Macrolides
Key Points
- Macrolides are broad-spectrum antibacterial agents active against many gram-positive and gram-negative organisms.
- They are primarily bacteriostatic, suppressing bacterial reproduction by inhibiting protein synthesis.
- Common indications include respiratory infections, otitis media, pelvic inflammatory infection, and chlamydia.
- Use cautiously in clients with liver disease because hepatic dysfunction risk is clinically important.
- Serious adverse effects include prolonged QT interval, dysrhythmias, jaundice, and onset or worsening of myasthenia gravis.
- Discontinue and escalate immediately if cardiac-rhythm abnormalities, jaundice, or neuromuscular worsening occurs.
Mechanism of Action
Macrolides inhibit bacterial protein synthesis and suppress bacterial reproduction. Because they inhibit growth rather than directly killing organisms, they are generally bacteriostatic.
Clinical Use
- Respiratory infections.
- Otitis media.
- Pelvic inflammatory infection.
- Chlamydial infection.
Common reference medications in this source are erythromycin and azithromycin.
Nursing Considerations
- Check allergy history before administration.
- Use cautiously in liver impairment and monitor for signs of hepatic injury.
- Monitor systemic infection response using WBC trend, fever trend, and site-of-infection findings.
- Oral azithromycin suspension can be given with or without food; take with food if GI upset occurs.
- IV azithromycin: reconstitute and dilute per protocol, infuse 500 mg over at least 1 hour, and never administer as IV bolus or IM injection.
- Discontinue immediately and notify the provider for QT prolongation, dysrhythmias, jaundice/liver injury signs, or new/worsening myasthenia gravis symptoms.
Side Effects and Adverse Effects
- Common: GI upset, drowsiness.
- Additional: hypersensitivity and photosensitivity.
- Serious: prolonged QT interval, cardiac dysrhythmias, jaundice, and neuromuscular weakness progression in myasthenia gravis.
Health Teaching
- Take with food if GI upset occurs.
- Avoid excessive sunlight and use sunscreen/protective clothing.
- Report chest pain, palpitations, yellowing of the skin or eyes, rash, or worsening weakness immediately.
- Use caution with activities requiring alertness if drowsiness occurs.
- Report persistent adverse effects promptly rather than self-discontinuing without provider guidance.
Related Concepts
- antibiotics - Broad antimicrobial framework for bacteriostatic and bactericidal therapy.
- drug-interactions - Medication-reconciliation context for adverse-effect risk and safe administration.
- myasthenia-gravis - Macrolides may precipitate onset or worsening neuromuscular weakness.
- culture-and-sensitivity-testing-in-infection-management - Guides targeted therapy refinement when microbiology results are available.
Self-Check
- Which new findings in a client receiving azithromycin require immediate discontinuation and provider notification?
- Why should macrolides be used cautiously in clients with liver impairment?
- What nursing checks are required before and during IV azithromycin infusion?