Macrolides

1. Warnings

1.1. QT prolongation (erythro > azith > clarith) >> caution in CVD, decreased K/Mg

1.2. Hepatotoxicity

1.3. Exacerbation of myasthenia gravis

2. AEs

2.1. GI upset, taste perversion

3. DDI

3.1. Clarith & erythro both strong CYP3A4 inhibitors (statins)

4. Inhibits RNA-dependent protein synthesis

4.1. Excellent atypical coverage

4.2. Good options for community-acquired upper & lower RTI

5. **Azithromycin**

5.1. Common uses: CAP, COPD exacerbations, pertussis, chlamydia in pregnancy, MAC prophylaxis, severe traveler's diarrhea

6. **Clarithromycin**

6.1. C/I with lovastatin/simvastatin, colchicine in renal/hepatic impairment

6.2. Caution in CAD pts due to increased mortality

6.3. Common use: H. pylori tx

7. **Erythromycin**

7.1. C/I with lovastatin/simvastatin

7.2. Highest QT prolongation risk

7.3. Common use: increase gastric motility & gastroparesis

8. Contraindication

8.1. Hx of cholestatic jaundice/hepatic dysfunction with prior use