12.11 Macrolides
Macrolides are complex antibacterial broad-spectrum medications that are effective against both gram-positive and gram-negative bacteria. Two medications are erythromycin and azithromycin.
Mechanism of Action:
Macrolides inhibit RNA protein synthesis and suppress reproduction of the bacteria. Macrolides are bacteriostatic as they do not actually kill bacteria, but inhibit additional growth and allow the body’s immune system to kill the offending bacteria.[1]
Indications for Use:
Macrolides are often used for respiratory infections, otitis media, pelvic inflammatory infections, and chlamydia.
Nursing Considerations:
Administration: oral or IV. For oral dosing, give with or without food. Take with food if GI upset.
Macrolides are safe for children over 6 months of age.
Pregnancy: use with caution with benefits outweighing risk.
Use with caution with liver dysfunction and renal failure; anticipate dose adjustment.
Monitor labs: may increase serum bilirubin, liver enzymes, potassium, PT, BUN, serum creatinine, and blood glucose. May decrease WBC and platelet count.
Adverse/Side Effects:
Common side effects include GI effects of abdominal pain, nausea, diarrhea.
Adverse effects, although rare, include hypersensitivity reactions, hepatoxicity, torsades de pointes, and Steven-Johnson syndrome.
Client Teaching:
- GI upset is common and clients can be advised to take medication with food.
- May also cause drowsiness and dizziness. Avoid driving or other activities that require mental alertness.
- Clients should also be advised to avoid excessive sunlight and to wear protective clothing and use sunscreen when outside, as well as to report any adverse reactions immediately. Advise clients to report symptoms of chest pain, palpitations, or yellowing of eyes or skin.
- Report any severe diarrhea and abdominal pain.
uCentral, n.d.; Vallerand & Sanoski, 2024
Macrolides Medication Card
Now let’s take a closer look at the medication card for erythromycin and azithromycin.[3][4] Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
To help with comparing the medications and to learn important considerations for each medication, refer to the Chapter 12 Antimicrobials Medication Cards
Medication Card: Macrolides
Prototypes: erythromycin, azithromycin
Mechanism: Bacteriostatic – work by inhibiting RNA protein synthesis and suppressing reproduction of the bacteria. It inhibits translocation of proteins (binding to ribosome 50S = cell death). It is effective against species that reproduce inside host cells (listeria, Neisseria, campylobacter) instead of just ones in bloodstream/interstitial spaces. Macrolides are an alternative to B-lactam if client is allergic to those class meds, such as penicillin.
Indications
- upper, lower respiratory tract infections
- skin and soft tissue infections
- STIs: syphilis, gonorrhea, chlamydia
- lyme disease
- streptococcus
Administration
- Oral, IV
- PO:
- Don’t crush, take with a full glass of water.
- Best on empty stomach
- Can be given with or without food. Take with food if GI upset occurs
- Not with citrus foods
- IV: Reconstitute and shake until well dissolved. Dilute as instructed and infuse over recommended time. Never give as a bolus or IM injection
Side Effects
- Erythromycin: GI irritation = increase gastric motility.
- drowsiness and dizziness
- Hypersensitivity
- Skin rashes
- Rare: cholestasis
- tinnitus
- May increase serum bilirubin, liver enzymes, potassium, PT, BUN, serum creatinine, and blood glucose. May decrease WBC and platelet count.
- May prolong QT interval segment. Monitor for dysrhythmias
- risk of photosensitivity – wear sunscreen and protective clothing
Contraindications
- competes with other drugs for liver metabolism because it is highly protein bound (warfarin, digoxin, phenytoin, cyclosporin)
- decreased efficiency of oral birth control
- caution with using statins as increase risk of myopathy.
- cautious use with pregnancy
- caution with older adult
- risk of hepatotoxicity
Nursing Considerations
- Monitor for systemic signs of infection: elevated WBC, fever, assess culture results
- Monitor site of infection for improvement
- May prolong QT interval segment. Monitor for dysrhythmias consider ECG prior to dose if cardiac concern (assess for dizziness, CP., palpitations)
- monitor skin (rashes) and bowel changes
- monitor labs: liver enzymes, renal panel, CBC, lytes, and blood glucose levels.
- good category if pt allergic to penicillin
Clincal Reasoning and Decsion-Making Activity
Using the above information, consider the following clinical scenario question:
A nurse is administering azithromycin to a client with an acute bacterial worsening of COPD. Today the client’s sclera appear yellow, which is a new finding. What is the nurse’s next best response?
Note: Answers to the Clinical Reasoning Activities and Critical Thinking questions can be found in the Chapter 12: Antimicrobial Medications answer key – Fundamentals of Nursing Pharmacology – 2nd Canadian Edition section at the end of the book.
References
- This work is a derivative of Microbiology by OpenStax licensed under CC BY 4.0. Access for free at https://openstax.org/books/microbiology/pages/1-introduction ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- Daily Med, https://dailymed.nlm.nih.gov/dailymed/index.cfm, used for hyperlinked medications in this module. Retrieved June 28, 2019. ↵
- UpToDate (2021). Erythromycin. https://www.uptodate.com/contents/search ↵
- Vallerand, A. & Sanoski, C. (2024). Davis’s Canadian drug guide for nurses (19th ed.). F.A. Davis Company: Canada
