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Clarithromycin is principally excreted via the liver and kidney. Therefore, it should be administered with caution to patients with impaired renal or hepatic function and doses should be reduced in those with severe renal impairment.
Attention should also be paid to the possibility of cross resistance between Clarithromycin and other macrolide drugs, as well as lincomycin and clindamycin.
Resistance: Prescribing Clarithromycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistance.
Erythromycin-resistant isolates of Streptococcus pneumoniae are commonly cross-resistant to Clarithromycin. The incidence of resistance to Clarithromycin and other macrolides is higher among penicillin-resistant strains than among penicillin-sensitive strains.
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