Clarithromycin Pediatric Dosing
For children over 1 month of age, administer clarithromycin at 15 mg/kg/day divided into 2 doses, with a maximum daily dose of 1 gram. 1
Weight-Based Dosing for Oral Administration
The British Thoracic Society provides specific weight-based dosing that translates the mg/kg recommendation into practical doses 1:
- Under 8 kg: 7.5 mg/kg twice daily 1
- 8-11 kg: 62.5 mg twice daily 1
- 12-19 kg: 125 mg twice daily 1
- 20-29 kg: 187.5 mg twice daily 1
- 30-40 kg: 250 mg twice daily 1
- Adolescents 12-18 years: 500 mg twice daily (adult dosing) 1
Treatment Duration by Indication
- Pertussis: 7 days 1
- Community-acquired pneumonia (atypical pathogens): Standard respiratory infection duration, typically 7-10 days 1, 2
- Mycobacterial infections: Extended duration as part of multidrug regimen 1
Critical Safety Considerations
Absolute contraindication: History of hypersensitivity to any macrolide antibiotic 1
Common adverse effects (2-6% of patients) include 1:
- Epigastric distress
- Abdominal cramps
- Nausea, vomiting, and diarrhea
Rare but serious reactions requiring vigilance 1:
- QTc prolongation
- Hepatotoxicity
- Stevens-Johnson syndrome
- Anaphylaxis
Required Monitoring
For patients on clarithromycin therapy, the British Thoracic Society recommends 1:
- Baseline ECG before starting therapy
- Repeat ECG at 2 weeks and after adding any QT-prolonging medication
- Baseline audiometry with repeat assessment if symptoms develop
- Intermittent laboratory monitoring throughout treatment
Dosage Adjustments
- Severe renal impairment: Dosage adjustment required, though specific pediatric guidelines are limited 1
- Isolated hepatic impairment with normal renal function: No adjustment needed 1
Clinical Context
Research demonstrates that clarithromycin maintains a safe and well-tolerated profile even when administered at higher-than-recommended doses in children, with no statistically significant differences in tolerability or adverse events between standard and higher dosing groups 3. The drug achieves higher tissue concentrations in respiratory tract tissues and fluids compared to plasma, making it particularly effective for respiratory infections 4, 5.