;
• Fromilid Uno;
• Ecositrin.

If there are no analogues of the drug for the active substance, you can follow the links below to the diseases for which the corresponding drug helps, and look at the available analogues for the therapeutic effect.

pharmachologic effect

Semi-synthetic antibiotic of the macrolide group. Clarithromycin has an antibacterial effect by interacting with the 50S ribosomal subunit and inhibiting the protein synthesis of bacteria sensitive to it.

Clarithromycin demonstrated high activity in vitro against both standard laboratory strains of bacteria and those isolated from patients during clinical practice. Shows high activity against many aerobic and anaerobic gram-positive and gram-negative microorganisms. The minimum inhibitory concentrations (MICs) of clarithromycin for most pathogens are less than the MICs of erythromycin on average per Iog 2 dilution.

Clarithromycin in vitro highly active against Legionella pneumophila, Mycoplasma pneumoniae. Has a bactericidal effect against Helicobacter pylori; This activity of clarithromycin is higher at neutral pH than at acidic pH.

In addition, in vitro and in vivo data indicate that clarithromycin is active against clinically relevant mycobacterial species Enterobacteriaceae and Pseudomonas spp., as well as other non-lactose-fermenting gram-negative bacteria that are not sensitive to clarithromycin.

The activity of clarithromycin against most strains of the microorganisms listed below has been proven both in vitro and in clinical practice for the diseases listed in the "Indications" section.

Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus pyogenes, Listeria monocytogenes; Haemophilus influenzae, Haemophilus parainftuenzae, Moraxella catarrhalis, Neisseria gonorrhoeae, Legionella pneumophila; other microorganisms: Mycoplasma pneumoniae, Chlamydia pneumoniae (TWAR), mycobacteria Mycobacterium leprae, Mycobacterium kansasii, Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium avium complex (MAC): complex including Mycobacterium avium, Mycobacterium intracellulare.

The production of beta-lactamase does not affect the activity of clarithromycin.

Most strains of staphylococci resistant to methicillin and oxacillin are also resistant to clarithromycin.

Helicobacter pylori

The sensitivity of Helicobacter pylori to clarithromycin was studied on Helicobacter pylori isolates isolated from 104 patients before starting drug therapy. Helicobacter pylori strains resistant to clarithromycin were isolated in 4 patients, moderately resistant strains were isolated in 2 patients, and Helicobacter pylori isolates were sensitive to clarithromycin in the remaining 98 patients.

Clarithromycin is effective in vitro against most strains of the microorganisms listed below, however, the safety and effectiveness of clarithromycin in clinical practice has not been confirmed by clinical studies, and the practical significance remains unclear.

Aerobic gram-positive microorganisms: Streptococcus agalactiae, streptococci (groups C, F, G), streptococci of the Viridans group; aerobic gram-negative microorganisms: Bordetella pertussis, Pasteurella multocida; anaerobic gram-positive microorganisms:Сlostridium perfringens, Peptococcus niger, Propionibacterium acnes; anaerobic gram-negative microorganisms: Bacteroides melaninogenicus; spirochetes: Borrelia burgdorferi, Treponema pallidum; Campylobacter jejuni.

The main metabolite of clarithromycin in the human body is the microbiologically active metabolite 14-hydroxyclarithromycin (14-OH-clarithromycin). The microbiological activity of the metabolite is the same as that of the parent substance, or 1-2 times weaker against most microorganisms. The exception is Haemophilus influenzae, for which the effectiveness of the metabolite is 2 times higher. The parent substance and its main metabolite have either an additive or synergistic effect against Haemophilus influenzae in vitro and in vivo, depending on the bacterial strain.

Pharmacokinetics

Suction

The pharmacokinetics of clarithromycin extended-release tablet formulations have been studied in adults compared with clarithromycin regular-release tablet formulations at 250 and 500 mg doses. Absorption of the drug in both cases was the same when administered in equivalent doses.

Absolute bioavailability is about 50%. With repeated administration of the drug, no accumulation was detected; the nature of metabolism in the human body did not change.

Distribution, metabolism, excretion

In vitro studies have shown that clarithromycin binds to plasma proteins by 70% at concentrations from 0.45 to 4.5 μg/ml. At a concentration of 45 μg/ml, binding decreases to 41%, probably as a result of saturation of binding sites. This is observed only at concentrations many times higher than the therapeutic value.

Healthy

After taking the drug Klacid ® CP at a dose of 500 mg 1 time / day after meals, C max of clarithromycin and 14-OH-clarithromycin in blood plasma was 1.3 μg/ml and 0.48 μg/ml, respectively; T1/2 of clarithromycin and metabolite were 5.3 hours and 7.7 hours, respectively. With a single dose of Klacid ® SR at a dose of 1000 mg (500 mg 2 times a day), Cmax of clarithromycin and its hydroxylated metabolite reached 2.4 μg/ml and 0.67 μg/ml, respectively. T1/2 of clarithromycin when used at a dose of 1000 mg was 5.8 hours, while the same figure for 14-OH-clarithromycin was 8.9 hours. The time to reach Cmax when taking both 500 mg and 1000 mg was approximately 6 hours. Cmax 14-OH-clarithromycin did not increase proportionally to the dose of clarithromycin, while T1/2 of both clarithromycin and its hydroxylated metabolite tended to increase with increasing dose. This nonlinear pharmacokinetics of clarithromycin, coupled with a decrease in the formation of 14-hydroxylated and N-demethylated products at high doses, indicates a nonlinear metabolism of clarithromycin, which becomes more pronounced at high doses.

Approximately 40% of ingested clarithromycin is excreted by the kidneys; Approximately 30% is excreted through the intestines.

Patients

Clarithromycin and its metabolite 14-OH-clarithromycin quickly penetrate into body tissues and fluids. There are limited patient data indicating that oral cerebrospinal fluid concentrations of clarithromycin are negligible (i.e., only 1-2% of serum levels in cerebrospinal fluid when the BBB is permeable). Concentrations in tissues are usually several times higher than in serum.

Pharmacokinetics in special clinical situations

In patients with moderate to severe liver dysfunction, but with preserved renal function, no dose adjustment of clarithromycin is required. The equilibrium plasma concentration and systemic clearance of clarithromycin do not differ between patients in this group and healthy patients. The steady-state concentration of 14-OH-clarithromycin in people with impaired liver function is lower than in healthy people.

At renal dysfunction Cmax and Cmin of clarithromycin in blood plasma, T1/2, AUC of clarithromycin and 14-OH metabolite increase. The elimination constant and urinary excretion decrease. The degree of changes in these parameters depends on the degree of renal dysfunction.

U elderly patients

Indications

Infectious and inflammatory diseases caused by microorganisms sensitive to clarithromycin:

- lower respiratory tract infections (such as bronchitis, pneumonia);

- upper respiratory tract infections (such as pharyngitis, sinusitis);

- infections of the skin and soft tissues (such as folliculitis, inflammation of the subcutaneous tissue, erysipelas).

Dosage regimen

Klacid ® SR tablets should be taken orally, without breaking or chewing, and swallowed whole.

Adults and children over 12 years old prescribed 500 mg (1 tablet) 1 time/day with meals. At severe infections the dose is increased to 1000 mg (2 tablets) 1 time/day with meals. Typically the duration of treatment is from 5 to 14 days.

The exceptions are community-acquired pneumonia and sinusitis, which require treatment from 6 to 14 days.

) the use of the drug Klacid ® SR is contraindicated. U

Side effect

Classification of adverse reactions by frequency of development (number of registered cases/number of patients): very often (≥1/10), often (≥1/100,<1/10), нечасто (≥1/1000, <1/100), частота неизвестна (побочные эффекты из опыта постмаркетингового применения; частота не может быть оценена на основе имеющихся данных).

Allergic reactions: often - rash; uncommon - anaphylactoid reaction 1, hypersensitivity, bullous dermatitis 1, itching, urticaria, maculopapular rash 3; frequency unknown - anaphylactic reaction, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS syndrome).

From the nervous system: often - headache, insomnia; uncommon - loss of consciousness 1, dyskinesia 1, dizziness, drowsiness, tremor, anxiety, increased excitability 3; frequency unknown - convulsions, psychotic disorders, confusion, depersonalization, depression, disorientation, hallucinations, dream disturbances (nightmares), paresthesia, mania.

From the skin: often - intense sweating; frequency unknown - acne, hemorrhages.

From the urinary system: frequency unknown - renal failure, interstitial nephritis.

Metabolism and nutrition: infrequently - anorexia, loss of appetite.

From the musculoskeletal system: infrequently - muscle spasm 3, musculoskeletal stiffness 1, myalgia 2; frequency unknown - rhabdomyolysis 2*, myopathy.

From the digestive system: often - diarrhea, vomiting, dyspepsia, nausea, abdominal pain; uncommon - esophagitis 1, gastroesophageal reflux disease 2, gastritis, proctalgia 2, stomatitis, glossitis, bloating 4, constipation, dry mouth, belching, flatulence, cholestasis 4, hepatitis, incl. cholestatic and hepatocellular 4; frequency unknown - acute pancreatitis, discoloration of the tongue and teeth, liver failure, cholestatic jaundice.

From the respiratory system: uncommon - asthma 1, epistaxis 2, pulmonary embolism 1.

From the senses: often - dysgeusia, taste perversion; infrequently - vertigo, hearing loss, ringing in the ears; frequency unknown - deafness, ageusia (loss of taste), parosmia, anosmia.

From the cardiovascular system: often - vasodilation 1; uncommon - cardiac arrest 1, atrial fibrillation 1, prolongation of the QT interval on the ECG, extrasystole 1, atrial flutter; frequency unknown - ventricular tachycardia, incl. "pirouette" type.

From the laboratory parameters: often - a deviation in the liver test; infrequently - increased creatinine concentration 1, increased urea concentration 1, change in albumin-globulin ratio 1, leukopenia, neutropenia 4, eosinophilia 4, thrombocythemia 3, increased blood concentrations of ALT, AST, GGT 4, ALP 4, LDH 4; frequency unknown - agranulocytosis, thrombocytopenia, increased MHO value, prolongation of prothrombin time, change in urine color, increased bilirubin concentration in the blood.

From the body as a whole: very often - phlebitis at the injection site 1, often - pain at the injection site 1, inflammation at the injection site 1; infrequently - malaise 4, hyperthermia 3, asthenia, chest pain 4, chills 4, fatigue 4.

Immunosuppressed patients

In patients with AIDS and other immunodeficiencies receiving clarithromycin in higher doses over a long period of time for the treatment of mycobacterial infections, it is often difficult to distinguish adverse effects of the drug from symptoms of HIV infection or concomitant disease.

The most common adverse events in patients taking a daily dose of clarithromycin equal to 1000 mg were: nausea, vomiting, taste disturbance, abdominal pain, diarrhea, rash, flatulence, headache, constipation, hearing loss, increased concentrations of AST and ALT in blood. Low incidence adverse events such as shortness of breath, insomnia and dry mouth were also reported.

In patients with suppressed immunity, laboratory parameters were assessed, analyzing their significant deviations from standard values ​​(sharp increase or decrease). Based on this criterion, 2-3% of patients receiving clarithromycin at a dose of 1000 mg daily had significant increases in AST and ALT concentrations in the blood, as well as a decrease in the number of leukocytes and platelets. Increases in residual urea nitrogen concentrations have also been reported in a small number of patients.

*In some reports of rhabdomyolysis, clarithromycin was co-administered with other drugs known to be associated with rhabdomyolysis (statins, fibrates, colchicine or allopurinol).

1 Reports of these adverse reactions were received only with the use of the drug Klacid ®, lyophilisate for the preparation of solution for infusion.

2 Reports of these adverse reactions were received only with the use of the drug Klacid ®, extended-release film-coated tablets.

3 Reports of these adverse reactions were received only with the use of the drug Klacid ®, powder for the preparation of suspension for oral administration.

4 Reports of these adverse reactions were received only when using the drug Klacid ®, film-coated tablets.

Contraindications for use

- severe renal failure (creatinine clearance less than 30 ml/min);

- simultaneous use of clarithromycin with astemizole, cisapride, pimozide, terfenadine;

- simultaneous use of clarithromycin with ergot alkaloids, for example, ergotamine, dihydroergotamine;

- simultaneous use of clarithromycin with midazolam for oral administration;

- simultaneous use of clarithromycin with HMG-CoA reductase inhibitors (statins), which are largely metabolized by the CYP3A4 isoenzyme (lovastatin, simvastatin), due to an increased risk of myopathy, including rhabdomyolysis;

- simultaneous use of clarithromycin with colchicine;

- simultaneous use of clarithromycin with ticagrelor or ranolazine;

- a history of QT interval prolongation, ventricular arrhythmia or torsade de pointes;

- hypokalemia (risk of QT interval prolongation);

- severe liver failure occurring simultaneously with renal failure;

- a history of cholestatic jaundice/hepatitis that developed during the use of clarithromycin;

- porphyria;

- galactose intolerance, - lactase deficiency, - glucose-galactose malabsorption syndrome;

- lactation period (breastfeeding);

- children under 12 years of age (efficacy and safety have not been established);

- hypersensitivity to clarithromycin, other components of the drug and other macrolides.

WITH caution:

- moderate renal failure;

- moderate to severe liver failure;

- simultaneous use of clarithromycin with benzodiazepines, such as alprazolam, triazolam, midazolam for intravenous use;

- simultaneous use of clarithromycin with other ototoxic drugs, especially aminoglycosides;

- simultaneous use with drugs that are metabolized by the CYP3A isoenzyme, for example, carbamazepine, cilostazol, cyclosporine, disopyramide, methylprednisolone, omeprazole, indirect anticoagulants (for example, warfarin), quinidine, rifabutin, sildenafil, tacrolimus, vinblastine;

- simultaneous use with drugs that induce the CYP3A4 isoenzyme, for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort;

- simultaneous use of clarithromycin with statins that do not depend on the metabolism of the CYP3A isoenzyme (for example, fluvastatin);

- simultaneous use with blockers of slow calcium channels, which are metabolized by the CYP3A4 isoenzyme (for example, verapamil, amlodipine, diltiazem);

— IHD, severe heart failure, hypomagnesemia, severe bradycardia (less than 50 beats/min);

- patients simultaneously taking class IA (quinidine, procainamide) and class III antiarrhythmic drugs (dofetilide, amiodarone, sotalol);

- pregnancy.

Use during pregnancy and breastfeeding

The safety of clarithromycin during pregnancy and breastfeeding has not been established.

The use of clarithromycin during pregnancy (especially in the first trimester) is possible only in the absence of alternative therapy, and the potential benefit to the mother outweighs the potential risk to the fetus.

Clarithromycin is excreted in breast milk. If it is necessary to take it during lactation, breastfeeding should be stopped.

Use in children

The use of the drug in children under 12 years of age is contraindicated (efficacy and safety have not been established).

Overdose

Symptoms: Taking clarithromycin in high doses may cause symptoms of gastrointestinal disorders. One patient with a history of bipolar disorder developed mental status changes, paranoid behavior, hypokalemia, and hypoxemia after taking clarithromycin 8 g.

Treatment: in case of overdose, the unabsorbed drug should be removed from the gastrointestinal tract and symptomatic therapy should be carried out. Hemodialysis and peritoneal dialysis do not have a significant effect on the concentration of clarithromycin in serum, which is also typical for other macrolide drugs.

Drug interactions

The use of the following drugs concomitantly with clarithromycin is contraindicated due to the potential for serious side effects:

Cisapride, pimozide, terfenadine and astemizole

With simultaneous use of clarithromycin with cisapride/pimozide/terfenadine/astemizole, an increase in the concentration of the latter in the blood plasma has been reported, which can lead to an increase in the QT interval and the appearance of cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation and torsade de pointes (TdP).

Ergot alkaloids

Post-marketing studies show that with simultaneous use of clarithromycin with ergotamine or dihydroergotamine, the following effects associated with acute poisoning with drugs of the ergotamine group are possible: vascular spasm, ischemia of the limbs and other tissues, including the central nervous system. Concomitant use of clarithromycin and ergot alkaloids is contraindicated.

HMG-CoA reductase inhibitors (statins)

Concomitant use of clarithromycin with lovastatin or simvastatin is contraindicated due to the fact that these statins are largely metabolized by the CYP3A4 isoenzyme, and co-administration with clarithromycin increases their serum concentrations, which leads to an increased risk of developing myopathy, including rhabdomyolysis. Cases of rhabdomyolysis have been reported in patients taking clarithromycin concomitantly with these drugs. If clarithromycin is necessary, lovastatin or simvastatin should be discontinued during therapy.

Clarithromycin should be used with caution in combination therapy with other statins. It is recommended to use statins that do not depend on the metabolism of the CYP3A isoenzyme (for example, fluvastatin). If coadministration is necessary, it is recommended to take the lowest dose of statin. The development of signs and symptoms of myopathy should be monitored.

Effect of other drugs on clarithromycin

Drugs that are CYP3A inducers (for example, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) may induce the metabolism of clarithromycin. This may result in subtherapeutic concentrations of clarithromycin, resulting in reduced effectiveness. In addition, it is necessary to monitor the concentration of the CYP3A isoenzyme inducer in the blood plasma, which may increase due to the inhibition of CYP3A by clarithromycin. With simultaneous use of rifabutin and clarithromycin, an increase in plasma concentrations of rifabutin and a decrease in serum concentrations of clarithromycin were observed with an increased risk of developing uveitis.

The following drugs have a proven or suspected effect on clarithromycin plasma concentrations; if used concomitantly with clarithromycin, dosage adjustments or switching to alternative treatment may be required.

Efavirenz, nevirapine, rifampicin, rifabutin and rifapentine

Strong inducers of the cytochrome P450 system, such as efavirenz, nevirapine, rifampicin, rifabutin and rifapentine, can accelerate the metabolism of clarithromycin and, thus, reduce the plasma concentration of clarithromycin and weaken the therapeutic effect, and at the same time increase the concentration of 14-OH-clarithromycin, a metabolite. also being microbiologically active. Since the microbiological activity of clarithromycin and 14-OH-clarithromycin differs against various bacteria, the therapeutic effect may be reduced when clarithromycin is used concomitantly with enzyme inducers.

Etravirine

The concentration of clarithromycin decreases with the use of etravirine, but the concentration of the active metabolite 14-OH-clarithromycin increases. Because 14-OH-clarithromycin has low activity against MAC infections, overall activity against MAC infections may be affected, and alternative treatments should be considered for the treatment of MAC.

Fluconazole

Co-administration of fluconazole 200 mg daily and clarithromycin 500 mg twice daily in 21 healthy volunteers resulted in an increase in the mean minimum steady-state concentration of clarithromycin (C min) and AUC by 33% and 18%, respectively. However, simultaneous use did not significantly affect the average steady-state concentration of the active metabolite 14-OH-clarithromycin. No dose adjustment of clarithromycin is required when used concomitantly with fluconazole.

Ritonavir

A pharmacokinetic study showed that co-administration of ritonavir 200 mg every 8 hours and clarithromycin 500 mg every 12 hours resulted in a marked suppression of the metabolism of clarithromycin. When co-administered with ritonavir, clarithromycin C max increased by 31%, C min increased by 182% and AUC increased by 77%. Complete suppression of the formation of 14-OH-clarithromycin was noted. Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with renal failure (with CC 30-60 ml/min), the dose should be reduced by 50%. Ritonavir should not be taken concomitantly with clarithromycin in doses exceeding 1 g/day.

Effect of clarithromycin on other drugs

Antiarrhythmic drugs (quinidine and disopyramide)

Ventricular tachycardia of the "pirouette" type may occur with the simultaneous use of clarithromycin and quinidine or disopyramide. When clarithromycin is used concomitantly with these drugs, ECG monitoring should be performed regularly to monitor for QT interval prolongation, and serum concentrations of these drugs should also be monitored.

During post-marketing use, cases of hypoglycemia have been reported during co-administration of clarithromycin and disopyramide. It is necessary to monitor the concentration of glucose in the blood while using clarithromycin and disopyramide.

Oral hypoglycemic agents/insulin

When clarithromycin is used together with oral hypoglycemic agents (for example, sulfonylureas) and/or insulin, severe hypoglycemia may occur. Concomitant use of clarithromycin with certain hypoglycemic drugs (for example, nateglinide, pioglitazone, repaglinide and rosiglitazone) may lead to inhibition of the CYP3A isoenzyme by clarithromycin, which may result in hypoglycemia. Careful monitoring of glucose concentrations is recommended.

Interactions due to CYP3A isoenzyme

Co-administration of clarithromycin, which is known to inhibit the CYP3A isoenzyme, and drugs primarily metabolized by CYP3A may be associated with a mutual increase in their concentrations, which may increase or prolong both therapeutic and side effects. Clarithromycin should be used with caution in patients receiving drugs that are substrates of the CYP3A isoenzyme, especially if these drugs have a narrow therapeutic index (for example, carbamazepine) and/or are extensively metabolized by this enzyme. If necessary, the dose of the drug taken together with clarithromycin should be adjusted. Also, whenever possible, serum concentrations of drugs primarily metabolized by CYP3A should be monitored.

The following drugs/classes are metabolized by the same CYP3A isoenzyme that metabolizes clarithromycin, e.g., alprazolam, carbamazepine, cilostazol, cyclosporine, disopyramide, ergot alkaloids, methylprednisolone, midazolam, omeprazole, indirect anticoagulants (eg, warfarin), quinidine, rifabutine, sildenafil , tacrolimus, triazolam and vinblastine. Also, agonists of the CYP3A isoenzyme include the following drugs that are contraindicated for combined use with clarithromycin: astemizole, cisapride, pimozide, terfenadine, lovastatin, simvastatin and ergot alkaloids. Drugs that interact in this manner through other isoenzymes within the cytochrome P450 system include phenytoin, theophylline, and valproic acid.

Indirect anticoagulants

When taking warfarin and clarithromycin together, bleeding and a marked increase in MHO and prothrombin time are possible. In case of simultaneous use with warfarin or other indirect anticoagulants, it is necessary to monitor MHO and prothrombin time.

Omeprazole

Clarithromycin (500 mg every 8 hours) was studied in healthy adult volunteers in combination with omeprazole (40 mg daily). With simultaneous use of clarithromycin and omeprazole, steady-state plasma concentrations of omeprazole were increased (Cmax, AUC 0-24, and T1/2 increased by 30%, 89% and 34%, respectively). The average gastric pH over 24 hours was 5.2 when taking omeprazole alone and 5.7 when taking omeprazole simultaneously with clarithromycin.

Sildenafil, tadalafil and vardenafil

Each of these phosphodiesterase inhibitors is metabolized at least in part by CYP3A. However, CYP3A may be inhibited in the presence of clarithromycin. Concomitant use of clarithromycin with sildenafil, tadalafil or vardenafil may result in increased phosphodiesterase inhibitory effects. When using these drugs together with clarithromycin, consider reducing the dose of sildenafil, tadalafil and vardenafil.

Theophylline, carbamazepine

With the simultaneous use of clarithromycin and theophylline or carbamazepine, it is possible to increase the concentration of these drugs in the systemic circulation.

Tolterodine

The primary metabolism of tolterodine occurs through the 2D6 isoform of cytochrome P450 (CYP2D6). However, in a portion of the population lacking CYP2D6, metabolism occurs via CYP3A. In this population, inhibition of CYP3A results in significantly higher serum concentrations of tolterodine. In populations that are poor metabolizers via CYP2D6, a reduced dose of tolterodine may be required in the presence of CYP3A inhibitors such as clarithromycin.

Benzodiazepines (eg, alprazolam, midazolam, triazolam)

With the combined use of midazolam and clarithromycin in the form of tablets (500 mg 2 times / day), an increase in the AUC of midazolam was noted: 2.7 times after intravenous administration of midazolam and 7 times after oral administration. Concomitant oral administration of midazolam and clarithromycin should be avoided. If intravenous midazolam is used concomitantly with clarithromycin, the patient's condition should be carefully monitored for possible dose adjustment. The same precautions should be applied to other benzodiazepines that are metabolized by CYP3A, including triazolam and alprazolam. For benzodiazepines whose elimination is not dependent on CYP3A (temazepam, nitrazepam, lorazepam), a clinically significant interaction with clarithromycin is unlikely.

When clarithromycin and triazolam are used together, effects on the central nervous system, such as drowsiness and confusion, are possible. Therefore, if concurrent use occurs, it is advisable to monitor for symptoms of CNS impairment.

Interaction with other drugs

Aminoglycosides

When taking clarithromycin concomitantly with other ototoxic drugs, especially aminoglycosides, caution should be exercised and the functions of the vestibular and auditory systems should be monitored both during and after therapy.

Colchicine

Colchicine is a substrate of both CYP3A and the P-glycoprotein (Pgp) transporter protein. Clarithromycin and other macrolides are known to be inhibitors of CYP3A and Pgp. When clarithromycin is used concomitantly with colchicine, inhibition of Pgp and/or CYP3A may result in increased effects of colchicine. The development of clinical symptoms of colchicine poisoning should be monitored. There have been post-marketing reports of cases of colchicine poisoning when taken concomitantly with clarithromycin, most often in elderly patients. Some of the reported cases occurred in patients with renal failure. Some cases were reported to be fatal. The simultaneous use of clarithromycin and colchicine is contraindicated.

Digoxin

Digoxin is thought to be a substrate for Pgp. Clarithromycin is known to inhibit Pgp. When clarithromycin and digoxin are used together, inhibition of Pgp by clarithromycin may lead to increased effects of digoxin. Coadministration of digoxin and clarithromycin may also result in increased serum concentrations of digoxin. Some patients have experienced clinical symptoms of digoxin toxicity, including potentially fatal arrhythmias. Serum digoxin concentrations should be carefully monitored when clarithromycin and digoxin are coadministered.

Zidovudine

Concomitant use of clarithromycin tablets and zidovudine in adult HIV-infected patients may result in a decrease in zidovudine C ss. Because clarithromycin interferes with the oral absorption of zidovudine, the interaction can be largely avoided by taking clarithromycin and zidovudine 4 hours apart. This interaction has not been observed in HIV-infected children taking clarithromycin suspension with zidovudine or dideoxyinosine. Since clarithromycin may interfere with the absorption of zidovudine when administered concomitantly orally in adult patients, such an interaction is unlikely to occur when clarithromycin is used intravenously.

Phenytoin and valproic acid

There is evidence of interactions between CYP3A inhibitors (including clarithromycin) and drugs that are not metabolized by CYP3A (phenytoin and valproic acid). When used simultaneously with clarithromycin, it is recommended to determine the serum concentrations of these drugs, because there are reports of their increase.

Bidirectional drug interactions

Atazanavir

Clarithromycin and atazanavir are both substrates and inhibitors of CYP3A. There is evidence of a bidirectional interaction between these drugs. Concomitant use of clarithromycin (500 mg 2 times/day) and atazanavir (400 mg 1 time/day) may result in a twofold increase in clarithromycin exposure and a 70% decrease in 14-OH-clarithromycin exposure, with an increase in atazanavir AUC by 28%. Due to the wide therapeutic range of clarithromycin, dose reduction is not required in patients with normal renal function. In patients with moderate renal failure (creatinine clearance 30-60 ml/min), the dose of clarithromycin should be reduced by 50%. In patients with CC less than 30 ml/min, the dose of clarithromycin should be reduced by 75% using the appropriate dosage form of clarithromycin. Clarithromycin in doses exceeding 1000 mg/day should not be used in combination with protease inhibitors.

Slow alcium channel blockers

When using clarithromycin simultaneously with slow calcium channel blockers that are metabolized by the CYP3A4 isoenzyme (for example, verapamil, amlodipine, diltiazem), caution should be exercised as there is a risk of arterial hypotension. Plasma concentrations of clarithromycin, as well as slow calcium channel blockers, may increase with simultaneous use. Arterial hypotension, bradyarrhythmia and lactic acidosis are possible when taking clarithromycin and verapamil simultaneously.

Itraconazole

Clarithromycin and itraconazole are substrates and inhibitors of CYP3A, which determines the bidirectional interaction of the drugs. Clarithromycin may increase plasma concentrations of itraconazole, while itraconazole may increase plasma concentrations of clarithromycin. Patients taking itraconazole and clarithromycin concomitantly should be closely monitored for symptoms of increased or prolonged pharmacological effects of these drugs.

Saquinavir

Clarithromycin and saquinavir are CYP3A substrates and inhibitors, resulting in a bidirectional drug interaction. Co-administration of clarithromycin (500 mg twice daily) and saquinavir (soft gelatin capsules, 1200 mg three times daily) in 12 healthy volunteers increased the AUC and Cmax of saquinavir by 177% and 187%, respectively, compared with saquinavir administration alone. separately. The AUC and Cmax values ​​of clarithromycin were approximately 40% higher than with clarithromycin monotherapy. When these two drugs are used concomitantly for a limited time at the doses/formulations indicated above, no dose adjustment is required. The results of drug interaction studies using saquinavir soft gelatin capsules may not be consistent with the effects observed with saquinavir hard gelatin capsules. The results of drug interaction studies with saquinavir monotherapy may not be consistent with the effects observed with saquinavir/ritonavir therapy. When using saquinavir with ritonavir, the potential effect of ritonavir on clarithromycin should be considered.

Conditions for dispensing from pharmacies

The drug is available with a prescription.

Storage conditions and periods

The drug should be stored out of the reach of children, protected from light at a temperature of 15° to 30°C. Shelf life - 5 years.

Use for liver dysfunction

The use of the drug is contraindicated in case of severe liver failure occurring simultaneously with renal failure, with a history of cholestatic jaundice/hepatitis that developed during the use of clarithromycin.

The drug should be prescribed with caution for moderate to severe liver failure.

Use for renal impairment

Patients with severe renal failure (creatinine clearance less than 30 ml/min) the use of the drug Klacid ® SR is contraindicated.

U patients with moderate renal impairment (creatinine clearance from 30 to 60 ml/min) the dose of the drug is reduced by half, which is no more than 500 mg (1 tablet)/day.

Use in elderly patients

U elderly patients the concentration of clarithromycin and its 14-OH metabolite in the blood was higher, and elimination was slower than in the group of young people. However, after adjustment for renal CK, there were no differences in both groups. Thus, the main influence on the pharmacokinetic parameters of clarithromycin is renal function, and not age.

special instructions

Long-term use of antibiotics can lead to the formation of colonies with an increased number of insensitive bacteria and fungi. In case of superinfection, appropriate therapy must be prescribed.

Cases of hepatic dysfunction (increased concentrations of liver enzymes in the blood, hepatocellular and/or cholestatic hepatitis with or without jaundice) have been reported with the use of clarithromycin. Liver dysfunction can be severe but is usually reversible. There have been cases of fatal liver failure, mainly associated with the presence of serious concomitant diseases and/or concomitant use of other drugs. If signs and symptoms of hepatitis appear, such as anorexia, jaundice, dark urine, itching, abdominal tenderness on palpation, clarithromycin therapy should be stopped immediately.

In the presence of chronic liver diseases, it is necessary to regularly monitor serum enzymes.

When treated with almost all antibacterial agents, incl. clarithromycin, cases of pseudomembranous colitis have been described, the severity of which can range from mild to life-threatening. Antibacterial drugs can change the normal intestinal microflora, which can lead to the growth of Clostridium difficile. Pseudomembranous colitis caused by Clostridium difficile should be suspected in all patients who experience diarrhea after using antibacterial agents. After a course of antibiotic therapy, careful medical monitoring of the patient is necessary. Cases of the development of pseudomembranous colitis 2 months after taking antibiotics have been described.

Clarithromycin should be used with caution in patients with coronary artery disease, severe heart failure, hypomagnesemia, severe bradycardia (less than 50 beats/min), as well as when used simultaneously with class IA (quinidine, procainamide) and class III antiarrhythmic drugs (dofetilide, amiodarone, sotalol). In these conditions and when clarithromycin is used concomitantly with these drugs, ECG monitoring should be carried out regularly to check for QT interval prolongation.

It is possible to develop cross-resistance to clarithromycin and other macrolide antibiotics, as well as lincomycin and clindamycin.

Given the increasing resistance of Streptococcus pneumoniae to macrolides, it is important to perform susceptibility testing when prescribing clarithromycin to patients with community-acquired pneumonia. For hospital-acquired pneumonia, clarithromycin should be used in combination with appropriate antibiotics.

Mild to moderate skin and soft tissue infections are most often caused by Staphylococcus aureus and Streptococcus pyogenes . Moreover, both pathogens can be resistant to macrolides. Therefore, it is important to conduct a sensitivity test.

Macrolides can be used for infections caused by Corynebacterium minutissimum, for acne vulgaris and erysipelas, as well as in situations where penicillin cannot be used.

If acute hypersensitivity reactions occur, such as anaphylactic reaction, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms (DRESS syndrome), Henoch-Schönlein purpura, you should immediately stop taking clarithromycin and begin appropriate therapy.

When used simultaneously with warfarin or other indirect anticoagulants, it is necessary to monitor MHO and prothrombin time.

Impact on the ability to drive vehicles and operate machinery

There are no data regarding the effect of clarithromycin on the ability to drive a car or use machinery.

Caution should be exercised when driving because of the potential for dizziness, vertigo, confusion, and disorientation that may occur while taking this drug.

Analogues of the drug Klacid are presented, in accordance with medical terminology, called “synonyms” - drugs that are interchangeable in their effects on the body, containing one or more identical active ingredients. When selecting synonyms, consider not only their cost, but also the country of production and the reputation of the manufacturer.

Description of the drug

List of analogues

Note! The list contains synonyms for Klacid, which have a similar composition, so you can choose a replacement yourself, taking into account the form and dose of the medicine prescribed by your doctor. Give preference to manufacturers from the USA, Japan, Western Europe, as well as well-known companies from Eastern Europe: KRKA, Gedeon Richter, Actavis, Egis, Lek, Hexal, Teva, Zentiva.

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Official instructions for use

Klacid ®

INN:

Registration number:

Indications for use:

Contraindications:

Carefully:

Use during pregnancy and breastfeeding:

Directions for use and dosage:

Side effect:

Overdose:

Interaction with other drugs:

Special instructions:

Impact on the ability to drive vehicles and engage in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions:

Vacation conditions:

The information on the page was verified by physician-therapist E.I. Vasilyeva.

They offer a great variety of medications with different trade names. Moreover, the composition of some drugs is absolutely identical. A variety of generics and substitutes, supplemented with secondary components and additives, are increasingly filling the shelves of pharmacy chains. Today you will find out which analogue of Klacida you can choose. You should immediately understand that self-medication can be dangerous. Doctors especially discourage taking antibiotics on their own whim.

"Klacid": instructions for use, reviews

The antibiotic is available in three forms. At your discretion, you can choose tablets, injections or suspension. The latter is more often used in children. The active ingredient of the drug, clarithromycin, belongs to the broad-spectrum antimicrobial agents, macrolides. The drug “Klacid” (tablets and suspension) is prescribed for bacterial lesions of the upper and lower respiratory tract, ENT organs, and skin. It is important that the microorganisms causing the infection are sensitive to the active substance. For example, gram-negative bacteria that decompose lactose are resistant to the claimed drug.

"Klacid" is used 250-500 mg twice a day. The duration of treatment varies from 5 to 14 days. For children, the drug is prescribed in an individual dosage, depending on age and body weight, under the supervision of a doctor. The use of the medicine is contraindicated in case of hypersensitivity, impaired renal function, pregnancy and lactation.

“Klacid” (suspension) - reviews say - has a pleasant taste. Conveniently, it can be given to children along with milk. This drug costs about 400 rubles for 60 ml. The medicine in tablets (10 pieces of 250 mg each) can be purchased for 600 rubles. Infusions, patients say, are prescribed quite rarely. The cost of an ampoule with a dosage of 500 mg is 650-700 rubles.

Inexpensive substitute for Clarithromycin

An analogue of "Klacida" can be found cheaply. Many consumer reviews are negative only because of the price of the antibiotic. Not every person can afford to buy tablets for almost 1000 rubles. There is a need to find a more affordable drug. This is what Clarithromycin became. It contains the same active ingredient as in the original product. However, the cost of the tablets is about 250 rubles. Moreover, the package will contain 14 pills, not 10. Unlike the expensive American drug, this medicine is produced in Russia.

The analogues' readings are the same. The difference is that the domestic medicine can also be used to treat gastrointestinal ulcers, but in combination with additional medications. This medication is not used in the same cases as its predecessor. It is unacceptable to give it to children under 12 years of age. If you choose between purchasing “Klacid” or “Clarithromycin” for a child, the first medicine in the form of a suspension will have an advantage.

"Ecositrin": a drug based on clarithromycin

What other analogue can be found? "Klacid" can be replaced with "Ecositrin" tablets. This drug costs from 200 rubles. Each tablet contains 500 mg of clarithromycin and excipients. Medicine is prescribed for bacterial infections of the ear, nose, throat, bronchi and lungs. Used to treat skin infections and stomach ulcers. It is contraindicated to use Ecositrin in case of renal failure, sensitivity, or hypokalemia. The remaining contraindications coincide with the declared drug. The duration of treatment, unlike previous analogues, is 10-14 days. In some cases, it is advisable to take an antibiotic for six months.

"Sumamed": a popular analogue

“Klacid” or “Sumamed” - which is better? This question often arises among people who have at least a little knowledge of medicine. These two drugs are compared because they are both macrolides. The substances included in their composition are different. The component of Sumamed is azithromycin. This medicine, as stated, is available in the form of tablets and suspension. A solution for internal administration is produced, but it is practically not in demand. The cost of a package of “Sumamed” is approximately 500 rubles. The drug is prescribed for the same purpose as Klacid. This analogue can also be used to treat sexually transmitted infections.

If the doctor prescribes Klacid or Sumamed, which is better to choose? The latter medicine is very popular. Another advantage is that you only need to take one tablet per day. Unlike Klacid, Sumamed should not be consumed during meals, much less mixed with milk.

Amoxicillin-based substitutes

If you have an intolerance to the active ingredients of the drug "Klacid", then you can choose a substitute with a different composition, for example, based on amoxicillin. This active substance belongs to the penicillin series of antibiotics. A popular representative is the Flemoxin tablets. There are also trade names of drugs: “Amoxicillin”, “Amosin”, “Ospamox”, “Ecobol” and others. “Klacid” or “Flemoxin” - which is better to choose? The latter drug has its advantages and disadvantages:

• "Flemoxin" should be taken three times a day, and "Klacid" - twice;
• penicillin antibiotics more often provoke digestive disorders;
• "Flemoxin" - dispersible tablets (can be dissolved in water);
• This analogue costs about 350 rubles. for 20 pcs.;
• "Flemoxin" helps with gastrointestinal diseases caused by microorganisms sensitive to it;
• This medicine can be used during pregnancy and to treat babies.

Cephalosporin series

"Klacid" - tablets and suspensions that can provoke allergies. With this outcome, the medication is often replaced with antibiotics belonging to the cephalosporon series, a new generation. You can replace the declared remedy with the following drugs: Suprax, Cephalexin, Ceftriaxone, Cefatoxime, and so on.

These antibiotics inhibit the growth of bacteria by damaging their wall. Doctors say that only Cephalexin is absorbed from the gastrointestinal tract. Therefore, other medications are prescribed for intravenous and intramuscular administration. If taken orally, there will be severe irritation of the mucous membranes of the stomach and intestines. The cost of the drug "Cefalexin" (16 tablets) is no more than 150 rubles. Affordable price is also important for the consumer.

Opinions emerging about interchangeable medicines

If you decide to take an analogue of Klacid, you should definitely discuss this with your doctor. All the drugs described have a broad antibacterial effect. Perhaps this is the only thing that unites them. Cost, dosage regimen, trade name and composition - this is how they differ. Some medications are often prescribed to children and expectant mothers (Flemoxin), others are prohibited drugs in pediatrics.

There are many medicines with the same active ingredient. However, some analogues of Klacid belong to the group of amoxicillins. Medicines do not differ in their effect on inflammatory processes. So people wonder which replacement drug is best?

About the drug Klacid

The drug is available in tablet form. Depending on the package, 250 mg and 500 mg. One blister contains 7-14 tablets. The cost reaches 660 rubles. The drug Klacid is used for infectious diseases of the upper and lower respiratory tract. In addition, the product is used for bacterial skin lesions. The drug is used to prevent infectious lesions. The active ingredient in Klacid is the antibiotic clarithromycin. The substance belongs to the group of macrolides.

Klacid should not be used if you are hypersensitive to the active substance. The medicine is contraindicated in pregnant women and during breastfeeding. In addition, the product should not be used for porphyria, or for children under 3 years of age.

If the rules of use are not followed, side effects may occur. Klacid for children is used as a last resort, but is effective for pharyngitis, acute bronchitis and tonsillitis. It is necessary to take medicine with liver and kidney diseases with caution. When using other drugs with a general effect, side effects occur.

Clarithromycin

A cheap analogue of Klacid is Clarithromycin. Both medicines contain the same substance. The active ingredient is clarithromycin. The antibiotic belongs to the group of macrolides. The medicine is available in tablets of 250 mg and 500 mg. The composition of the medication includes excipients. The medicine costs about 120 rubles. Indications for the use of Clarithromycin are the following diseases:

• inflammation and infections of the respiratory tract;
• skin lesions;
• bacterial inflammation of the digestive tract;
• inflammation of the genitourinary system.

The Klacida analogue is used in the complex treatment of gonorrhea, ureaplasmosis and chlamydia. Clarithromycin is used after diagnosis and testing of pathogenic microflora for an active antibiotic. Tablets are contraindicated in case of hypersensitivity to the components of the drug. The drug should not be taken in case of hepatic encephalopathy and in children under 12 years of age. For women during pregnancy, use is limited to the first three months. In addition, you should not take the drug during breastfeeding. If the recommendations for using the medicine are not followed, adverse reactions may occur.

Summed

The medication is available in tablet form. The active ingredient of this analogue is azithromycin. One tablet contains 500 mg of antibiotic. Summamed is prescribed for the treatment of infectious lesions. In this case, the drug in tablets is used for prevention of respiratory diseases. In addition, Summamed is used for inflammation of the urinary tract and infectious skin lesions. The medicine is prescribed for etiotropic therapy. The drug is used for the initial development of Lyme disease.

An analogue of the drug Klacida in tablets has the following contraindications:

• liver inflammation;
• taking medications ergotamine and dihydroergotamine;
• dysfunction of absorption in the stomach;
• lactose and fructose intolerance;
• insufficient lactose synthesis;
• individual intolerance to azithromycin.

Summamed should not be taken by children under 6 years of age. Special instructions for the use of the Klacida analogue include careful use for myasthenia gravis and liver dysfunction. Otherwise, temporarily limit the use of the medicine if there are problems with heart contraction. In addition, the drug is not compatible with antipsychotics, antidepressants and warfarin.

Flemoxin Solutab

The drug Flemoxin Solutab is an analogue of Klacid and is available in tablets. If the pills interact with water, the product breaks up into a suspension. There are 5 blisters in a cardboard package. Each tablet contains 125 mg, 25 mg, 500 mg and 1000 mg of the active ingredient amoxicillin. The drug is aimed at treating inflammatory diseases:

• sinusitis;
• tonsillitis;
• pharyngitis;
• tracheitis;
• pneumonia.

In addition, the Klacida analogue helps with infections of the musculoskeletal system and inflammation of the genital organs. Flemoxin Solutab is used to treat skin lesions. Despite the effectiveness of the medicine, the analogue is prescribed after consultation, diagnosis and relevant tests.

The patient should follow the doctor's recommendations, otherwise taking the drug may complicate the diagnosis. Therefore, the analogue has contraindications. The drug is limited in use in cases of liver and kidney dysfunction. The medicine is not prescribed to children under 12 years of age and pregnant women in the first trimester.

Amoxicillin

The medicine is sold in Russian-made tablets. The cost of the analog Klacid is cheaper and ranges from 37-100 rubles. This depends on the number of tablets in the package. In pharmacies the product is available in 250-500 mg doses.

In addition, injections are sold where the medicine is mixed in a sodium chloride solution. Amoxicillin is indicated for bacterial infections of the intestines. The drug is prescribed to cure ear diseases and acute respiratory infections. The product effectively helps with chronic bronchitis. The analogue has contraindications, which include:

• hypersensitivity to the active substance and penicillin;
• digestive tract disorders;
• children under 3 years of age;
• hay fever

Side effects occur when bronchial asthma and allergic diathesis occur. Special instructions for taking the Klacid analogue include parallel treatment with Metronidazole. When using medications together, an allergic reaction occurs. If Amoxicillin is prescribed for renal impairment, the dosage is reduced and the interval is increased. The analogue is recommended to be taken during meals. This helps avoid the occurrence of intestinal disorders.

Amoxiclav

The drug is available in the form of tablets and powder for suspension and injection. The active antibiotic for this analogue is amoxicillin. The substance content in tablets is 250-875 mg. The Klacida analogue is prescribed to adults and children. The powder contains 5 ml of active substance. The suspension comes in a ratio of 125 mg, 250 mg and 400 mg. For the preparation of injections, one bottle contains from 500 mg to 1000 mg of amoxicillin. In this case, the composition includes clavulanic acid at 100 and 200 mg. Any form of medicine is used to treat the following diseases:

• for gynecological infections;
• odontogenic infections;
• with damage to the respiratory tract;
• for connective tissue lesions;
• for gastrointestinal infections;
• for skin lesions.

The Klacida analogue in the form of injections is recommended for prophylaxis after surgery. In addition, the drug is prescribed for the treatment of bile ducts. The drug is contraindicated in cases of cholestatic jaundice and hepatitis. The analogue is not recommended for people with hypersensitivity to penicillins and the active substance.

The medication in any form cannot be used for mononucleosis and lymphocytic leukemia. Use for colitis, renal encephalopathy and kidney disorders leads to side effects. Otherwise, the use of the Klacid analogue is limited. During pregnancy and breastfeeding, a woman should consult a doctor.

Klacid has cheap and expensive analogues containing the antibiotics clarithromycin or amoxicillin. In most cases, drugs are sold in tablet form. However, Amoxiclav is available in powder dosage form for injections and suspensions. Can analogs be taken by infants and children? Amoxiclav is suitable for this.