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Macrolides are a class of drugs used to manage and treat various bacterial infections. Azithromycin, clarithromycin, and erythromycin are commonly used to treat infections like pneumonia, sinusitis, pharyngitis, and tonsillitis. They are also used in uncomplicated skin infections and otitis media in pediatric patients. Clarithromycin is used to treat Helicobacter pylori infections in standard triple therapy protocol regardless of clarithromycin resistance status. Macrolides are also commonly used to treat sexually transmitted infections such as gonococcal and chlamydial infections. This activity reviews the mechanism of action, indications, contraindications, and other key factors (e.g., off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) related to macrolides. Objectives: Identify the mechanism of action of the macrolide class of antibiotics. Describe the potential adverse effects of the macrolide class of antibiotics. Review the appropriate monitoring necessary for patients on agents in the macrolide class of antibiotics. Describe interprofessional team strategies for improving the proper administration and management of macrolide antibiotics. Access free multiple choice questions on this topic.

Due to the severity of the cardiac side effects, monitoring the QT interval on ECG should be done in high-risk patients to avoid the induction of deadly arrhythmias like Torsades de Pointes. Patients at high risk should have electrolytes checked before administering the medications, specifically calcium, potassium, and magnesium.[4] Cessation of the drug is necessary if serious side effects arise in a patient. If possible, another antibiotic should be used over macrolides in these high-risk patients to avoid the chance of inducing arrhythmias.

Although macrolides are a very safe class of antibiotics, proper healthcare administration by the entire interprofessional team should be done to minimize adverse events. All members of the interprofessional healthcare team should monitor patients for the common side effects as well as the uncommon ones. All members need education regarding common gastrointestinal side effects and the serious cardiac effects this drug has. Every healthcare team member shares the responsibility of providing top-notch care to their patients and should always be on the lookout for potential side effects. When deciding to initiate macrolide therapy, the clinician (MD, DO, NP, or PA) would do well to include a pharmaceutical consult, which would consist of verifying the appropriateness of the agent chosen, verification of proper dosing, and checking for drug-drug interactions. Pharmacists can also assist the patient by answering their questions, warning of signs of adverse events, reinforcing prescriber directions, and reporting any concerns they may have to the clinician. Nursing can monitor and answer patient questions about their therapy and report to the prescriber on treatment progress or lack thereof or the presence of adverse effects. All interprofessional team members should know the most common uses of the macrolide class of antibiotics and exercise collaborative efforts to ensure optimal patient outcomes. [Level 5]