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Biaxin, or Clarithromycin, is an antibiotic useful for treating a variety of bacterial infections, including bronchitis and pneumonia. Especially useful in treating infections in the middle ear, sinus, skin, and throat, its specific dosing options in the calculator make pediatric care streamlined and effective.
Biaxin has a distinct role in pediatric infections involving the respiratory tract, including community-acquired pneumonia, sinusitis, and pharyngitis, especially when *Mycoplasma* or *Legionella* is suspected. It is also used for atypical mycobacterial infections, especially in immunocompromised pediatric patients (like those with HIV). The drug's twice-daily dosing and pleasant taste make it suitable for outpatient use, and its availability in suspension form supports pediatric administration. Compared to erythromycin, clarithromycin causes fewer gastrointestinal side effects and is generally better tolerated. It is metabolized in the liver and has a moderate risk for drug interactions, so it should be used with care in children on multiple medications.
Biaxin (Clarithromycin) is a trusted antibiotic that helps children fight bacterial infections. Understanding when and how it's used ensures your child receives the right treatment at the right time for their infection.
Biaxin (Clarithromycin) is widely used in pediatric practice for respiratory infections, H. pylori, mycobacterial infections. It is FDA-approved for use in infants 6 months and older with typical dosing of 15 mg/kg/day divided twice daily. Clinical evidence supports its safety and efficacy when used as directed.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Community-Acquired Pneumonia (Atypical Pathogens) | School-aged children and adolescents | No | Clarithromycin is used to treat pneumonia caused by atypical organisms like *Mycoplasma pneumoniae* and *Chlamydophila pneumoniae*. Often used when beta-lactams are ineffective or atypical pathogens are suspected based on symptoms and age. |
| Streptococcal Pharyngitis (Strep Throat) | Children >3 years with penicillin allergy | No | Alternative to penicillin or amoxicillin for children with true IgE-mediated penicillin allergies. Effective against group A Streptococcus when appropriate culture or antigen testing confirms the diagnosis. |
| Acute Bacterial Sinusitis | Toddlers and older children | No | Clarithromycin may be used in children with sinus infections who are allergic to first-line beta-lactam antibiotics, particularly when pathogens like *H. influenzae* or *M. catarrhalis* are suspected. |
| Skin and Soft Tissue Infections | All pediatric ages | No | Useful in treating skin infections caused by susceptible organisms such as *Staphylococcus aureus* or *Streptococcus pyogenes*, especially in cases requiring oral outpatient therapy and where beta-lactams are not appropriate. |
| Disseminated Atypical Mycobacterial Infection (MAC prophylaxis/treatment) | Children with advanced HIV (usually >6 months) | Yes | Clarithromycin is part of standard combination therapy for treating or preventing *Mycobacterium avium complex* (MAC) infections in immunocompromised children, especially those with AIDS. |
| Helicobacter pylori Infection (as part of combination therapy) | School-aged children and adolescents | Yes | Used as part of a multidrug regimen (usually triple therapy) for treating *H. pylori*-associated gastritis or peptic ulcer disease in children. Clarithromycin helps eradicate the organism and reduce recurrence. |
FDA-approved primary uses with Level A evidence
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Quick selection guides and diagnostic pearls
When to consider other medications
How to explain treatment to families
Biaxin (clarithromycin) is generally well-tolerated in pediatric patients aged 6 months and older, with gastrointestinal effects being most common. Taste disturbance (dysgeusia) affects up to 16% of patients, making it one of the most frequent side effects. QT prolongation is a serious concern requiring cardiac monitoring in high-risk patients. While hepatotoxicity is rare, it can be severe when it occurs, particularly with higher doses. Safety and efficacy are not established in children under 6 months for bacterial infections.
Biaxin adverse effects in pediatric patients include gastrointestinal symptoms (3-6% incidence), taste disturbance (up to 16%), and rare but serious QT prolongation and hepatotoxicity. The medication has extensive drug interactions due to CYP3A4 inhibition. Most side effects are mild and reversible, but cardiac and hepatic complications require immediate attention.
Diarrhea
3% in clinical trials • Mild to Moderate (Grade 1-2)
Nausea and Vomiting
Nausea: 3%; Vomiting: 6% in pediatric trials • Mild (Grade 1)
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Taste Disturbance (Dysgeusia)
Up to 16% of patients; most common side effect • Mild to Moderate (Grade 1-2)
Headache
Common in immunocompromised patients on higher doses • Mild (Grade 1)
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QT Prolongation
Infrequent but documented; higher risk with predisposing factors • Moderate to Severe (Grade 2-3)
Torsade de Pointes
Rare; life-threatening arrhythmia associated with QT prolongation • Life-threatening (Grade 4)
Cholestatic Hepatitis
Rare; more common with higher doses (1-2 g/day) • Moderate to Severe (Grade 2-3)
Acute Liver Failure
Very rare; fatal cases reported, particularly in elderly with comorbidities • Life-threatening (Grade 4)
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Biaxin provides excellent coverage against both typical and atypical respiratory pathogens with the convenience of twice-daily dosing. Its effectiveness against Mycoplasma and Chlamydia makes it valuable for treating pneumonia that doesn't respond to first-line antibiotics.
Emergency contact: If you have any concerns about dosing or your child's response to the medication, contact your pediatrician immediately.
Biaxin's effectiveness against atypical respiratory pathogens makes it valuable for specific indications, though careful attention to drug interactions and taste management are essential for successful treatment. Its room temperature storage and twice-daily dosing provide practical advantages.
Different formulations and concentrations
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Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Biaxin contraindications include absolute restrictions (macrolide allergies, certain cardiac arrhythmias, specific drug combinations) and relative cautions (liver disease, myasthenia gravis, QT prolongation risk). Its extensive drug interaction profile requires comprehensive medication review before use.
Understanding when Biaxin should not be used is crucial for your child's safety. Most importantly, avoid this medication if your child has had allergic reactions to macrolide antibiotics, has heart rhythm problems, or is taking medications that interact with Biaxin.
Biaxin works by blocking bacteria's ability to make essential proteins, effectively starving them. Its exceptional tissue penetration and ability to concentrate inside cells make it particularly effective against intracellular organisms that cause atypical pneumonia.
Biaxin's mechanism involves protein synthesis inhibition through 50S ribosomal subunit binding, enhanced by superior tissue penetration and intracellular accumulation. Its CYP3A4 interaction profile creates significant drug interactions while its extended tissue residence enables effective treatment of atypical respiratory pathogens.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
These clinical pearls come from years of experience using Biaxin in pediatric practice. They emphasize the critical importance of drug interaction screening, understanding its unique role for atypical organisms, managing taste challenges, and recognizing when this specialized antibiotic provides advantages over alternatives.
Clinical pearls for Biaxin highlight the critical drug interaction screening requirements, unique effectiveness for intracellular organisms, longer course needs for atypical pathogens, taste management strategies, appropriate second-line positioning, and the importance of comprehensive medication review.
Core insights every provider should know
Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Biaxin and monitor your child's response to treatment.
Clarithromycin (Biaxin) treats bacterial infections like pneumonia (especially caused by atypical organisms), sinus infections, strep throat (in children allergic to penicillin), and certain skin infections. It is also used for treating or preventing mycobacterial infections in immunocompromised children, and as part of combination therapy for *H. pylori* in gastrointestinal infections. It is not effective for viral illnesses like colds or the flu.
Children typically begin improving within 2 to 3 days of starting clarithromycin. For conditions like strep throat or pneumonia, you may notice a drop in fever and improved energy. However, full symptom resolution may take longer, depending on the infection. If there’s no improvement in 72 hours or if symptoms worsen, follow up with your healthcare provider.
If a dose is missed, give it as soon as remembered unless it’s close to the next dose – in that case, skip the missed one and continue with the regular schedule. Do not double the dose. If your child spits out the medicine right away, and it’s within 15 minutes, you may repeat the dose. If unsure, check with your doctor or pharmacist. Try offering the medicine with food or after something sweet to help with taste issues.
The most common side effects include nausea, mild stomach discomfort, diarrhea, or changes in taste. These are typically mild and improve with food intake or once the course is completed. Rash can occur and should be reported to your doctor, especially if it’s itchy or associated with other symptoms. Serious side effects like yellowing of the eyes or trouble breathing are rare but require immediate medical attention.
Clarithromycin interacts with several medications due to its effect on liver enzymes (CYP3A4 pathway). Always tell your doctor about any medicines your child is taking, including supplements or over-the-counter drugs. In particular, avoid combining clarithromycin with drugs known to prolong the QT interval or those heavily metabolized by CYP3A4 unless under close supervision.
Yes. It’s essential to complete the full prescribed course to fully treat the infection and prevent bacterial resistance. Stopping early may cause the infection to return or allow bacteria to develop resistance. Only stop early if advised by your healthcare provider.