Macrolides Flashcards
Macrolides (specificity)
Gram +(staph, strep)
Gram - (Nisseria, Bordatela, Campylobacter, H. Pylori, Listeria)
Macrolides (Clinical Uses)
PCN allergy pts
AOM
GAS
SSTI (Erysipelas and cellulitis prevention)
Rheumatic fever prophylaxis
Also
Community acquired (CAP) and atypical Pneumonia
Gastroparesis
Macrolides (Adverse Effects)
Long QT syndrome
-Ventricular arrythmia
-Prolonged Qt on EKG
Macrolides (other)
41% of strep in US is resistant due to efflux, decreased membrane perm., and modded binding site.
Concentration-dependent bacterial action
(Static until cidal), depends on concentration and target organ.
Erythromycin (forms)
Base
Stearate
Estolate
Ethylsuccinate (EES)
Erythromycin (specificity)
Concentration dependent
Erythromycin (clinical uses)
Respiratory infections
SSTI
Chlamydia (Pregnancy)
Pertussis
Diptheria
Campylobacter gastroenteritis (2nd line)
Rheumatic fever prophylaxis
Endocarditis prophylaxi (in dental procedures)
Erythromycin (contraindications)
Hypersensitivity
Stevens-Johnson Sydrome
Toxic Epidermal Necrolysis (Ten)
Drug Interaction (Pimozide)
Liver disease (Estolate)
Pertusis -crossess placenta and is found in breast milk and may cause IHPS
Erythromycin (AE’s)
Long QT syndrome
-stimulates gastric emptying
Erythromycin (drug interactions)
P450 inhibitor (CYP 3A4) long QT drugs
-need to know pt. allergies, Cardiac status, pregnancy, liver status, and med list
Erythromycin (PK)
Stearates are acid susceptible Estolates and (EES) are used orally and are acid stable.
Short half life (1.5-2 hours) why dosed several times per day
Eliminated by liver via bile
Erythromycin (other)
IHPS= Infantile hypertrophic pyloric stenosis
Pimozide drug interaction is life threatening
For Chlamydia:
Pregnancy
Ophthalmia neonatorum tx
Lymphogranuloma venereum (Second line)
Clarithromycin (specificity)
Synthetic more acid-stable then erthromycin
Broader spectrum, better tolerability
Clarythromycin (clinical uses)
2nd line for PCN allergy
Pertussis (DOC)
CAP
H. pylori/duodenal ulcer (+ amoxicillin & a PPI)
Lyme Disease
Mycobacteria (DOC Prophylaxis and tx for AIDS pts)
Taxoplasmosis
Cryptosporidiosis
Endocarditis prophylacxis(in dental procedures/PCN allergy)
SSTI
Bartonella (cat scratch fever)
Clarythromycin (contraindications)
Hypersensitivity
Stevens-Johnson
Toxic Epidermal Necrolysis (Ten)
Interacting drugs
Liver disease
Congenital long QT