The Secret of Great Health Care
Macrolides have been around since early 1950’s. The first macrolide was erythromycin and was available commercially in 1952. Due to the multiple side effects of erythromycin other macrolides have been developed. The two most commonly used newer macrolides are: clarithromycin (Biaxin) and azithromycin (Zithromax). These medications were developed in the 1970’s and 1980’s respectively.
This class of medication has similar coverage (it actually covers a few more infections) to penicillin and is often used as an alternative to those with allergy to penicillin.
Bacterial resistance is becoming a larger problem with the macrolides. This is particularly problematic in patients with strep throat and sinus infections.
Macrolides treat a wide range of conditions. They are able to cover more infections than penicillins, but there is some resistance, as previously noted. They are commonly used for upper respiratory tract infections, skin infections, soft tissue infections, some pneumonias, diarrhea infections and some sexually transmitted diseases.
They are sometimes used when there is an allergy to penicillin in conditions such as strep throat, ear infections or sinus infections.
Azithromycin is used to treat ear infections, sinus infections (there is an increased rate of resistance in sinus infections), pneumonia, throat infections, exacerbation of chronic bronchitis, skin infections and some sexually transmitted diseases.
Clarithromycin is used for sinus infections, exacerbation of chronic bronchitis, pneumonia, throat infections, ear infections and skin infections
Telithromycin (Ketek) is indicated for only mild to moderate pneumonia
Common side effects include:
Less common side effects include:
The use of cholesterol lowering medications called statins (Lipitor, Zocor, Mevacor) along with macrolides may increase the risk of a condition called myopathy. Myopathy is a condition associated with muscle breakdown.
Another serious side effect is cardiac arrhythmias and is more common when combined with other medications and with the use of erythromycin and clarithromycin.
Erythromycin is not as commonly used due to its significant gastrointestinal side effects. It comes in multiple formulations. It is dosed between two and four times a day. It is associated with many drug interactions, so use caution with this antibiotic when on other medications.
Azithromycin (Zithromax), known commonly as the z-pak, is the most popular macrolide. This drug provides many advantages over other macrolides. It is dosed once a day for 3-5 days. There is even a one-time dose of this medication for some infections. It has the fewest side effects and the fewest drug interactions in the class. It is least likely to lead to cardiac rhythm problems.
Clarithromycin (Biaxin) is very similar to azithromycin in regard to what it treats. It is less commonly used because it requires a 7-14 day course of therapy and is dosed once (in the extended release form – which may be more expensive) or twice a day (in the standard form) compared to once a day dosing for 3-5 days with azithromycin.
Clarithromycin is associated with unique side effects. It is more likely to lead to interactions with cholesterol lowering drugs and lead to myopathy. It is also more likely to lead to cardiac rhythm disturbances. It is also associated with an abnormal (metallic) taste in the mouth.
Telithromycin (Ketek)
Telithromycin is technically not a macrolide, but it is closely related and will be discussed here. It is not used as frequently because it is associated with liver problems. It is reserved for cases when nothing else works. It is indicated for mild to moderate pneumonia.
