Antibiotics - Macrolides: Nursing Pharmacology

Macrolides are a class of antibiotics used to treat a wide range of infections caused by gram-positive and gram-negative bacteria. These medications include erythromycin, azithromycin, and clarithromycin.

All can be administered orally to treat mild to moderate bacterial infections of the respiratory, gastrointestinal, and genitourinary tracts; erythromycin can also be given intravenously, and azithromycin has an ophthalmic formulation to treat bacterial conjunctivitis.

Now, once administered, macrolides target the bacterial 50S ribosomal subunit in order to inhibit protein synthesis. As a result, these medications have a bacteriostatic effect, meaning they stop bacterial growth.

They’re also considered broad spectrum antibiotics, as they’re active against most gram-positive bacteria and moderately active against some gram-negative bacteria.

Typically, macrolides are well tolerated, and rarely cause side effects. The most common ones can include headaches, a skin rash, and gastrointestinal disturbances like diarrhea, abdominal pain, nausea, and vomiting.

In addition, macrolides may disrupt the normal intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short.

Some clients on macrolides may also develop vaginitis and candidiasis, and if they’re used for a prolonged time, they can also lead to ototoxicity and hearing loss.