clarithromycin

Clarithromycin is part of first-line H. pylori eradication regimens in regions where clarithromycin resistance is below 15%. Maastricht VI/Florence 2022 recommends triple therapy PPI + amoxicillin 1000 mg twice daily + clarithromycin 500 mg twice daily for 14 days. When resistance exceeds 15%, the first-line regimen is switched to bismuth-containing quadruple therapy without clarithromycin. The Russian Ministry of Health clinical recommendation "Gastritis and duodenitis in adults" (ID 708, 2024) lists clarithromycin in first-line regimens where susceptibility is confirmed.

In Russia, H. pylori resistance to clarithromycin varies from 10% to 30% across regions. Susceptibility testing or use of local resistance maps before starting therapy is preferable.

Clarithromycin is included in empirical regimens for community-acquired pneumonia in outpatient adults without comorbidities and risk factors for drug-resistant pneumococci. IDSA/ATS 2019 recommend macrolide monotherapy where regional S. pneumoniae macrolide resistance is below 25%. For inpatients the macrolide is combined with a beta-lactam. The 2018 Cochrane review confirms comparable efficacy of macrolides and beta-lactams in the outpatient group.

In regions with S. pneumoniae macrolide resistance above 25% monotherapy is not used. In Russia, monitoring data from 2022 show that several cities exceed this threshold – clinicians rely on local resistance maps.

For routine prophylaxis of infective endocarditis before dental procedures in low-risk patients, clarithromycin is not prescribed. AHA 2021 restricted prophylaxis indications to patients with prosthetic valves, prior endocarditis, congenital cyanotic heart defects, and cardiac transplant recipients with valvulopathy. Clarithromycin, in cases of beta-lactam allergy, remains a reserve option only in these high-risk groups.

For acute viral bronchitis in immunocompetent adults without comorbid pathology, antibiotics are not prescribed. NICE NG191 2023 and IDSA state that antibacterial therapy does not shorten cough duration or improve outcomes. Prescribing a macrolide for a simple viral upper respiratory infection or bronchitis is an example of irrational antibiotic use and increases the risk of selecting macrolide-resistant pneumococci.