Clarithromycin

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications: 

• Lower respiratory tract infection, such as bronchitis, pneumonia
• Upper respiratory tract infections, such as pharyngitis, tonsillitis due to S. pyogenes and sinusitis
• Skin and soft tissue infections due to S. aureus, such as folliculitis, cellulitis and erysipelas
• Acute otitis media due to S. pneumonia, M. catarrhalis and H. influenzae (mild to moderately severe)
• Eradication of H. pylori (when used in combination with a proton pump inhibitor and another antibiotic to decrease recurrence of duodenal ulcer)
• Disseminated and localised infections in HIV-positive adults, due to Mycobacterium avium or Mycobacterium intracellular (in combination with other antimycobacterials)

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Hypersensitivity to other macrolides
• Severe renal impairment (creatinine clearance <30 m/min/1.73m²) (MR tab)
• Severe hepatic impairment in combination with renal impairment
• History of QT prolongation (congenital or documented acquired QT prolongation) or ventricular cardiac arrhythmia, including torsades de pointes
• Hypokalaemia
• Porphyria
• Coadministration with ergot alkaloids (e.g. ergotamine or dihydroergotamine)
• Coadministration with oral midazolam
• Coadministration with any of the following: astemizole, cisapride, pimozide and terfenadine, ticagrelor, renolazine, HMG-CoA reductase inhibitors (lovastatin or simvastatin), strong CYP3A4 inhibitors, colchicine

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment (eGFR ≤80ml/min/1.73m²)
• Hepatic impairment
• Pre-existing hepatic disease
• Prolonged use
• Myasthenia gravis
• Infection caused by S. aureus and Streptococcus spp.
• Coronary artery disease
• Severe cardiac insufficiency
• Conduction disturbances or clinically relevant bradycardia
• Electrolyte disturbances, such as hypomagnesaemia
• Diabetes mellitus (sus)
• Coadministration with agents associated with QT prolongation
• Coadministration with oral hypoglycaemic agents and/or insulin
• Coadministration with other hepatotoxic agents
• Coadministration with triazolobenzodiazepines
• Coadministration with agents that induce the cytochrome CYP3A4 enzyme
• Coadministration with other statins (not mentioned in Contraindications)
• Coadministration with oral anticoagulants
• Coadministration with other ototoxic agents, especially aminoglycosides
• Fructose intolerance (sus)
• Galactose intolerance (MR tab)
• Lapp lactase deficiency (MR tab)
• Glucose-galactose malabsorption (sus, MR tab)
• Sucrase-isomaltase insufficiency (sus)
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: inj, tab, modified release tab (MR tab), sus

Dosages below include:

• South African registered indications and dosages
• Indications and dosages registered in other jurisdictions

Infection caused by: Some aerobic, gram-positive microorganisms such as Streptococcus group F, Corynebacterium diptheriae; Some aerobic, gram-negative microorganisms such as Bordetella pertusis, Moraxella catarrhalis, Pasteurella multocida, Legionella spp.; Some anaerobic microorganisms such as Clostridium spp., other than C. difficile; Other microorganisms such as Mycoplasma pneumoniae, Chlamydia trachomatis, Clamydophila pneumoniae, Clamydophilapsitacci, Mycobacterium spp.; Arcanobacter sp., B. pertussis, Bartonella sp.

Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

South African registered indications and dosages

Lower respiratory tract infection 
- Bronchitis
- Pneumonia
Upper respiratory tract infections
- Pharyngitis
- Tonsillitis
- Sinusitis
Skin and soft tissue infections due to S.aureus
- Folliculitis
- Cellulitis
- Erysipelas
Acute otitis media due to S. pneumonia, M. catarrhalis and H. influenzae - mild to moderately severe

• Oral (tab): Usual dose: 250mg, 12hrly; Severe infections: 500mg, 12hrly; Treatment duration: 5-10 days, depending on the pathogen involved and the severity of infection
• Oral (MR tab): Usual dose: 500mg, dly taken with food; Severe infections: 1000mg, dly
• IV: 500mg, 12hrly, as an infusion over 60min; Treatment duration: 2-5 days in the very ill, switch to oral clarithromycin whenever possible thereafter

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See additional prescribing points for IV administration directions (dilution procedure)

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Eradication of H. pylori (additional agents required)
- When used in combination with a proton pump inhibitor and another antibiotic to decrease recurrence of duodenal ulcer

• Oral (tab): 500mg, 12hrly; Treatment duration: 7-10 days
• Oral (MR tab): 1000mg, dly with food; Treatment duration: 7-10 days

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The safety and efficacy of clarithromycin in combination with proton pump inhibitors other than omeprazole has not been established 

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Atypical mycobacterial infections (MAC) in HIV patients (additional agents required)
- Disseminated and localised infections, due to Mycobacterium avium or Mycobacterium intracellular , M. chelonae, M. kansasii)

• Oral (tab): 500mg, 12hrly
• IV: 1000mg/day, in 2 divided doses; as an infusion over 60min
• Oral (MR tab): 1000mg, dly with food

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Treatment of disseminated MAC infections in AIDS patients should continue as long as clinical and microbiological benefit is demonstrated.  A decrease in efficacy has been noted in patients on clarithromycin for >12 weeks. Clarithromycin should be used in conjunction with other antimycobacterial agents

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Indications and dosages registered in other jurisdictions

Infections of the upper respiratory tract, such as bacterial pharyngitis/tonsillitis
- As an alternative when beta-lactam antibiotics are not appropriate
Infections of the lower respiratory tract, such as community-acquired pneumonia - mild to moderate
Acute bacterial sinusitis (adequately diagnosed)
Acute exacerbation of chronic bronchitis
Skin infections and soft tissue infections - mild to moderate
- Folliculitis
- Cellulitis
- Erysipelas

• Oral (tab, sus): Standard dose: 250mg, 12hrly; High dose (severe infections): 500mg, 12hrly; Treatment duration: 7-14 days, continue for ≥2 days after symptoms have subsided

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The dosage of clarithromycin depends on the type and severity of the infection and has to be defined in any case by the physician

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 In Streptococcus pyogenes (group A beta-haemolytic streptococcus) infections the duration of therapy should be at least 10 days

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• Oral (MR tab): Usual dose: 500mg, dly taken with food; Severe infections: 1000mg, dly; Treatment duration: 6-14 days

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Do not crush or chew the 500mg MR tabs

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• IV: 500mg, 12hrly, appropriately diluted; Treatment duration: 2-5 days, switch to oral clarithromycin whenever possible thereafter; Total treatment duration: 6-14 days

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The total duration of treatment should not exceed more than 14 days

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See additional prescribing points

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H. pylori eradication in peptic ulcer disease (additional agents required) 
-  In combination with antibacterial therapeutic regimens and an appropriate ulcer healing agent

• Oral (tab, sus): 500mg, 12hrly; Treatment duration: 7 days

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Usually clarithromycin is administered in combination with another antibiotic and a proton-pump inhibitor for one week

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The national recommendations for Helicobacter pylori eradication have to be considered

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The therapy may be repeated if the patient is still H. pylori-positive

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All indications: The duration of therapy with clarithromycin depends on the type and severity of the infection and has to be defined in any case by the physician

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The tablet should be swallowed whole with a sufficient amount of fluid (eg. one glass of water). Clarithromycin may be given irrespective of food intake

Paed. forms avail. in SA and covered in this monograph: sus, tab, inj

Paed. dosages below include:

• General dosing range
• South African Standard Treatment Guidelines indications and dosages
• South African registered indications and dosages
• Indications and dosages registered in other jurisdictions

Infection caused by: Some aerobic, gram-positive microorganisms such as Streptococcus group F, Corynebacterium diptheriae; Some aerobic, gram-negative microorganisms such as Bordetella pertusis, Moraxella catarrhalis, Pasteurella multocida, Legionella spp.; Some anaerobic microorganisms such as Clostridium spp., other than C. difficile; Other microorganisms such as Mycoplasma pneumoniae, Chlamydia trachomatis, Clamydophila pneumoniae, Clamydophilapsitacci, Mycobacterium spp.; Arcanobacter sp., B. pertussis, Bartonella sp.

General dosing range

28 days and younger

• No information available

Older than 28 days

• IV/Oral (tab, sus): 15mg/kg/day, in 2 divided doses, 12hrly; Max: 1000mg/24hrs

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

South African Standard Treatment Guidelines indications and dosages

Mycobacterium avium complex infection (Additional agent required)

• Oral (sus): 7.5mg/kg/dose, 12hrly
  (STG, Paed. 2017)

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South African registered indications and dosages

Lower respiratory tract infection 
- Bronchitis
- Pneumonia
Upper respiratory tract infections
- Pharyngitis
- Tonsillitis
- Sinusitis
Skin and soft tissue infections due to S.aureus
- Folliculitis
- Cellulitis
- Erysipelas
Acute otitis media due to S. pneumonia, M. catarrhalis and H. influenzae - mild to moderately severe

Younger than 6 months

• Not established for use

Older than 6 months

• Oral (sus): 7.5mg/kg, 12hrly; Max: 1000mg/24hrs (as 500mg, 12hrly) for the most severe infections; See table below

Weight*	Age	Dosage
8-11kg	1-2 years	62.5mg, 12hrly; Treatment duration: 5-10 days, depending on pathogen and severity of infection
12-19kg	2-4 years	125mg, 12hrly; Treatment duration: 5-10 days, depending on pathogen and severity of infection
20-29kg	4-8 years	187.5mg, 12hrly; Treatment duration: 5-10 days, depending on pathogen and severity of infection
30-40kg	8-12 years	250mg, 12hrly; Treatment duration: 5-10 days, depending on pathogen and severity of infection

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See additional prescribing points

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Indications and dosages registered in other jurisdictions

Infections of the upper respiratory tract, such as bacterial pharyngitis/tonsillitis
- As an alternative when beta-lactam antibiotics are not appropriate
Infections of the lower respiratory tract, such as community-acquired pneumonia - mild to moderate
Acute bacterial sinusitis (adequately diagnosed)
Acute exacerbation of chronic bronchitis
Skin infections and soft tissue infections - mild to moderate
- Folliculitis
- Cellulitis
- Erysipelas

Younger than 12 years and <30kg

• IV: Use not recommended
• Oral (tab): Use not recommended
• Oral (MR tab): Use not recommended
• Oral (sus): Below 6 months: Not established for use
• Oral (sus): Between 6 months and 12 years: 7.5mg/kg, 12hrly; See table below

Weight*	Age	Dosage
8-11kg	1-2 years	62.5mg, 12hrly; Treatment duration: 5-10 days, continue for ≥2 days after symptoms have subsided
12-19kg	2-4 years	125mg, 12hrly; Treatment duration: 5-10 days, continue for ≥2 days after symptoms have subsided
20-29kg	4-8 years	187.5mg, 12hrly; Treatment duration: 5-10 days, continue for ≥2 days after symptoms have subsided
30-40kg	8-12 years	250mg, 12hrly; Treatment duration: 5-10 days, continue for ≥2 days after symptoms have subsided

*Children weighing less <8 kg should be treated based on their body-weight

12 years and older and/or ≥30kg

• See adult dosage

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Children <12 years of age should use clarithromycin paediatric suspension

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For the indication community-acquired pneumonia, the effect in children <3 years is not documented

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In Streptococcus pyogenes (as a beta-haemolytic streptococcal) infections the duration of therapy should be at least 10 days

Pregnancy

• Caution; not recommended
• The safety of clarithromycin for use during pregnancy has not been established. Based on variable results obtained from studies in mice, rats, rabbits and monkeys, the possibility of adverse effects on embryofoetal development cannot be excluded. Therefore, use during pregnancy is not advised without carefully weighing the benefits against risk
• The physician should not prescribe clarithromycin to pregnant women without carefully weighing the benefits against risk, particularly during the first three months of pregnancy

Breastfeeding

• Caution; not recommended
• The safety of clarithromycin for use during breastfeeding of infants has not been established. Clarithromycin is excreted into human breast milk
• Diarrhoea and fungus infection of the mucous membranes could occur in the breastfed infant. Breastfeeding might have to be discontinued. The possibility of sensitisation should be borne in mind. The benefit of the treatment of the mother should be weighed against the potential risk for the infant

Fertility

• There are no data available on the effect of clarithromycin on fertility in humans. In rats, the limited data available do not indicate any effects on fertility

Renal Impairment

• eGFR ≥30-80ml/min/1.73m²: Caution; no dose adjustment recommended
• eGFR <30ml/min/1.73 m²: Caution; dose adjustment recommended (tab, sus, inj)
  Oral (tab, sus): Treatment should not be continued beyond 14 days in these patients
  When recommended, loading doses must not be adjusted and should be administered in full

eGFR (ml/min/1.73m2)	Dose
≥30	No adjustment necessary
≥11-29	Reduce maintenance dose by 50%
≤10	Reduce daily dose by 50%; Increase frequency to 24-48hrly
ESRD or RRT (Scheduled Dialysis)	No dose adjustment is recommended. Administer full (recommended) dose post-dialysis; Increase dosing frequency to 24hrly

• eGFR <30ml/min/1.73 m²: Contraindicated (MR tab)
• Avoid modified-/sustained-release formulations in patients with impaired renal function

Hepatic Impairment

• Caution; no dose adjustment recommended
• Severe: In combination with renal impairment: Contraindicated
  Clarithromycin should not be used in patients who suffer from severe hepatic failure in combination with renal impairment

Elderly

• No dose adjustment recommended
  In elderly patients, the possibility of renal impairment should be considered

Porphyria Information

• Possibly porphyrinogenic (PSP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Anxiety
• Insomnia
• Nervousness (sus)
• Depression
• Hallucinations
• Psychotic disorders
• Disorientation
• Depersonalisation
• Unpleasant dreams
• Confusional state
• Abnormal dreams
• Mania
• Headache
• Loss of consciousness (inj)
• Dyskinesia
• Seizures
• Dizziness
• Somnolence
• Tremor
• Paresthesia
• Fatigue (tab)
• Muzziness (inj)

Cardiovascular Disorders

• Cardiac arrest (inj)
• Atrial fibrillation (inj)
• Prolonged electrocardiogram QT
• Extrasystoles (inj)
• Palpitations
• Ventricular tachycardia
• Torsades de Pointes
• Ventricular fibrillation
• Vasodilation (inj)
• Haemorrhage
• Chest pain (tab)

Respiratory Disorders

• Asthma (inj)
• Epistaxis (MR tab)
• Pulmonary embolism (inj)

Gastrointestinal Disorders

• Nausea and vomiting
• Diarrhoea
• Dyspepsia
• Abdominal pain
• Oesophagitis (inj)
• Gastrooesophageal reflux disease
• Gastritis
• Proctalgia (MR tab)
• Reversible discolouration of teeth and tongue
• Glossitis
• Stomatitis
• Abdominal distension
• Constipation
• Dry mouth
• Eructation
• Flatulence
• Acute pancreatitis
• Pseudomembranous colitis
• Anorexia

Hepatobiliary Disorders

• Abnormal liver function tests
• Hepatic failure
• Hepatitis (tab)
• Cholestasis (tab)
• Increased alanine aminotransferase
• Increased aspartate aminotransferase
• Increased gamma-glutamyltransferase (tab)
• Hepatocellular jaundice
• Increased blood alkaline phosphatase (tab)

Genitourinary Disorders

• Increased blood creatinine
• Increased blood urea
• Interstitial nephritis
• Renal failure
• Abnormal urine colour
• Vaginal infection

Endocrine and Metabolic Disorders

• Hypoglycaemia
• Decreased appetite
• Increased blood lactate dehydrogenase (tab)

Musculoskeletal Disorders

• Muscle spasms (sus)
• Musculoskeletal stiffness (inj)
• Rhabdomyolysis (MR tab)
• Myopathy
• Myalgia (MR tab)

Skin and Subcutaneous Tissue Disorders

• Rash
• Hyperhidrosis
• Bullous dermatitis (inj)
• Pruritus
• Maculopapular rash (sus)
• Cellulitis (inj)
• Erysipelas
• Urticaria
• Stevens-Johnson's disease
• Toxic epidermal necrolysis
• Drug rash with eosinophilia and systemic symptoms (DRESS)
• Acute generalised exanthematous pustulosis (AGEP)
• Injection site reactions (inj)
  - Phlebitis
  - Pain
  - Inflammation

Immune, Blood and Lymphatic System Disorders

• Candidiasis
• Gastroenteritis
• Infection
• Leukopenia
• Neutropenia (tab)
• Thrombocythemia (sus)
• Eosinophilia (tab)
• Agranulocytosis
• Thrombocytopenia
• Anaphylactoid reaction (inj)
• Hypersensitivity
• Anaphylactic reaction
• Angioedema
• Fever (sus)
• Chills (tab)
• Abnormal albumin globulin ratio (inj)
• Prolonged prothrombin time
• Increased International Normalised Ratio

Sensory Disorders

• Tinnitus
• Impaired hearing/ Reversible hearing loss
• Vertigo
• Deafness
• Taste perversion
• Dysgeusia
• Ageusia
• Parosmia
• Anosmia

• Ergot alkaloids
• Ergotamine
• Dihydroergotamine
• Midazolam
• Astemizole
• Cisapride
• Pimozide
• Terfenadine
• Ticagrelor
• Ranolazine 
• HMG-CoA reductase inhibitors (statins)
• Lovastatin
• Simvastatin
• Strong CYP3A4 inhibitors
• Colchicine
• CYP3A4 inducers
• Rifampicin
• Phenytoin
• Carbamazepine
• Phenobarbital
• Rifabutin
• Ritonavir
• Efavirenz
• Nevirapine
• Rifapentine
• Etravirine
• Fluconazole
• CYP3A substrates
• Carbamazepine
• Alprazolam
• Cilostazol
• Ciclosporin
• Disopyramide
• Methylprednisolone
• Omeprazole
• Oral anticoagulants
• Warfarin
• Atypical antipsychotics
• Quetiapine
• Quinidine
• Sildenafil
• Sirolimus
• Tacrolimus
• Terfenadine
• Triazolam
• Vinblastine
• Antiarrhythmics
• Oral hypoglycemic agents
• Insulin
• Sulfonylurea
• Nateglinide
• Repaglinide
• Antacids
• Ranitidine
• Tadalafil
• Vardenafil
• Theophylline
• Tolterodine
• Triazolobenzodiazepines
• P-glycoprotein substrates
• Digoxin
• Zidovudine
• Dideoxyinosine
• Valproate
• Atazanavir
• Calcium channel blockers
• Itraconazole
• Saquinavir
• Oral contraceptives

Other interactions

• St. John Wort

None routine. Specific cases may require

• Vestibular and auditory function
• Renal function
• Culture and sensitivity studies
• Blood urea nitrogen levels
• Glucose levels (coadministration with hypoglycaemics)
• Prothrombin levels (coadministration with anticoagulants)
• International Normalized Ratio (INR) (coadministration with anticoagulants)
• Drug levels (coadministration with interacting agents - See Interactions)
• Electrocardiograms

Additional observations

• Increased CNS pharmacological effects
• Signs and symptoms of myopathy (coadministration with statins)

Tablet 500mg, Suspension 250mg/5ml - EML (Primary)

Injection 500mg - Non EML

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Administration directions

• DO NOT administer as IM or IV bolus
• Clarithromycin should be administered into one of the larger proximal veins as an IV infusion over 60 minutes, using a solution concentration of about 2mg/ml
• The dilution is to be made under aseptic conditions
• The solution is to be inspected visually for particulate matter and discolouration prior to administration. The solution should only be used if the solution is clear and free from particles
• IV infusion: Reconstitute: 500mg with 10ml sterile water for injection; Further dilute with 250ml diluent; Infuse over 60mins; Use within 6hrs
• Suitable diluents (IV) include: Dextrose 50mg/ml (5%) solution for infusion in Lactated Ringer's Solution, Dextrose 50mg/ml (5%) solution for infusion, Lactated Ringer's Solution, Sodium Chloride 9mg/ml (0.9%) solution for infusion
• MR Tab: Swallow whole with food
• Granules for oral suspension: Reconstitute as below

Pack Size (ml)	Volume water to be added (ml)
50	29
100	53

• The prepared suspension can be taken with or without meals and can be taken with milk

Suspension dosing table

Weight (kg)	Approximate age	Dose in ml of 125mg/5ml suspension	Dose in ml of 250mg/5ml suspension
8-11	1-2 years	2.5ml, 12 hrly	-
12-19	2-4 years	5ml, 12hrly	2.5ml, 12hrly
20-29	4-8 years	7.5ml, 12hrly	3.75ml, 12hrly
30-40	8-12 years	10ml, 12hrly	5ml, 12hrly

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Do not crush or chew the modified-release clarithromycin 500 tablets (e.g. XL and MR)

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Emergence of resistance and cross-resistance

• Attention should be paid to the possibility of cross-resistance between clarithromycin and other macrolide drugs, as well as lincomycin and clindamycin
• Pneumonia: In view of the emerging resistance of Streptococcus pneumoniae to macrolides, it is important that sensitivity testing be performed when prescribing clarithromycin for community-acquired pneumonia. In hospital-acquired pneumonia, clarithromycin should be used in combination with additional appropriate antibiotics 5
• Skin and soft tissue infections (mild to moderate severity): These infections are most often caused by Staphylococcus aureus and Streptococcus pyogenes, both of which may be resistant to macrolides. Therefore, it is important that sensitivity testing be performed. In cases where beta–lactam antibiotics cannot be used (e.g. allergy), other antibiotics, such as clindamycin, may be the drug of first choice. Currently, macrolides are only considered to play a role in some skin and soft tissue infections, such as those caused by Corynebacterium minutissimum, acne vulgaris, and erysipelas and in situations where penicillin treatment cannot be used

Clarithromycin is a semi-synthetic derivative of erythromycin A. It exerts its antibacterial action by binding to the 50s ribosomal sub-unit of susceptible bacteria and suppresses protein synthesis. It is highly potent against a wide variety of aerobic and anaerobic gram-positive and gram-negative organisms. The minimum inhibitory concentrations (MICs) of clarithromycin are generally two-fold lower than the MICs of erythromycin. The 14-hydroxy metabolite of clarithromycin also has antimicrobial activity. The MICs of this metabolite are equal or twofold higher than the MICs of the parent compound, except for H. influenzae where the 14-hydroxy metabolite is two-fold more active than the parent compound.

Spectrum of activity: Some aerobic, Gram-positive microorganisms such as Streptococcus group F, Corynebacterium diptheriae; Some aerobic, Gram-negative microorganisms such as Bordetella pertusis, Moraxella catarrhalis, Pasteurella multocida, Legionella spp.; Some anaerobic microorganisms such as Clostridium spp. (other than C. difficile); Other microorganisms such as Mycoplasma pneumoniae, Chlamydia trachomatis, Clamydophila pneumoniae, Clamydophilapsitacci, Mycobacterium spp.; Arcanobacter sp., B. pertussis, Bartonella sp.

 

Tablet 250mg

• Clacee (Abbott)
• Klaryvid fct (Watson)
• Klaribin (Aurobindo)
• Klarizon (Biotech)

Tablet 500mg

• Apex-Clarithromycin (Camox)
• Clacee (Abbott)
• Clarihexal (Sandoz SA)
• Simayla Clarithromycin (Ranbaxy Pharmaceuticals)
• Klaryvid fct (Watson) 
• Klaribin (Aurobindo)
• Klarizon (Biotech)
• Klarithran 500mg (Ranbaxy Pharmaceuticals)
• Mylan Clarithromycin (Xixia)

Tablet MR 500mg

• Klarithran MR 500 fct (Ranbaxy Pharmaceuticals)
• Clarihexal (Sandoz SA)
• Clarithromycin Unicorn 500 XL (Sandoz SA)
• Klacid XL (Abbott) originator

Suspension (per 5ml) 125mg

• Claren (Specpharm)
• Clarihexal 125P (Sandoz SA)
• Klacid P125 (Abbott) originator
• Klaribin (Ranbaxy Pharmaceuticals)
• Klarithran (Ranbaxy Pharmaceuticals)

Suspension (per 5ml) 250mg

• Claren (Specpharm)
• Clarihexal 250P (Sandoz SA)
• Klacid P250 (Abbott) originator
• Klaribin (Ranbaxy Pharmaceuticals)
• Klarithran (Ranbaxy Pharmaceuticals)

Injection (per vial) 500mg

• Claricule (Ruby Pharmaceuticals)
• Klacid IV (Abbott) originator
• Klincid (Kahma Biotech)