MACROLIDES
NAME OF DRUG MECHANISM OF ACTION
 Binds to a ribosomal subunit of
Drug Name:
 Zithromax, Zmax
 inhibiting RNA-dependent protein
Generic Name:
 Azithromycin
Classification:
 Antibiotic
Dosage and Frequency:
 Adults.500 mg as a single dose on
day 1, followed by 250 mg daily
on days 2 through 5. Children age
6 months or over with acute otitis
media or community-acquired
pneumonia.10 mg/kg as a single
dose (not to exceed 500 mg daily)
on day 1, followed by 5 mg/kg
(not to exceed 250 mg daily) daily
on days 2 through 5. Or, for acute
otitis media, 30 mg/kg of oral
suspension as a single dose or 10
mg/kg daily for 3 days. Children
age 12 or over with pharyngitis or
tonsillitis.12 mg/kg (not to
INDICATIONS AND
susceptible bacteria, blocking
peptide translocation and
synthesis. Drug concentrates in
phagocytes, macrophages, and
fibroblasts, which release it
slowly and may help move it to
infection sites.
NURSING RESPONSIBILITIES
CONTRAINDICATIONS/ ADVERSE
EFFECTS
Indications:
 To treat mild community-
acquired pneumonia, otitis
media, pharyngitis, tonsillitis, and
uncomplicated skin and soft-
tissue infections
Contraindications:
 Hypersensitivity to
azithromycin,erythromycin,
ketolide antibiotics, or other
macrolide antibiotics
Adverse Reactions:
 CNS: Aggressiveness, agitation,
anxiety asthenia, dizziness,
fatigue, headache, hyperactivity,
malaise, nervousness,
paresthesia, seizures,
somnolence, syncope, vertigo
 CV: Chest pain, edema, elevated
serum CK level, hypotension,
palpitations, prolonged QT
interval, torsades de pointes,
ventricular tachycardia
 EENT: Hearing loss,
mucocutaneous candidiasis,
 •Obtain culture and sensitivity
test results, if possible, before
starting therapy.
 Use azithromycin cautiously in
patients with hepatic dysfunction
(drug is metabolized in the liver)
or renal dysfunction (effects are
unknown in this group).
 Give azithromycin capsules 1
hour before or 2 to 3 hours after
food. Give tablets or suspension
without regard to food.
 If hepatic function is impaired,
monitor liver function studies
because drug is eliminated mainly
by the liver.
 Assess patient for bacterial or
fungal superinfection, which may
occur with prolonged or repeated
therapy. If it occurs,
 expect to give another antibiotic
or antifungal. •Monitor bowel
elimination; if needed, obtain
stool culture to rule out
pseudomembranous colitis. If it
occurs, expect to stop
azithromycin and give fluid,
 exceed 500 mg daily) as single perversion or loss of taste or electrolytes, and antibiotics
dose daily for 5 days. smell, tinnitus ENDO: effective with Clostridium
Route: Hyperglycemia difficile.
 Oral  GI: Abdominal pain, anorexia,
cholestatic jaundice,
constipation, diarrhea, dyspepsia,
elevated liver function test
results, flatulence, hepatic
necrosis or failure, hepatitis,
nausea, pancreatitis,
pseudomembranous colitis,
vomiting
 GU: Acute renal failure, elevated
BUN and serum creatinine levels,
nephritis, vaginal candidiasis
 HEME: Leukopenia, neutropenia,
thrombocytopenia
 MS: Arthralgia
 SKIN: Erythema multiforme,
photosensitivity, pruritus, rash,
Stevens-Johnson syndrome, toxic
epidermal necrolysis, urticarial
 Other :Allergic reaction,
anaphylaxis, angioedema,
elevated serum phosphorus level,
hyperkalemia, infusion site
reaction (such as pain and
redness),new or worsening
myasthenia syndrome,
superinfection
DRUG NAME FREQUENCY,ROUTE, AND DOSAGE
 Clarithromycin  ORAL SUSPENSION, TABLETS Adults and adolescents. 250 mg every 12 hr
for 10 days.
 Children.15 mg/kg daily in divided doses every 12 hr for 10 days.
 Dirithromycin  TABLETS Adults and adolescents.500 mg daily for 7 days.
 Erythromycin  CAPSULES, CHEWABLE TABLETS,DELAYED-RELEASE CAPSULES,DELAYED-
RELEASE TABLETS,ORAL SUSPENSION,TABLETS,I.V.INFUSION Adults. 250 to
500 mg (base) every 6 hr for 10 days. Children.250 to 500 mg (base) q.i.d.
or 20 to 50 mg (base)/kg daily in divided doses for 10 days.For H.
influenzae infections, erythromycin ethylsuccinate is administered with
150 mg/kg daily of sulfisoxazole. Maximum: Adult dosage, or 6 g daily for
erythromycin ethylsuccinate.