Does clarithromycin (antibiotic) cause diarrhea?

Clarithromycin and Diarrhea

Yes, clarithromycin commonly causes diarrhea as a side effect. According to FDA drug labeling, diarrhea is one of the most frequent adverse events associated with clarithromycin use 1.

Gastrointestinal Side Effects of Clarithromycin

• Diarrhea is specifically listed as a common problem caused by clarithromycin, which usually resolves when the antibiotic is discontinued 1
• The FDA drug label explicitly advises patients that diarrhea is a common adverse effect of clarithromycin treatment 1
• In cases of overdosage, gastrointestinal symptoms including diarrhea are among the primary adverse reactions 1
• Other common gastrointestinal side effects include:
  • Nausea 2
  • Vomiting 2
  • Abdominal pain 2
  • Metallic taste 2

Incidence and Severity

• In clinical trials of clarithromycin extended-release formulation, diarrhea occurred in approximately 6% of patients 3
• Diarrhea was reported more frequently with the immediate-release formulation compared to the extended-release formulation (p=0.029) 4
• Most gastrointestinal adverse events, including diarrhea, are mild to moderate in severity and transient in nature 4, 3
• The CDC guidelines note that diarrhea is among the most common adverse effects associated with clarithromycin when used for treatment of various infections 2

Mechanism and Risk Factors

• Clarithromycin, like other antibiotics, can disrupt the normal intestinal microbiota, which may contribute to diarrhea development 5
• Antimicrobials are responsible for approximately 25% of all drug-induced diarrhea cases 5
• The disease spectrum of antibiotic-associated diarrhea ranges from benign self-limiting diarrhea to more severe forms 5
• Dose-related toxicity is common with clarithromycin, with higher doses potentially increasing the risk of adverse effects including diarrhea 2

Clinical Management

• Diarrhea typically resolves upon discontinuation of the antibiotic 1
• Patients should be advised to contact their healthcare provider if they develop watery or bloody stools (with or without stomach cramps and fever), even up to two months after taking the last dose of clarithromycin 1
• When treating travelers' diarrhea, clarithromycin is not typically a first-line agent; azithromycin is preferred due to its efficacy and once-daily dosing 6
• For patients experiencing significant diarrhea with clarithromycin:
  • Consider switching to an extended-release formulation which has been shown to cause less diarrhea than immediate-release formulations 4, 3
  • Evaluate for Clostridioides difficile infection if diarrhea is severe or persistent 5
  • Ensure adequate hydration 1

Special Considerations

• Elderly patients with low body weight may require lower doses of clarithromycin to reduce toxicity, including gastrointestinal effects 2
• Patients with a history of gastrointestinal disorders may be at higher risk for developing diarrhea with clarithromycin use 2
• When prescribing clarithromycin, clinicians should follow antibiotic stewardship principles to minimize adverse effects, including limiting duration of therapy when possible 2