Macrolides

Question 1

MOA of macrolides

Answer 1

Inhibit protein sysnthesis by binding to the ribosomal 50S unit

Question 2

Cover of macrolides

Answer 2

Gram positive and negative + atypical cover

Question 3

Why are macrolides a good alternative to penicillin in pen allergic patients?

Answer 3

Cover is similar to penicllins

Question 4

Which macrolide is most associated with GI effects such as diarroea, nausea, and vomiting?

Answer 4

Erythromycin

Question 5

Indications of macrolides

Answer 5

H pylori eradication alongside amoxicillin or metronidazole and a PPI

Severe pneumonia alongside amoxicillin for atypical cover.

Respiratory infections

Skin and soft tissue infections

COPD prophylaxis (azithromycin 250mg three times a week)

Question 6

Caution of macrolides?

Answer 6

Predisposition to QT interval e.g., elctrolyte disturbances

Question 7

Interactions of macrolides

Answer 7

QT prolonging drugs such as SSRIs, quinolones, quinine, antipsychotics, amiodarone

Warfarin- increased bleeding risk

Statins- increased risk of myopathy

Question 8

MHRA alert associated with erythromycin

Answer 8

Increased risk of bleeding with rivaroxaban

Question 9

MHRA alerts associated with macrolides

Answer 9

Risk of QT prolongation

Question 10

SEs of macrolides

Answer 10

Thrombophlebitis with IV

Nausea and vomiting

QT prolongation

Ototoxicity in high doses

Liver impairment