Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Bites - human and animal - Management
Erythromycin or clarithromycin

  • Common adverse effects include gastrointestinal disturbances (e.g. nausea, vomiting, diarrhoea), especially at higher doses. Gastrointestinal adverse effects are less common with clarithromycin than with erythromycin [BNF 55, 2008].
  • Erythromycin and clarithromycin can increase the plasma levels of certain other drugs (e.g. theophylline, carbamazepine) and can potentiate the effects of warfarin. A dose reduction may be required in these circumstances.
    • Advise the person to seek medical advice if symptoms of toxicity to these drugs occur during treatment with erythromycin or clarithromycin.
    • If a person is taking additional medication that may interact with erythromycin or clarithromycin, an alternative macrolide (azithromycin) may be considered [BNF 53, 2007].
  • If erythromycin or clarithromycin is taken with a statin, there is an increased risk of myopathy. Advise the person to stop the statin whilst the macrolide is being taken.
  • Erythromycin and clarithromycin may cause the combined oral contraceptive pill or patch to fail during the first few weeks of treatment [Baxter, 2006]. Advise women to use additional contraception during the course of treatment and for 7 days afterwards. If this 7-day period runs beyond the end of the pack of contraceptive pills, advise the woman to start a new pack without a break (omitting any inactive tablets) [FFPRHC, 2005; FFPRHC, 2007].

© NHS Institute for Innovation and Improvement