3.11 Macrolides
Macrolides are complex antibacterial broad-spectrum medications that are effective against both gram-positive and gram-negative bacteria.
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: Macrolides are often used for respiratory infections, otitis media, pelvic inflammatory infections, and chlamydia.
Nursing Considerations: Macrolides can have a significant impact on liver function and should be used cautiously in clients with liver disease or impairment.
Side Effects/Adverse Effects: Common side effects include GI upset. Additional side effects include hypersensitivity and photosensitivity. Adverse effects include prolonged QT interval, cardiac dysrhythmias, jaundice, and onset or worsening of myasthenia gravis.
Health Teaching & Health Promotion: GI upset is common, and clients can be advised to take medication with food. 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. Additionally, clients should be advised that these medications can cause drowsiness.[2]
Now let’s take a closer look at the medication grid for erythromycin and azithromycin in Table 3.11.[3]
Table 3.11 Macrolides Medication Grid
Class/Subclass |
Prototype/Generic |
Nursing Considerations |
Therapeutic Effects |
Side/Adverse Effects |
|---|---|---|---|---|
| Macrolides | erythromycin | Check for allergies
PO: Reconstitute suspension with water. Can be given with or without food. Take with food if GI upset occurs IV: Reconstitute and shake until well-dissolved. Dilute as instructed. Infuse a 500-mg dose of azithromycin IV over 1 hour or longer according to agency policy. Never give as a bolus or IM injection |
Monitor for systemic signs of infection:
-WBCs -Fever Monitor actual site of infection |
GI upset
Hypersensitivity Photosensitivity Discontinue immediately if: -QT prolongation or dysrhythmias -Signs of liver damage or jaundice -Onset or worsening of myasthenia gravis |
Critical Thinking Activity 3.11
Using the above grid 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 appears yellow, which is a new finding. What is the nurse’s next best response?
Note: Answers to the Critical Thinking activities can be found in the “Answer Key” section at the end of the book.
- 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 ↵
- This work is a derivative of DailyMed by U.S. National Library of Medicine in the Public Domain. ↵
