Pharmacology

MACROLID
ES
 Macrolides
- Antibiotic that interfere with
protein synthesis in susceptible
bacteria.
- It includes
Erythromycin
Clarithromycin
Dirithromycin
Azithromycin
- considered bacteriostatic
Classification

Dirithromycin
(Dynabac)

Azithromycin
(Zithromax)
(continue)

Classification
Erythromycin
(Ery-Tab, Eryc)

Clarithromycin
(Biaxin)
Dosage and Route
(continue)

Dosage and Route

 Therapeutic Action
- Exert effect by binding to the
bacterial cell membrane and
changing protein function.
- Prevent the cell from dividing or
cause cell death, depending on the
sensitivity of the bacteria and the
concentration of the drug
(continue)

Therapeutic Action
- To treat gram positive and some
gram-negative organism
- For client who are allergic to
penicillin
- To treat respiratory infection
- To prevent recurrent of rheumatic
fever
Pharmacokinetics
(continue)

Pharmacokinetics
(continue)

Pharmacokinetics
 Indication
•Respiratory infections - macrolides
have an anti-inflammatory action which
makes them useful in lung diseases
such as asthma, bronchiolitis and
cystic fibrosis.
•Campylobacter enteritis
•Chlamydia
•Sinusitis, otitis media or throat
infections, where the patient is penicillin
hypersensitive
(continue)

Indication

•Widespread impetigo
•Infective endocarditis prophylaxis
in patients
•allergic to penicillin
•Lyme disease: azithromycin
•Trachoma: azithromycin (unlicensed
indication)
 Contraindication

- Macrolides should be avoided in

severe liver disease due toincreased
risk of hepatotoxicity and altered
handling.
- A previous hypersensitivity reaction
is a contraindication.
 Mode of Action

-an effective long-term treatment

for the idiopathic, Asian-prevalent lung
disease diffuse panbronchiolitis(DPB).

- produces substantial anti-inflammatory

results
(continue)

Mode of Action

- Inhibition of bacterial protein

biosynthesis by binding reversibly to
the subunit 50S of the bacterial
ribosome, thereby inhibiting
translocation of peptidyl tRNA.
 Adverse Effect
Nausea, vomiting and diarrhea in
some patients:
If the infection is mild, giving a lower
dose. e.g. 250 mg four times daily
may avoid this.

Cholestatic jaundice and hepatitis

(particularly with the estolate ester)
 Side Effect
The common side effects are gastro-
intestinal disturbances (nausea,
vomiting, diarrhea, dyspepsia,
abdominal pain and cramps)

Allergic reactions, headache,

taste disturbance, eosinophilia,
reversible hearing loss, and
hepatotoxicity
Nursing Care Process
Assessment:
• Assess vital signs and urine output. Report
abnormal findings
• Obtain specific information about the
nature and occurrence of allergic reaction
• Obtain Past Health History
• Perform culture and sensitivity test at the
site of infection.
• Examine the skin fro any rash or lesion
• Monitor temperature
(continue)

Nursing Care Process

•Assess renal and liver function test

Nursing Diagnosis:
•Acute Pain r/t GI, CNS, skin effect of
drug
•Risk fro infection r/t potential for super-
infections
•Deficient Knowledge regarding drug therapy
(continue)

Nursing Care Process

Implementation and Rationale:
1. Check culture and sensitivity report to ensure
that this is drug of choice of the patient
2. Monitor hepatic and renal function test value
before therapy begins to arrange the reduction
of dosage as needed.
3. Ensure that the patient receives the full course
of macrolides as prescribed to eradicate the
infection and to help prevent the emergence
of resistant strain.
(continue)

Nursing Care Process

4. Monitor the site of infection and presenting
signs and symptoms throughout the course
of drug therapy. Failure of these sign and
symptoms to resolve may indicate the need
to reculture the sites.
5. Provide small, frequent meal as tolerated,
frequent mouth care, and ice chips or
sugarless candy to suck if dry mouth is a
problem to relieve discomfort and provide
nutrition, and adequate fluids to replace those
lost with diarrhea.
(continue)

Nursing Care Process

6. Ensure ready access to bathroom facilities

to assist patient with problems associated
with diarrhea.
7. Institute safety measure to protect patient
from injury in CNS effect occurs.
8. Arrange for appropriate treatment to
superinfection as needed to decrease severity
of infection and complications.
(continue)

Nursing Care Process

• Ensure that the patient receives instructions
about the appropriate dosage schedule and
possible adverse effects to enhance patient
knowledge about drug therapy and to
promote compliance.

The patient should:

• Take safety precaution; including changing
position slowly and avoiding driving and
hazardous task, if CNS effects occur.
(continue)

Nursing Care Process

•Try to drink a lot a fluids and to maintain

nutrition, although nausea and vomiting and
diarrhea occur.
•Report difficulty of breathing, severe
headache, severe diarrhea, severe skin rash,
fainting spells, and heart palpitation to the
health care provider.
(continue)

Nursing Care Process

Evaluation:
• Monitor patient response to the drug
• Monitor for adverse effect
• Evaluate the effectiveness of the
teaching plan
• Monitor the effectiveness of comfort
and safety measure and compliance
with the therapeutic regimen.