Key takeaway
Macrolides are bacteriostatic and inhibit bacterial protein synthesis.
What is macrolides?
They are well tolerated but cause GI upset and can prolong the QT interval. The key safety concern is QT prolongation and many drug interactions through CYP450 inhibition.
Key points to remember
- Macrolides are bacteriostatic and inhibit bacterial protein synthesis.
- They are a common alternative for patients allergic to penicillin.
- GI upset, nausea, and abdominal cramping are the most common side effects, especially with erythromycin.
- They can prolong the QT interval and increase arrhythmia risk.
- Erythromycin and clarithromycin inhibit CYP450 and raise levels of warfarin, statins, and digoxin.
- Azithromycin has a long half-life, allowing short, once-daily courses like the 5-day Z-Pak.
Nursing priorities
- Assess the medication list for interacting drugs such as statins, warfarin, and digoxin.
- Monitor the ECG in patients with cardiac risk for QT prolongation.
- Give erythromycin with food if GI upset occurs and as directed for the specific formulation.
- Monitor for and report signs of liver dysfunction.
- Observe for improvement in the infection and document response.
Labs & values
AST10-40 units/L (monitor liver function)
ALT7-56 units/L (monitor liver function)
Potassium3.5-5.0 mEq/L (correct before QT-prolonging drugs)
Patient teaching
- Take the medication exactly as scheduled and finish the full course.
- Report palpitations, dizziness, or fainting.
- Tell your provider about all other medications, especially cholesterol and blood thinner drugs.
- Report yellowing of the skin or eyes or severe diarrhea.
Red flags: report now
- Palpitations, fainting, or signs of arrhythmia require prompt evaluation.
- Jaundice, dark urine, or right upper quadrant pain may signal hepatotoxicity and must be reported.
- Severe diarrhea may indicate C. difficile colitis and must be reported.
References
Clinical references for this topic
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