What is the recommended dosing of clarithromycin (macrolide antibiotic) for treating sinus infections in adults?

From the Guidelines

The recommended dosage of clarithromycin for treating sinus infections in adults is 500 mg orally twice daily for 10-14 days. This dosage is based on the most recent and highest quality study available, which provides guidance on the treatment of rhinosinusitis and nasal polyps 1. The study compares various short-term antibiotics for the treatment of patients with chronic rhinosinusitis (CRS) and suggests that clarithromycin is an effective option. Although the study does not provide a direct comparison of different dosages of clarithromycin, it does mention that a high-dose group demonstrated significant improvement in nasal symptom scores, Lund-Kennedy, and SNOT-20 at weeks 2 and 4 compared with the baseline values and low-dose group 1.

Some key points to consider when prescribing clarithromycin for sinus infections include:

• The medication should be taken with or without food, though taking it with food may help reduce gastrointestinal side effects such as nausea or stomach upset.
• Clarithromycin works by inhibiting bacterial protein synthesis, effectively stopping the growth of susceptible bacteria commonly involved in sinus infections, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
• Clarithromycin is typically prescribed as an alternative when first-line antibiotics like amoxicillin are contraindicated, such as in patients with penicillin allergy.
• Patients should complete the full course of antibiotics even if symptoms improve before completion to prevent antibiotic resistance and ensure complete eradication of the infection.
• Common side effects include gastrointestinal disturbances, altered taste, and potential for drug interactions, particularly with medications metabolized by the CYP3A4 enzyme system.

It's also worth noting that the diagnosis and management of sinusitis guidelines provide additional information on commonly used antibiotics for sinusitis, including clarithromycin 1. However, the most recent and highest quality study available provides the best guidance on the recommended dosage of clarithromycin for treating sinus infections in adults.

From the FDA Drug Label

ADULT DOSAGE GUIDELINES Clarithromycin Immediate-Release Tablets Infection Dosage (q12h) Duration (days) ... Acute maxillary sinusitis due to H. influenzae 500 mg 14 M. catarrhalis S. pneumoniae

The recommended dosing of clarithromycin for treating acute maxillary sinusitis in adults is 500 mg every 12 hours for 14 days 2.

From the Research

Clarithromycin Dosing for Sinus Infection in Adults

• The recommended dosing of clarithromycin for treating sinus infections in adults is typically 500 mg orally twice daily for 10-14 days 3, 4.
• Alternatively, a 7-day course of clarithromycin extended-release 1000 mg once daily has been shown to be effective in treating acute maxillary sinusitis, with clinical cure rates of 85% 5.
• The extended-release formulation of clarithromycin has been found to have an improved gastrointestinal tolerability profile compared to the immediate-release formulation 5.
• Studies have also compared the efficacy of clarithromycin to other antibiotics, such as levofloxacin and amoxicillin/clavulanic acid, and found similar clinical success rates 3, 4.
• The choice of dosing regimen may depend on individual patient factors, such as renal function and potential drug interactions 6.

Key Considerations

• Clarithromycin is a broad-spectrum macrolide antibacterial agent active against the major pathogens responsible for respiratory tract infections in immunocompetent patients 6.
• The drug is highly active in vitro against pathogens causing atypical pneumonia and has similar activity to other macrolides against certain bacteria 6.
• Dosage adjustments may be required for patients with severe renal failure, but not for elderly patients or those with hepatic impairment 6.