Antimicrobials: Macrolides and Lincosamides

Question 1

macrolides drugs (3)

Answer 1

erythromycin
clarithromycin
azithromycin

Question 2

macrolide activity

Answer 2

good against gram positives and gram negative aerobes

Question 3

which macrolide is the best for gram pos?

Answer 3

erythromycin

Question 4

which macrolide is the worst for gram pos?

Answer 4

azithromycin

Question 5

which macrolide is the best for gram negative?

Answer 5

azithromycin

Question 6

which macrolide is the worst for gram negative?

Answer 6

erythromycin

Question 7

main use for clarithromycin

Answer 7

h pylori

Question 8

clarithromycin dosing is different from azithromycin, how?

Answer 8

it is dosed more frequently, typically 2x/day

Question 9

macrolide and gram negative aerobes

Answer 9

no efficacy

Question 10

macrolide are very useful in the setting of

Answer 10

pneumonia, especially the atypical pathogens of pneumonia

Question 11

atypical pathogens of pneumonia

Answer 11

legionella pneumophila
mycoplasma pneumoniae
chlamoydophila pmneumoniae

Question 12

macrolide have activity against these organisms

Answer 12

strep pneumo and other strep spp
h influenzae
m cat
legionella pneumoniae
mycoplasma pneumoniae
chlamydophila pneumoniae
chalmidia trachomatis
ureaplasma urealyticum
borrelia burgdorfei
h pylori (clari, azith)

Question 13

erythromycin drug:drug interactions due to

Answer 13

metabolism through the CYP450 enzyme system

Question 14

macrolides for MAC

Answer 14

clarithromycin

azithromycin

Question 15

MAC prophylaxis

Answer 15

large dose of azithromycin 1x a week

Question 16

azithromycin t 1/2

Answer 16

5 days

Question 17

azithromycin vs fluoroquinolones

Answer 17

activity against atypical organisms may be superior in azithromycin

Question 18

macrolides + EKG changes

Answer 18

QTc prolongation

*watch other QTc prolonging drugs

Question 19

azithromycin course of therapy

Answer 19

only 5 days, has PAE.

Question 20

erythromycin

dose related adverse events

Answer 20

GI: abdominal cramps, nausea, vomiting, diarrhea

thrombophlebitis if given IV

choelstatic hepatitis in rare cases

Question 21

clarithromycin and azithromycin side effects

Answer 21

GI: less than erythromycin

tinnitus and dizziness (dose related)

Question 22

erythromycin distribution

Answer 22

poor penetration into many body tissues/fluids

Question 23

clarithromycin/azithromycin distribution

Answer 23

penetrates well into tissues, particularly sputum and lungs. achieves high concentration in alveolar macrophages.

Question 24

elimination of macrolides

Answer 24

excreted in bile, small amounts in urine

Question 25

t 1/2 of erythro and clarithro

Answer 25

short half lives

Question 26

azithromycin t 1/2

Answer 26

68 hours. long.

Question 27

dose adjustment in macrolides

Answer 27

hepatic impairment | renal impairment

Question 28

Lincosamides drug

Answer 28

clindamycin

Question 29

MoA Clindamycin, a lincosamide

Answer 29

binds to 50S ribosomal subunit, decreases protein synthesis.

Question 30

distribution of clindamycin, a lincosamide

Answer 30

concentrates in bone, bile, and most other tissues but does not penetrate well into the CSF.

Question 31

lincosamides are bacteriocidal or static?

Answer 31

static

Question 32

lincosamides are very against

Answer 32

staph & strep (mssa, mrsa, streptococcus) and b fragilis | head and neck flora/mouth flora/sometimes GI

Question 33

lincosamides and gram neg aerobes

Answer 33

no activity

Question 34

lincosamides and toxoplasmosis

Answer 34

good activity against it

Question 35

bone penetration of lincosamides

Answer 35

excellent

Question 36

when is lincosamide a go to drug?

Answer 36

when they're on a staph/strep IV abx and there isn't an easy conversion to a PO drug. clindamycin may be used in this instance.

Question 37

t 1/2 lincosamides

Answer 37

short, 2.4 hours | multi times a day dosing

Question 38

GI adverse events: lincosamidses, specifically clindamycin

Answer 38

GI intolerance/diarrhea/*pseudomembranous colitis*

Question 39

liver function and lincosamides

Answer 39

can cause LFTs and hepatotoxicity

Question 40

patient education for lincosamides

Answer 40

esophageal irritant | drink lots of water, no laying down

Question 41

hematologic side effect of lincosamide

Answer 41

rare: neutropenia/thrombocytopenia

Question 42

dose adjustment for lincosamides

Answer 42

not required for renal insufficiency

Question 43

higher doses of lincosamides may lead to

Answer 43

dose limiting GI toxicity

Question 44

lincosamide monitoring

Answer 44

C&S CBC RFT bowel changes

Question 45

pregnancy/lactation considerations for lincosamides

Answer 45

C | excreted into breast milk

Question 46

pediatric considerations: lincosamides

Answer 46

diarrhea

Question 47

geriatric consideration for lincosamides

Answer 47

diarrhea

Question 48

renal impairment and lincosamides

Answer 48

no adjustment needed

Question 49

hepatic impairment and lincosamides

Answer 49

consider dose adjusting in severe hepatic dysfunction

Question 50

macrolides monitoring

Answer 50

C&S CBC RFT LFT for long term use

Question 51

Pregnancy/lactation considerations for macrolides

Answer 51

category B/C | excreted into breastmilk at low concs

Question 52

pediatric considerations for macrolides

Answer 52

n/a

Question 53

geriatric considerations for macrolides

Answer 53

renal insufficiency

Question 54

renal impairment and macrolides

Answer 54

dose adjust for GFR <30

Question 55

hepatic impairment and macrolides

Answer 55

LFTs may increase