Clarithromycin is an antibiotic used to treat many different types of bacterial infections in children. You might see a brand name such as Biaxin on the label. It comes as liquid, tablets, or extended release tablets.

The extended release tablets should be taken with food, but the other forms are fine to take either way. If you find it upsets the stomach, taking it with food may help. Clarithromycin should be taken at least two hours before any antacids that contain magnesium or aluminum, because these can interfere with the absorption of the antibiotic.

Liquid clarithromycin should be shaken before giving each dose. To get the correct dose, skip the silverware spoon and use a measuring spoon or dose-measuring device (ask your pharmacist for one if you don’t have one). It may be stored at room temperature. Do not keep the liquid in the refrigerator. Discard any unused clarithromycin 14 days after it was first prepared by the pharmacist.

Clarithromycin is a recommended first antibiotic for some children with ear infections who are allergic to amoxicillin. It is usually given twice daily, but the extended release form may be given once daily.

If your child is taking clarithromycin for an ear infection, you should expect improvement within 48 to 72 hours. If not, contact your doctor to discuss switching to another antibiotic, such ceftriaxone or clindamycin.

Do Not use clarithromycin if your child is known to be allergic to this or to any similar antibiotics such as azithromycin or erythromcyin. Other antibiotic options might include ceftriaxone, or clindamycin. Be sure the prescribing doctor knows if your child has any other medication allergies, or has kidney disease, liver disease, or a heart rhythm problem. Be sure to report any other medicines your child might be taking.

Diarrhea is a common side effect of antibiotics. Whenever antibiotics are given, consider also giving your child probiotics (beneficial bacteria). Out of ten well-designed studies, nine showed significantly less diarrhea in the children receiving probiotics (the studies used between 5 and 40 billion cfu per day). Probiotics are available as supplements or in some foods and beverages (yogurt, kefir, juice). Whatever you choose, look for at least 5 billion colonies.

Get emergency care if your child is showing signs of a serious allergic reaction, such as difficulty breathing, spreading hives, or swelling of the lips, tongue, or throat.

Other side effects are possible with this or any medication. Be sure to report unexpected new symptoms to your healthcare provider. Whether they are caused by the antibiotic or by the illness getting worse, unexpected symptoms are important to report.

AAP Clinical Practice Guideline. Diagnosis and management of acute otitis media. Pediatrics, May 2004, 113(5):1451-1465.
Johnston BC, Supina AL, Ospina M, Vohra S. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD004827. DOI: 10.1002/14651858.CD004827.pub2.

Published on: June 18, 2009
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Dr. Greene is a practicing physician, author, national and international TEDx speaker, and global health advocate. He is a graduate of Princeton University and University of California San Francisco.
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