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Azithromycin Macrolide

azithromycin macrolide

What are Macrolides?

Macrolides are a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria.

Macrolides inhibit protein synthesis in bacteria by reversibly binding to the P site of the 50S unit of the ribosome. Macrolides mainly affect gram-positive cocci and intracellular pathogens such as mycoplasma, chlamydia, and legionella. Erythromycin was the first macrolide discovered; other macrolides include azithromycin, clarithromycin, and roxithromycin.

Their action is primarily bacteriostatic but may be bactericidal at high concentrations, or depending on the type of microorganism.

The appropriate use of macrolides

Macrolides are a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin. First-line indications for macrolides include the treatment of atypical community acquired pneumonia, H. Pylori (as part of triple therapy), chlamydia and acute non-specific urethritis. Macrolides are also a useful alternative for people with penicillin and cephalosporin allergy.

Side effect

Common side effects

Up to one in 10 people may experience the following:

  • pain in the stomach or intestines,
  • diarrhoea,
  • nausea, and
  • vomiting
  • dizziness
  • stomach irritation
  • indigestion (dyspepsia
  • skin rash.

Rare and very rare side effects

Between one in 1,000 and one in 10,000 people may experience the following:

  • jaundice,
  • heart arrhythmias (disorders that affect the way the heart beats),
  • Stevens-Johnson syndrome (a very severe allergic reaction), and
  • tinnitus - this usually disappears once you stop taking the macrolide antibiotics.

What are macrolides and how do they work?

Macrolides are a class of antibiotic that includes erythromycin, roxithromycin, azithromycin and clarithromycin. They are useful in treating respiratory, skin, soft tissue, sexually transmitted, H. pylori and atypical mycobacterial infections. Macrolides share a similar spectrum of antimicrobial activity with benzylpenicillin making them useful alternatives for people with a history of penicillin (and cephalosporin) allergy. Bacteria often display cross-resistance between the macrolides.

Macrolides interfere with bacterial protein synthesis and, depending on concentration and bacterial species, are either bactericidal (kill bacteria), or bacteriostatic (inhibit growth of bacteria). Macrolides also have immunomodulatory and anti-inflammatory effects, which can be beneficial in some situations, e.g. when they are used in the treatment of cystic fibrosis.


Macrolide antibiotics may also be prescribed to prevent certain types of bacterial infection.

For example, if you have sickle-cell disease, or have had your spleen removed (splenectomy), you may need to regularly use antibiotics to prevent infections.

Also, if you have undergone any type of dental procedure and are at risk of endocarditis (infection of the heart lining and valves), you may need to take a course of antibiotics. Speak to your dentist and GP before any procedure for further advice.


Missed dose

If you forget to take your dose of macrolide antibiotic, take that dose as soon as you remember and then continue to take your course of antibiotics as normal.

However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

If you have to take two doses closer together than normal, there is an increased risk of side effects.

Accidentally take one extra dose

Accidentally taking one extra dose of your macrolide antibiotic is unlikely to cause you any serious harm. However, it will increase your chances of experiencing gastrointestinal side effects such as pain in your stomach, diarrhoea, nausea and vomiting.

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