Macrolides

Question 1

What are the macrolides?

Answer 1

azithromycin
clarithromycin
erythromycin

Question 2

Azithromycin dose

Answer 2

Z-Pak: 500mg on day 1, then 250mg on days 2-5
Tri-Pak: 500mg daily for 3 days

Question 3

Macrolide contraindications

Answer 3

clarithromycin and erythromycin: do not use with lovastatin or simvastatin

Question 4

Macrolide warnings

Answer 4

QT prolongation (highest risk with erythromycin)
hepatotoxicity
clarithromycin: caution with CAD

Question 5

Macrolide side effects

Answer 5

GI upset

Question 6

What are the common uses of macrolides?

Answer 6

all macrolides: CAP, alternative to a beta-lactam for pharyngitis

Question 7

What are the common uses of azithromycin?

Answer 7

COPD exacerbations, pertussis, chlamydia (in pregnant patients), prophylaxis for mycobacterium avium complex, severe travelers’ diarrhea (including dysentery)

Question 8

What are the common uses of erythromycin?

Answer 8

increase gastric motility and is used for gastroparesis

Question 9

What is the common azithromycin dosing?

Answer 9

two 250mg tablets x1 then 250mg x4 days

Question 10

QT prolongation in macrolides

Answer 10

caution with CVD, decreased K/Mg and other QT-prolonging drugs (azole antifungals, antipsychotics, methadone, quinolones)

Question 11

Drug interactions with macrolides

Answer 11

clarithromycin and erythromycin are CYP3A4 inhibitors; lovastatin and simvastatin are contraindicated (increase risk of muscle toxicity)