克拉黴素
Clarithromycin
6-O-Methylerythromycin
別名: Biaxin XL · Klacid · Klaricid · Maclar · Prevpak (combination) · 6O-Methylerythromycin · TE-031 · A-56268
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of severe or refractory cases of canine leproid granuloma syndrome | 15-25 mg/kg total daily dose PO given divided q8-12h | PO | q8-12h | 4-8 weeks until lesions are substantially reduced or resolved | 🌎 NA |
| Susceptible infections | 2.5-10 mg/kg PO twice daily | PO | q12h | — | 🌎 NA |
| Susceptible infections | 5-10 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
- Treatment of severe or refractory cases of canine leproid granuloma syndrome: Used in combination with rifampin 10-15 mg/kg PO once daily.
貓
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of feline leprosy | 62.5 mg per cat q12h | PO | q12h | — | 🌎 NA |
| Treatment of Nocardia (N. nova) infections | 62.5-125 mg (total dose per cat) PO twice daily | PO | q12h | — | 🌎 NA |
| Treatment of H. pylori infections | 7.5 mg/kg PO twice daily | PO | q12h | 14 days | 🌎 NA |
| Treatment of M. tuberculosis-bovis variant infections | 5-10 mg/kg PO q12h | PO | q12h | At least 2 months, then maintenance for 4 months | 🌎 NA |
| Susceptible infections | 7.5 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
- Treatment of feline leprosy: Used in a regimen of 2 or 3 drugs including clofazimine and/or rifampin.
- Treatment of Nocardia (N. nova) infections: Combination therapy with amoxicillin and/or doxycycline.
- Treatment of H. pylori infections: Combination therapy with metronidazole and amoxicillin.
- Treatment of M. tuberculosis-bovis variant infections: Used with rifampin and enrofloxacin.
雪貂
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of Helicobacter mustelae infections | 12.5 mg/kg PO q12h | PO | q12h | 14 days | 🌎 NA |
| Treatment of Helicobacter mustelae infections | 12.5-50 mg/kg q8-24h | PO | q8-24h | — | 🌎 NA |
- Treatment of Helicobacter mustelae infections: With ranitidine bismuth citrate. Same regimen given q8h is also published.
- Treatment of Helicobacter mustelae infections: With omeprazole at 0.7 mg/kg PO once daily.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Treatment of Rhodococcus equi infection in foals | 7.5 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
| Treatment of Rhodococcus equi infection in foals | 7.5 mg/kg PO q12h | PO | q12h | — | 🌎 NA |
- Treatment of Rhodococcus equi infection in foals: In combination with rifampin at 5 mg/kg PO q12h or 10 mg/kg PO q24h.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
克拉黴素（Clarithromycin）是一種半合成的巨環類抗生素，與紅黴素（Erythromycin）結構相似。它透過內酯環第6位的甲基化進行結構修飾，這使其比母體化合物具有更好的胃酸穩定性、更高的口服生物利用度以及更廣的抗菌譜。
主要臨床特徵：
- 抗菌譜： 與紅黴素相似，但對非典型分枝桿菌（例如禽分枝桿菌複合群）、幽門螺旋桿菌及馬紅球菌具有極佳的療效。
- 臨床應用： 在小動物醫學中，主要用於治療非典型分枝桿菌感染（如貓痲瘋或犬痲瘋樣肉芽腫）以及幽門螺旋桿菌的根除療程。在馬科醫學中，它是治療幼駒馬紅球菌肺炎的核心藥物。
- 耐受性： 通常比紅黴素具有更好的耐受性，胃腸道副作用較少（因為其促進胃腸蠕動的胃動素受體激動作用較弱）。
臨床要點： 克拉黴素是細胞色素 P450 3A (CYP3A) 酵素系統的強效抑制劑。若與其他經此途徑代謝的藥物併用，必須謹慎評估以避免毒性反應。
作用機轉
Clarithromycin is typically bacteriostatic, though it can be bactericidal at high concentrations against highly susceptible organisms.
- Mechanism: It penetrates the bacterial cell wall and reversibly binds to the P site of the 50S ribosomal subunit.
- Pathway: Binding → Inhibition of RNA-dependent protein synthesis (blocks transpeptidation and translocation) → Suppression of bacterial growth.
- Post-Antibiotic Effect (PAE): Macrolides generally exhibit a prolonged PAE against Gram-positive pathogens, allowing for sustained efficacy even when plasma levels drop below the MIC.
安全性與警告
禁忌症
- Known hypersensitivity to clarithromycin or other macrolide antibiotics (e.g., erythromycin, azithromycin)
- Concurrent use with cisapride (due to risk of fatal cardiac arrhythmias)
不良反應
- Gastrointestinal disturbances (nausea, vomiting, anorexia, diarrhea)
- Pinnal or generalized erythema (specifically noted in cats)
- Transient, mild BUN elevation
- Prolonged QT interval / torsades de pointes (rare)
- Hepatotoxicity (rare)
- Thrombocytopenia (rare)
- Pseudomembranous colitis secondary to Clostridium difficile (reported in humans)
注意事項
Pregnancy & Lactation: FDA Category C. High doses in animal studies showed some teratogenic effects (cleft palate, fetal growth retardation). Use only if benefits outweigh risks. Excreted into milk, though unlikely to be clinically significant. Hepatic/Renal Impairment: Use with caution; dose adjustments may be necessary in severe renal or hepatic dysfunction. Drug Interactions: Potent CYP3A inhibitor. Always review concurrent medications before prescribing.
藥物交互作用
Clarithromycin inhibits cisapride metabolism; concurrent use is contraindicated due to risk of severe cardiac arrhythmias.
May increase clarithromycin serum levels.
Clarithromycin may increase serum levels of digoxin.
Concurrent use can increase the plasma levels of both drugs.
May potentiate the effects of oral anticoagulant drugs.
Clarithromycin may decrease serum concentrations of zidovudine.
Clarithromycin inhibits CYP3A, potentially increasing plasma concentrations and toxicity of these drugs. Therapeutic monitoring or dose reduction may be required.
Increased levels and risk of prolonged QT interval.
Increased levels and risk of prolonged QT interval.
監測
- Clinical efficacy (resolution of infection)
- Gastrointestinal adverse effects
- Signs of erythema (especially in cats)
- Potential drug interactions if on concurrent medications
藥物動力學
半衰期
吸收
In dogs, bioavailability ranges from 60-83%, with higher values obtained in fasted animals. In foals, it is well absorbed after intragastric administration with peak serum concentrations at ~1.5 hours.
分佈
Widely distributed into tissues; penetrates susceptible bacterial cell walls effectively. Achieves high intracellular concentrations.
代謝
Undergoes hepatic metabolism. It is a known inhibitor of the CYP3A subfamily of the cytochrome P450 enzyme system.
排除
Excreted via urine and feces. Excreted into the milk of lactating animals.
過量
Overdoses of clarithromycin are generally not life-threatening and primarily result in gastrointestinal distress (vomiting, diarrhea, cramping).
- Treatment: For recent, large ingestions, administration of activated charcoal with a cathartic may help remove unabsorbed drug.
- Note: Forced diuresis, peritoneal dialysis, or hemodialysis are not effective in enhancing the elimination of clarithromycin from the body.
可用產品
劑型
- Oral tablets (regular and film-coated)
- Extended-release oral tablets
- Granules for oral suspension
人用標示
- Clarithromycin Regular & Film-coated Oral Tablets: 250 mg & 500 mg
- Clarithromycin Extended-release Tablets: 500 mg
- Clarithromycin Granules for Oral Suspension: 125 mg/5 mL & 250 mg/5 mL (after reconstitution)
- Pre-packaged combination (Prevpak) containing lansoprazole, amoxicillin, and clarithromycin
各地核准狀態
暫無法規資料: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Conventional 250 mg tablets: Protect from light, store in well-closed containers at 15-30°C (59-86°F). Conventional/ER 500 mg tablets: Store at controlled room temperature (20-25°C; 68-77°F). Granules for suspension: Store unmixed granules at 15-30°C. After reconstitution, store at room temperature (DO NOT refrigerate) and discard any unused drug after 14 days.
飼主須知
克拉黴素是一種用於治療特定細菌感染的抗生素。
- 給藥方式： 此藥物可與食物一起或空腹服用。如果您的寵物在空腹服藥後嘔吐，請在未來的劑量中搭配少量零食或正餐給予。
- 口服懸浮液： 如果您使用的是液體劑型，請勿冷藏。請將其保存在室溫下。每次使用前請充分搖勻，並在泡製 14 天後丟棄任何剩餘的藥水。
- 藥物交互作用： 克拉黴素會與許多其他藥物產生交互作用。在未諮詢獸醫師之前，絕對不要給您的寵物服用任何新藥、保健食品或成藥。
- 副作用： 請留意寵物是否有嘔吐、腹瀉或食慾不振的情況。在貓咪身上，您偶爾可能會注意到皮膚或耳朵發紅。如果出現這些情況，請聯繫您的獸醫師。
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