Macrolides

Here is our outline on Macrolides. Please let us know if this information is correct and pertinent to the teaching of safe administration.

Thank you for your valuable input!

Anne Fator & Damian Ellis

Macrolides- called broad-spectrum antibiotics

They are active against most gram-positive bacteria and moderately active against some gram-negative bacteria.

Includes:

• ·         Azithromycin (Zithromax)

• ·         Clarithromycin (Biaxin)

• ·         Erythromycin (E-Mycin)

Action:

• ·         Binds to the 50S ribosomal subunits and inhibits steps of protein synthesis, bacteriostatic in low-moderate doses, bactericidal in high doses.

Indications:

• ·         Upper and lower respiratory infections

• ·         Skin and soft tissue infections

• ·         Diptheria

• ·         Impetigo contagiosa

• ·         Chlamydial infections

• ·         Legionnaires’ disease

• ·         Pneumococal pneumonia

• ·         Acute pelvic inflammatory disease

• ·         Intestinal amebiasis

• ·         Helicobacter pylori

• ·         Mycobacterial species

• ·         Gram positive and negative organisms

Routes:

• ·         Oral

• ·         IV

Side effects/Adverse effects:

• ·         Nausea

• ·         Vomiting

• ·         Diarrhea

• ·         Abdominal cramping

• ·         Rash

• ·         Pruritus

• ·         Tinnitus

• ·         Superinfections

• ·         Vaginitis

• ·         Urticaria

• ·         Stomatitis

• ·         Hearing loss

• ·         Anaphylaxis

• ·         Hepatotoxicity

Pharmacokinetics:

• ·         Readily absorbed from the GI tract.

• ·         Excreted in bile, feces, and a small amount in urine.

Drug Interactions:

• ·         Antacids may reduce peak levels when taken at the same time.

• ·         Increases serum levels of theophylline, carbamazepine, and warfarin.

• ·         Erythromycin should not be used with other macrolides.

Nursing Interventions:

• ·         Assess Vital signs and urine output.

• ·         Obtain a culture and sensitivity before starting therapy.

• ·         Check lab tests (liver enzyme values) to determine liver function.

• ·         Administer any antacids 2 hours before or 2 hours after use of azithromycin.

• ·         Administer oral azithromycin 1 hour before or 2 hours after meals.

• ·         Infuse IV macrolides slowly to avoid unnecessary pain.

Teaching:

• ·         Should be taken with full glass of water (not fruit juice).

• ·         Report persistent diarrhea.

• ·         Report nausea, vomiting, diarrhea, abdominal cramps, and itching.

• ·         Take with food if GI upset occurs.

• ·         Importance to completing full course of antibacterial as prescribed.

Contraindications:

• ·         Hypersensitivity

• ·         Caution: Hepatic dysfunction, lactation, renal dysfunction