Clarithromycin

Clarithromycin is an oral macrolide antibiotic. NICE NG153 (Impetigo) and NICE NG190 (Infected Eczema) both name it as the alternative to Flucloxacillin when a child is penicillin-allergic or flucloxacillin is “unsuitable”. NG153 gives an example of unsuitability that fits toddlers well: the oral solution is unpalatable and the child cannot swallow capsules. Children aged 1 month to 11 years are dosed twice daily by weight: 8–11 kg 62.5 mg, 12–19 kg 125 mg, 20–29 kg 187.5 mg. The course is 5 days for impetigo and 5–7 days for infected eczema. In pregnancy Erythromycin is the preferred macrolide (NICE NG153/NG190).

Clarithromycin [treats] Infected Eczema Clarithromycin [treats] Impetigo NICE NG190 [regulates] Clarithromycin Clarithromycin [relates] Flucloxacillin

Giving it to a toddler. Medicines for Children says it is given twice a day, 10–12 hours apart. That is easier to fit around nursery than flucloxacillin’s four before-food doses. It comes as liquid (125 mg or 250 mg in 5 mL), and the granules can be stirred into a little yogurt and swallowed straight away. If the child vomits within 30 minutes, give the same dose again. Common side effects are an odd taste or smell, a discoloured tongue or teeth, diarrhoea, stomach ache and vomiting. Swelling of the face or lips, wheeze or rash means possible allergy and needs emergency care. A fast or skipping heartbeat or chest pain means calling the doctor. It interacts with several medicines, so the pharmacist should know everything else the child takes.

Clarithromycin [relates] Parent Experiences

Evidence and resistance. The evidence that any oral antibiotic improves infected eczema in children is weak: the Cochrane review (George et al., 2019) found no clear benefit over placebo (low-quality evidence). DermNet notes that macrolide resistance is “also high” among Staphylococcus aureus. A macrolide is therefore a second choice, not a like-for-like substitute. NICE says to review the antibiotic against swab results if the infection is not improving. How often toddler penicillin-allergy labels are accurate was not covered by these sources and is logged as an open question.

Antimicrobial Resistance [worsens] Clarithromycin Cochrane [contradicts] Clarithromycin

Connections

• Flucloxacillin — penicillin-allergy alternative, source: NICE NG153/NG190
• Impetigo — alternative oral antibiotic, source: NICE NG153
• Infected Eczema — alternative oral antibiotic, 5–7 days, source: NICE NG190
• Erythromycin — macrolide preferred in pregnancy, source: NICE NG153
• Staphylococcus aureus — macrolide resistance common, source: DermNet 2015
• Antimicrobial Resistance — reason it is second-line, source: DermNet; NICE
• Cochrane — oral antibiotics: no clear benefit in children, source: George 2019
• NICE NG190 — names it for penicillin allergy, source: NICE 2021