Macrolides

Mild to moderate respiratory tract, skin, and soft tissue infections: 500 mg orally in a single loading dose on day 1 followed by 250 mg/day as a single dose on days 2-5. Alternative regimen: Bacterial exacerbation of COPD: 500 mg/day for a total of 3 days

Bacterial sinusitis: 500 mg orally once daily x 3 days.
Extended release suspension (Zmax): 2 grams x 1.

Community-acquired pneumonia:
Oral (Zmax™): 2 g as a single dose.
I.V.: 500 mg IV qd at least 2 days, then 500 mg orally ( to complete a 7 to 10 day course of therapy).

Urethritis/cervicitis:
Due to C. trachomatis: 1 gram orally x 1.
Due to N. gonorrhoeae: 2 grams orally x 1.

Chancroid due to H. ducreyi: 1 gram orally x 1.

Pelvic inflammatory disease (PID): 500 mg IV qd x 1-2 days, then 250 mg orally once daily to complete a 7 day course of therapy.

Disseminated MAC disease in patient with advanced HIV infection: Prophylaxis: 1200 mg orally once weekly (may be combined with rifabutin). Treatment: 600 mg orally once daily in combination with ethambutol 15 mg/kg.

Endocarditis, prophylaxis (unlabeled use): Oral: 500 mg 1 hour prior to the procedure

Pertussis (CDC guidelines): Oral: 500 mg on day 1 followed by 250 mg/day on days 2-5 (maximum: 500 mg/day)

Renal Dosing: No adjustments required in renal failure. Hemodialysis: No adjustments required in renal failure.

Supplied:
Tablet: 250 mg, 500 mg, 600 mg.
Zithromax® TRI-PAK - 500 mg (Unit dose package: 3 tabs)
Zithromax® Z-PAK - 250 mg (Unit dose package: 6 tabs)
Oral Suspension: 100 mg/5 ml (15 ml); 200 mg/5 ml (15 ml, 22.5 ml, 30 ml) ; 1 gram - single dose packet. Zmax: 2 gram single-dose bottle (extended release formulation).
Injection (powder for reconstitution): 500mg vial.

Acute maxillary sinusitis: Oral: 500 mg every 12 hours or 1000 mg (two 500 mg extended release tablets) once daily for 14 days.

Endocarditis, prophylaxis: Oral: 500 mg 1 hour prior to procedure

Mycobacterial infection (prevention and treatment): Oral: 500 mg twice daily (use with other antimycobacterial drugs, eg, ethambutol or rifampin)

Peptic ulcer disease: Eradication of Helicobacter pylori: Oral: Dual or triple combination regimen with bismuth subsalicylate, tetracycline, clarithromycin, and an H2-receptor; or combination of omeprazole and clarithromycin; 500 mg every 8-12 hours for 10-14 days.

Pertussis (CDC guidelines): Oral: 500 mg twice daily for 7 days

Pharyngitis, tonsillitis: Oral: 250 mg every 12 hours for 10 days.

Pneumonia:
Oral:
C. pneumoniae, M. pneumoniae, and S. pneumoniae: 250 mg every 12 hours for 7-14 days or 1000 mg (two 500 mg extended release tablets) once daily for 7 days.
H. influenzae: 250 mg every 12 hours for 7 days or 1000 mg (two 500 mg extended release tablets) once daily for 7 days.

Skin and skin structure infection, uncomplicated: Oral: 250 mg every 12 hours for 7-14 days.

Renal Dosing:
[CRCL >30 ]: No changes.
[<30 ]: Half the normal dose or double the dosing interval.
Hemodialysis: 250 mg q12-24 hours. Schedule dose after HD on dialysis days.

Supplied:
Granules for oral suspension:
Biaxin®: 125 mg/5 mL, 250 mg/5 mL

Tablet: 250 mg, 500 mg
Biaxin®: 250 mg, 500 mg

Tablet, extended release:
Biaxin® XL: 500 mg

ADMINISTRATION — Clarithromycin may be given with or without meals. Give every 12 hours rather than twice daily to avoid peak and trough variation.

Biaxin® XL: Should be given with food. Do not crush or chew extended release tablet.

Children and Adults:
Ophthalmic: Instill 1 /2" (1.25 cm) 2-6 times/day depending on the severity of the infection
Topical: Apply over the affected area twice daily after the skin has been thoroughly washed and patted dry

Adults:
Treatment of susceptible infections:
Oral:
Base: 250-500 mg every 6-12 hours
Ethylsuccinate: 400-800 mg every 6-12 hours

 I.V. (lactobionate): 15-20 mg/kg/day divided every 6 hours or 500 mg to 1 g every 6 hours, or given as a continuous infusion over 24 hours (maximum: 4 g/24 hours)

Preop bowel preparation: Oral: 1 g erythromycin base at 1, 2, and 11 PM on the day before surgery combined with mechanical cleansing of the large intestine and oral neomycin

Gastrointestinal prokinetic (unlabeled use): Erythromycin has been used as a prokinetic agent to improve gastric emptying time and intestinal motility. In adults, 200 mg was infused I.V. initially followed by 250 mg orally 3 times/day 30 minutes before meals. Lower dosages have been used in some trials.

Renal Dosing:
[>10 ml/min]: No change.
[<10 ] 50-75% of usual dose at same interval. Max 2 grams/day. [Hemo]: 50-75% of usual dose at same interval. Max 2 grams/day. No supplement.

Supplied
Capsule, delayed release, enteric-coated pellets, as base (Eryc®): 250 mg
Granules for oral suspension, as ethylsuccinate (E.E.S.®): 200 mg/5 mL (100 mL, 200 mL)
Injection, powder for reconstitution, as lactobionate (Erythrocin®): 500 mg, 1 g
Tablet, chewable, as ethylsuccinate (EryPed®): 200 mg [fruit flavor] [DSC]
Tablet, delayed release, enteric coated, as base (Ery-Tab®): 250 mg, 333 mg, 500 mg
Tablet [film coated], as base: 250 mg, 500 mg
Tablet [film coated], as ethylsuccinate (E.E.S.®): 400 mg
Tablet [film coated], as stearate: 250 mg
Erythrocin®: 250 mg, 500 mg
Tablet [polymer-coated particles], as base (PCE®): 333 mg, 500 mg

To reduce the development of drug-resistant bacteria and maintain the effectiveness of KETEK and other antibacterial drugs, KETEK should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

3. MDRSP, Multi-drug resistant Streptococcus pneumoniae includes isolates known as PRSP (penicillin-resistant Streptococcus pneumoniae), and are isolates resistant to two or more of the following antibiotics: penicillin, 2nd generation cephalosporins, e.g., cefuroxime, macrolides, tetracyclines and trimethoprim/sulfamethoxazole.

CONTRAINDICATIONS
KETEK is contraindicated in patients with myasthenia gravis. Exacerbations of myasthenia gravis have been reported in patients and sometimes occurred within a few hours of the first dose of telithromycin. Reports have included fatal and life-threatening acute respiratory failure with a rapid onset and progression.

KETEK is contraindicated in patients with previous history of hepatitis and/or jaundice associated with the use of KETEK tablets, or any macrolide antibiotic.

KETEK is contraindicated in patients with a history of hypersensitivity to telithromycin and/or any components of KETEK tablets, or any macrolide antibiotic.

Concomitant administration of KETEK with cisapride or pimozide is contraindicated.

Concomitant administration of KETEK and colchicine is contraindicated in patients with renal or hepatic impairment.

DOSAGE AND ADMINISTRATION
Dosing (Adults): 
The dose of KETEK tablets is 800 mg (2 tablets of 400 mg) taken orally once every 24 hours, for 7–10 days. KETEK tablets can be administered with or without food.

KETEK may be administered without dosage adjustment in the presence of hepatic impairment.

Renal Dosing: 
In the presence of severe renal impairment (CLCR < 30 mL/min), including patients who need dialysis, the dose should be reduced to KETEK 600 mg once daily. In patients undergoing hemodialysis, KETEK should be given after the dialysis session on dialysis days.

In the presence of severe renal impairment (CLCR < 30 mL/min), with coexisting hepatic impairment, the dose should be reduced to KETEK 400 mg once daily.
 
Hemodialysis: Administer dose following dialysis.

Supplied:  300 mg, 400mg tab.