Are you aware of these problems in the clinical application of macrolides?

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Macrolide drugs are a class of drugs with the basic structure of a macrolide ring, and are usually used to treat various types of bacterial infections.

Among them, azithromycin, clarithromycin and erythromycin are often used to treat pneumonia, sinusitis and tonsillitis caused by infection.

Like other kinds of antibiotics, the application of macrolide drugs mainly depends on the sensitivity and resistance of the targeted microorganisms.

Under what circumstances can it be applied? The FDA has approved macrolide antibiotics for the treatment of various bacterial infections and simple skin infections and otitis media in children.

In addition, clarithromycin can also be used to treat Helicobacter pylori infection.

Macrolide drugs are also commonly used to treat sexually transmitted infections, such as gonococcal infections and chlamydia infections.

For atypical pneumonia caused by microorganisms such as Mycoplasma pneumoniae, Legionella pneumoniae and Chlamydia pneumoniae, macrolide drugs are also one of the main treatment options.

In addition to broad-spectrum antibacterial activity, macrolides also have anti-inflammatory and immunomodulatory effects independent of antibacterial and non-steroidal activities.

Can be tested for diffuse panbronchiolitis (DPR), chronic rhinosinusitis (CRS), bronchiectasis, pulmonary cystic fibrosis, severe asthma, chronic obstructive pulmonary (COPD) and cryptogenic organizing pneumonia, respiratory tract Viral infectious diseases and gastromotility disorders such as gastroparesis, etc.
, are more suitable for use when the above diseases are combined with sensitive bacteria infection.

Under what circumstances can it not be applied? Generally speaking, macrolide drugs are a group of relatively safe antibiotics, but due to their adverse reactions and interactions with other drugs, there are certain relative contraindications in clinical application.

For patients with prolonged QT interval on ECG examination, the use of macrolide drugs should be avoided because they can cause arrhythmia.

In addition, patients with type 2 long QT syndrome and those taking class Ia and class III antiarrhythmic drugs should also avoid using it.

Among the macrolides, erythromycin and azithromycin belong to category B drugs during pregnancy, and clarithromycin is category C.

Try to avoid using it during pregnancy.

What are the adverse reactions of macrolide drugs? Like other types of antibiotics, macrolide drugs also have the risk of typical adverse reactions such as nausea, vomiting, abdominal pain, and diarrhea.

In addition, the intestinal flora will also be affected by drugs, which can cause an imbalance between the inherent flora in the intestine and the pathogenic bacteria to be controlled.

Another common and serious side effect of macrolide drugs is cardiotoxicity, which can cause abnormal electrocardiogram, prolonged QT interval, malignant arrhythmia, torsade de pointes ventricular tachycardia, especially in and other possible cardiac QT When drugs with prolonged intervals are used in combination, it may cause fatal arrhythmia.

The ototoxicity of macrolide drugs can cause hearing loss and impaired vestibular function, which often occurs within 1-2 weeks of medication, and it occurs more frequently in elderly patients with renal dysfunction.

Most patients can recover their hearing loss after stopping the drug, but a small number of patients will experience irreversible sensorineural hearing loss.

Intravenous administration of macrolides often results in thrombophlebitis, and injection into the muscle or subcutaneously can cause severe pain, local induration or even necrosis.

Clinical studies have shown that the use of macrolides during breastfeeding may increase the risk of infants with hypertrophic pyloric stenosis.

Other serious side effects of macrolides include history-young syndrome and toxic epidermal necrolysis.
Although rare, clinical application still requires vigilance.

What are the factors that need to be considered in clinical application? In clinical application of macrolide drugs, factors that need to be considered include dosage, route of administration, and treatment goals.

There are many forms of administration of this kind of drugs, which mainly depend on the specific drugs needed and the reasons for their use.
They are commonly administered orally, but there are also topical creams, intravenous medications, and ophthalmic preparations.

Due to the continuous increase of antibiotic resistance, clinical prescribing of macrolide drugs should be cautious.
Common pathogens and local drug resistance need to be considered.

When prescribing macrolide drugs, clinicians need to consider the gastrointestinal side effects and adverse effects on the heart that may occur when patients use these drugs.

Due to its risk of prolonging the QT interval, patients with heart disease and taking antiarrhythmic drugs or taking drugs that are known to interact with macrolides need to be monitored.

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