MACROLIDES

MACROLIDES

Macrolides are used to treat many common infections. They include erythromycin
and its derivatives, such as:

• erythromycin estolate

• erythromycin ethylsuccinate

• erythromycin lactobionate

• erythromycin stearate.
• Other macrolides include:
• azithromycin
• clarithromycin
Pharmacokinetics

• Because erythromycin is acid-sensitive, it must be buffered or have an enteric

coating to prevent destruction by gastric acid.

• Erythromycin is absorbed in the duodenum.

• It’s distributed to most tissues and body fluids except, in most cases,
cerebrospinal fluid (CSF).

• However, as a class, macrolides can enter the CSF when meninges are
inflamed.
Pharmacodynamics

• Macrolides inhibit ribonucleic acid (RNA)–dependent protein

synthesis by acting on a small portion of the ribosome, much like
clindamycin.
Pharmacotherapeutics
• Erythromycin has a range of therapeutic uses.

• It provides a broad spectrum of antimicrobial activity against gram-positive and gram-

negative bacteria, including Mycobacterium, Treponema, Mycoplasma, and Chlamydia.

• It’s effective against pneumococci and group A streptococci.

• Staphylococcus aureus is sensitive to erythromycin; however, resistant strains may appear

during therapy.

• It’s the drug of choice for treating Mycoplasma pneumonia infections as well as pneumonia
caused by Legionella pneumophila
Drug interactions

• Erythromycin, azithromycin, and clarithromycin can increase

theophylline levels in patients receiving high dosages of theophylline,
increasing the risk of theophylline toxicity.

• Clarithromycin may increase the concentration of carbamazepine

when the drugs are used together.
 Adverse reactions
• epigastric distress

• nausea and vomiting

• diarrhea (especially with large doses)

• rashes

• fever

• eosinophilia (an increase in the number of eosinophils, a type of WBC)

• anaphylaxis
 Nursing process
• Assessment

• Assess the patient’s infection before therapy and regularly throughout

therapy.

• Obtain a specimen for culture and sensitivity tests before giving the first
dose. Therapy may begin pending results.

• Assess for adverse reactions and drug interactions.

• Assess the patient’s and family’s knowledge about drug therapy.

Key nursing diagnoses

• Risk for infection related to altered immune status

• Risk for deficient fluid volume related to adverse GI reactions

• Deficient knowledge related to drug therapy

Planning outcome goals

• The patient’s infection will resolve as evidenced by culture reports,

temperature, and WBC counts.

• The patient’s fluid volume will remain within normal limits as evidenced
by intake and output.

• The patient and his family will demonstrate an understanding of drug

therapy.
Implementation

• When giving the suspension, note the concentration.

• For best absorption, give the oral form with a full glass of water 1 hour before or 2
hours after meals.

• Coated tablets may be taken with meals.

• Tell the patient not to drink fruit juice with the drug.

• Chewable erythromycin tablets shouldn’t be swallowed whole.

• Coated tablets or encapsulated pellets cause less GI upset; they may be more
tolerable in patients who have trouble tolerating erythromycin.
• Reconstitute the drug according to the manufacturer’s directions, and dilute each 250 mg in
at least 100 mL of normal saline solution.

• Infuse over 1 hour.

• Don’t give erythromycin lactobionate with other drugs.

• Monitor hepatic function (increased levels of alkaline phosphatase, alanine

aminotransferase, aspartate aminotransferase, and bilirubin may occur).

• Be aware that erythromycin estolate may cause serious hepatotoxicity in adults (reversible
cholestatic jaundice).
• Other erythromycin derivatives cause hepatotoxicity to a lesser degree.

• Patients who develop hepatotoxicity from erythromycin estolate may react similarly to
treatment with other erythromycin preparations.

• Monitor the patient’s hydration status if adverse GI reactions occur.