Biaxin: Effective Macrolide Antibiotic for Bacterial Infections
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Biaxin (clarithromycin) is a semi-synthetic macrolide antibiotic indicated for the treatment of a wide spectrum of bacterial infections. It functions by inhibiting protein synthesis in susceptible bacteria, thereby arresting their growth and proliferation. This medication is commonly prescribed for respiratory tract infections, skin and soft tissue infections, and Helicobacter pylori eradication regimens. Its extended spectrum of activity and favorable pharmacokinetic profile make it a cornerstone in outpatient and certain inpatient antimicrobial therapies.
Features
- Active ingredient: Clarithromycin
- Available formulations: Immediate-release tablets (250 mg, 500 mg), extended-release tablets (500 mg), and oral suspension (125 mg/5 mL, 250 mg/5 mL)
- Pharmacologic class: Macrolide antibiotic
- Mechanism of action: Binds to the 50S ribosomal subunit, inhibiting bacterial protein synthesis
- Spectrum: Effective against many Gram-positive, some Gram-negative, and atypical pathogens
- Administration: Oral route, with or without food (though food may improve tolerability)
Benefits
- High clinical efficacy in treating community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, and acute maxillary sinusitis
- Demonstrated success in Helicobacter pylori eradication when used as part of combination therapy, reducing ulcer recurrence
- Convenient twice-daily dosing for most indications, supporting adherence
- Available in multiple formulations to accommodate pediatric and adult dosing needs
- Generally well-tolerated with a established safety profile in appropriate patient populations
- Lower incidence of gastrointestinal side effects compared to earlier macrolides like erythromycin
Common use
Biaxin is indicated for the treatment of mild to moderate infections caused by susceptible strains of designated microorganisms. Common uses include:
- Upper respiratory tract infections: Pharyngitis/tonsillitis (Streptococcus pyogenes)
- Lower respiratory tract infections: Acute bacterial exacerbation of chronic bronchitis (Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae), community-acquired pneumonia (Mycoplasma pneumoniae, Streptococcus pneumoniae, Chlamydophila pneumoniae)
- Acute maxillary sinusitis (Streptococcus pneumoniae, Haemophilus influenzae)
- Uncomplicated skin and skin structure infections (Staphylococcus aureus, Streptococcus pyogenes)
- Helicobacter pylori eradication: Used in combination with other antimicrobials and acid suppressants for duodenal ulcer disease
- Disseminated mycobacterial infections due to Mycobacterium avium complex (MAC)
Dosage and direction
Dosage varies based on indication, renal function, and formulation. Always follow prescribing physician instructions.
Adults (immediate-release tablets):
- Most infections: 250–500 mg every 12 hours for 7–14 days
- Helicobacter pylori eradication: 500 mg twice daily in combination with other medications for 10–14 days
- MAC prophylaxis/treatment: 500 mg twice daily
Adults (extended-release tablets):
- Acute bacterial exacerbation of chronic bronchitis: 1000 mg once daily for 7 days
- Community-acquired pneumonia: 1000 mg once daily for 7 days
Pediatric patients (oral suspension):
- Dosing based on body weight (7.5 mg/kg twice daily, maximum 500 mg per dose)
- Duration typically 5–10 days depending on indication
Take with food to minimize gastrointestinal upset. Complete the full course of therapy even if symptoms improve earlier.
Precautions
- Use with caution in patients with renal impairment (dose adjustment required for CrCl <30 mL/min)
- Hepatic impairment: Monitor liver function; consider alternative in severe hepatic dysfunction
- May prolong cardiac QT interval; avoid in patients with known QT prolongation, hypokalemia, or concurrent use of other QT-prolonging drugs
- Caution in patients with myasthenia gravis (may exacerbate muscle weakness)
- Superinfections: Prolonged use may result in fungal or bacterial superinfection, including Clostridium difficile-associated diarrhea
- Not recommended during pregnancy unless clearly needed (Pregnancy Category C)
- Breastfeeding: Clarithromycin excreted in human milk; consider alternative or discontinue nursing
Contraindications
- Known hypersensitivity to clarithromycin, other macrolides, or any component of the formulation
- Concurrent use with cisapride, pimozide, ergot alkaloids, or HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (e.g., lovastatin, simvastatin)
- History of cholestatic jaundice/hepatic dysfunction with prior clarithromycin use
- Patients with known QT prolongation or ventricular arrhythmias including torsades de pointes
Possible side effect
Most common adverse reactions (≥3%) include:
- Diarrhea (6%), nausea (6%), abnormal taste (6%), dyspepsia (5%), abdominal pain (5%)
- Headache (6%) Less common but serious side effects:
- Clostridium difficile-associated diarrhea
- QT prolongation and ventricular arrhythmias
- Hepatotoxicity (elevated liver enzymes, hepatitis, jaundice)
- Hearing loss (usually reversible)
- Stevens-Johnson syndrome, toxic epidermal necrolysis (rare)
Drug interaction
Biaxin is a potent inhibitor of CYP3A4 and CYP1A2 isoenzymes, resulting in numerous interactions:
- Contraindicated: Cisapride, pimozide, ergot derivatives, simvastatin, lovastatin
- Use with caution: Warfarin (increased INR monitoring required), colchicine (contraindicated in renal/hepatic impairment), digoxin (increased concentrations), theophylline (monitor levels), carbamazepine (increased levels)
- Antiretroviral drugs: Significant interactions with ritonavir, atazanavir, and other HIV protease inhibitors
- Oral hypoglycemics: May enhance effects; monitor glucose
- Sildenafil: Increased concentrations; reduce sildenafil dose
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to catch up. Maintain regular dosing schedule to ensure consistent antibiotic levels.
Overdose
Symptoms may include severe nausea, vomiting, diarrhea, and abdominal pain. Hepatic dysfunction and hearing loss have been reported. QT prolongation may occur. Treatment is supportive; gastric lavage may be considered if recent ingestion. Not removed by hemodialysis. Contact poison control or emergency department immediately.
Storage
Store at 20–25°C (68–77°F). Keep container tightly closed. Protect from light and moisture. Oral suspension: Store reconstituted suspension at room temperature; discard after 14 days. Do not freeze.
Disclaimer
This information is for educational purposes and does not replace professional medical advice. Always consult a healthcare provider for diagnosis and treatment decisions. Do not initiate, adjust, or discontinue medication without physician guidance.
Reviews
“Biaxin has been a reliable choice for respiratory infections in my practice. The twice-daily dosing supports adherence, and I find the extended-release formulation particularly useful for working adults.” – Infectious Disease Specialist, 12 years experience
“Our pediatric patients generally tolerate the oral suspension well. The banana flavor helps with compliance, and we’ve observed excellent clinical outcomes in streptococcal pharyngitis and community-acquired pneumonia.” – Pediatric Pulmonologist, 8 years experience
“While effective, I monitor elderly patients closely for QT prolongation, especially those on multiple medications. The drug interaction profile requires careful attention but remains manageable with appropriate screening.” – Geriatric Pharmacist, 15 years experience