CLASSES OF ABX: MACROLIDES Flashcards
Macrolide examples
Azithromycin
Clarithromycin
Erythromycin
Telithromycin
Spiramycin
STACE
MOA
Bind to the ribosomes of susceptible microorganisms = inhibition of protein synthesis.
Bacteriostatic
Activity against
- Bacteriostatic and bacteriacidal
- Broad spectrum
Indications
- Respiratory-tract infections
- Lyme disease
- Pertussis
- Syphilis.
Clarithromycin
BD
Taste disturbance
Erythromycin
BD or QDS
Empty stomach (1 hour before or 2 hours after)
Before indigestion remedies - 2 hour gap
Telithromycin
Beta-lactam resistant infections
Visual disturbances
Hepatotoxicity
Transient loss of consciousness - DRIVING!!
Spiramycin
Toxoplasmosis
Side effects
- Hepatoxicity
- Ototoxicity
o Hearing loss in large doses - GI SEs
- QT prolongation
Contraindications and cautions
- Myasthenia gravis
- Pregnancy
- Macrolides are CYP enzyme inhibitors
increased risk of bleeding - Hypokalaemia
- QT prolongation
Interactions
- Drugs that cause hepatotoxicity
- Drugs that cause ototoxicity
- QT interval drugs
Pregnancy
- Erythromycin is preffered in pregnancy over clarithromycin
o Avoid clari in 1st trimester
Macrolides are CYP enzyme inhibitors
o They increase the levels of CYP enzyme substrates
Statins – increased amounts of statins = increased risk of myopathy
Warfarin – increased amount of warfarin = increased risk of bleeding
Hypokalaemia drugs
o Loop /thiazide diuretics
o Steroids
o Salbutamol
o Theophylline
QT prolongation drugs
o Amiodarone
o Domperidone
o Fluconazole
o Lithium
o Methadone
o Ondansetron
o Quinine
o Quinolones
o SSRIs
