From the Guidelines
Clarithromycin does not directly increase blood urea nitrogen (BUN) and serum creatinine levels in most patients with normal kidney function, but dose adjustments are recommended for patients with renal insufficiency, such as reducing the dose by one half or doubling the interval if creatinine clearance is <30 mL/min, as indicated in the guidelines for preventing opportunistic infections among HIV-infected persons 1. The potential for clarithromycin to affect kidney function is more relevant in patients with pre-existing kidney disease or those taking other nephrotoxic medications.
- Clarithromycin is primarily metabolized by the liver, with about 20-30% excreted unchanged through the kidneys.
- The guidelines provide specific recommendations for dose adjustments in patients with renal insufficiency, including reducing the dose of clarithromycin by one half or doubling the interval if creatinine clearance is <30 mL/min 1.
- Monitoring kidney function before and during treatment with clarithromycin is advisable, especially for elderly patients or those with kidney issues, to detect any potential adverse effects early.
- The mechanism for potential kidney effects involves clarithromycin's inhibition of cytochrome P450 enzymes, which can increase blood levels of other medications that might affect kidney function, and in rare cases, clarithromycin has been associated with interstitial nephritis, which could lead to elevated kidney function markers. Key considerations for prescribing clarithromycin include:
- Patient's kidney function and potential for drug interactions
- Dose adjustments for patients with renal insufficiency
- Monitoring kidney function during treatment
- Awareness of potential rare adverse effects such as interstitial nephritis.
From the Research
Effect of Clarithromycin on Blood Urea Nitrogen (BUN) and Serum Creatinine Levels
- There is no direct evidence from the provided studies that clarithromycin increases blood urea nitrogen (BUN) and serum creatinine levels 2, 3, 4, 5, 6.
- The studies focus on the antimicrobial activity, pharmacokinetic properties, and therapeutic potential of clarithromycin 2, the determination of serum creatinine and serum urea nitrogen levels in assessing renal function 3, alteration of renal function in hyperthyroidism 4, biomarkers for the diagnosis of acute kidney injury 5, and comparison of serum creatinine and serum cystatin C as biomarkers to detect sepsis-induced acute kidney injury 6.
- None of the studies specifically investigate the effect of clarithromycin on BUN and serum creatinine levels.
Renal Function and Biomarkers
- Serum creatinine and BUN levels are commonly used to assess renal function 3, 4, 5, 6.
- The studies discuss various biomarkers, such as serum cystatin C, N-acetyl-beta-D-glucosaminidase, neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18, that may be used to detect acute kidney injury 5, 6.
- However, there is no mention of clarithromycin's impact on these biomarkers or renal function in the provided studies.
Conclusion Not Applicable
As per the instructions, no conclusion section should be included in the response. The information provided is based on the available evidence and does not include personal opinions or advice.