Background: Clarithromycin is a semisynthetic macrolide that exhibits broad
-spectrum activity against gram-positive, gram-negative, and atypical respi
ratory tract and skin/skin structure pathogens, Mycobacterium species, and
Helicobacter pylori. It is indicated for the treatment of a wide variety of
respiratory and dermatologic infections in children and adults as well as
prophylaxis and treatment of Mycobacterium avium complex infection and pept
ic ulcers due to H pylori.
Objective: In this article, we review the results of 3 studies of the stead
y-state pharmacokinetic profiles of clarithromycin and 14(R)-hydroxy-clarit
hromycin after multiple oral once-daily doses of 500-mg extended-release (E
R) clarithromycin tablets. We also review the drug tolerability in 2 phase
III comparative clinical trials of immediate-release (IR) and ER clarithrom
ycin conducted in adults with acute maxillary sinusitis (AMS) and acute exa
cerbation of chronic bronchitis (AECB).
Methods: In the 3 pharmacokinetic studies, multiple-dose regimens of clarit
hromycin IR (one 250-mg or 500-mg tablet twice daily) and clarithromycin ER
(one or two 500-mg tablets once daily), administered to healthy male and f
emale volunteers, were evaluated. The effect of administration in nonfastin
g versus fasting conditions was assessed as well. Tolerability information
was collected from each adult patient enrolled in phase III efficacy studie
s conducted to support the application for US Food and Drug Administration
approval for the treatment of AMS and AECB. Regimens evaluated were 500 mg
IR clarithromycin tablets twice daily or 1000 mg (2 x 500 mg) ER clarithrom
ycin tablets once daily for 7 days (AECB) or 14 days (AMS).
Results: Bioavailability of the ER clarithromyin tablet administered with f
ood was equivalent to that of the reference IR tablet, based on area under
the plasma concentration-time curve (AUC) for both parent compound and acti
ve metabolite. The bioavailability of the ER tablet was 30% lower (based on
clarithromycin AUC) when administered under fasting versus nonfasting cond
itions. Compared with the IR tablet, administration of the ER tablet result
ed in significantly lower (P < 0.05) clarithromycin peak plasma concentrati
on (C-max), delayed time to C-max, and lower degree of concentration fluctu
ation, confirming its in vivo extended-release characteristics. The most fr
equently reported adverse events (AEs) in the phase III clinical trials wer
e diarrhea, abnormal taste, and nausea acid were generally mild or moderate
. The incidence of AEs was comparable for the 2 formulations. The severity
of gastrointestinal AEs was significantly less for the ER formulation than
for the IR formulation (P = 0.018), as was the frequency of premature study
discontinuation due to gastrointestinal AEs or abnormal taste (P = 0.004).
Conclusions: The results from the 3 pharmacokinetic studies reviewed demons
trate the bioequivalence of the ER and IR formulations and support the use
of this clarithromycin ER formulation in a once-daily dosing regimen in pha
se III clinical trials. The ER tablet should be taken with food to maximize
bioavailability, The results of 2 phase III comparative clinical efficacy
and safety trials of clarithromycin ER tablets versus IR tablets in AMS and
AECB confirm the good tolerability of the ER formulation.