What is a Macrolide? Antibiotics Review

Young female nurse going over different antibiotics with elder Asian patient, including macrolide antibiotics

Macrolides are a class of bactericidal antibiotics drugs used to manage and treat various bacterial infections. They work by causing changes in protein synthesis and function.

The most common macrolides are Azithromycin, Clarithromycin, and Erythromycin. Macrolides typically end with the suffix -romycin.

When reviewing drugs and their names, the commonly taught principle is that when a drug ends in certain suffixes like “–lol,” that’s automatically a beta-blocker, and ones that end in “–pine” are calcium channel blockers.

However, there are always exceptions to the rule – like atropine which ends in “–pine,” but is not a calcium channel blocker, and is actually an anticholinergic. Atropine spikes the heart rate, which is the exact opposite of what a calcium channel blocker does.

Macrolide Antibiotic Suffix

Macrolides are antibiotics primarily given to patients with pneumococcal and streptococcal infections (especially when penicillin is prohibited). Azithromycin (AKA Zithromax), erythromycin, and clarithromycin are macrolides. 

Anything that ends in “–romycin” are considered a macrolide.

Of course, there are exceptions to the rule of pharmacology suffixes, and one of these exceptions is identifying macrolides. The majority of antibiotic medications end in “-mycin.” 

Therefore, it would be confusing for nurses to pinpoint which is a macrolide, or another form of antibiotic.

Is Clindamycin a Macrolide?

Don’t get confused with neomycin, clindamycin, or gentamycin because all these are different. Clindamycin is a lincosamide antibiotic.

Remember, macrolides are bactericidal agents – meaning they kill bacteria. On the other hand, lincosamides are bacteriostatic agents, meaning that they stop bacteria from multiplying and growing. 

Macrolides Nursing Considerations

Macrolides are safe for use for most patients, including in pregnancy and with pediatric patients. 

However, Macrolides can significantly impact liver function, so they should be administered with extra caution to anyone with liver impairment (or disease).

Macrolides Patient Teaching

There are two important pieces of information that you need to impart to patients who are taking macrolides, namely:

  • Do not take medication with food
  • Do not expose patients to the sun

Food causes ineffective absorption of macrolides.

Another important detail to remember with macrolides is that it is contraindicated to patients who are allergic to them.

Macrolides and Coumadin

One of the nitpicky stuff about macrolides is that they will affect Coumadin’s effect on coagulation. Therefore, if a patient is taking Coumadin and is also prescribed macrolides, checking the international normalized ratio (INR) is essential to check if the patient is not coagulating at an increased rate.

Macrolides Side Effects

Some of the primary concerns when taking macrolides are:

  1. Gastrointestinal irritation or disturbances, especially with erythromycin.
  2. ECG results will show prolongation in the QT interval, also with erythromycin.
  3. Interactions with various medications (from inhibiting liver metabolism).

Other adverse effects of macrolides are: 

  • Nausea
  • Abdominal cramps
  • Vomiting
  • Diarrhea

All of these side effects are related to gastrointestinal irritation. However, they’re uncommon with macrolides like azithromycin and clarithromycin.

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