Now, the next group of medications
are the macrolides.
An example is erythromycin,
also clarithromycin or azithromycin.
Now, if you've received a prescription,
you have likely either
been a recipient of Z-Pack, or know
somebody who got one,
but when we call a Z-Pack is
one of the macrolides, okay? So,
we've got erythromycin,
clarithromycin, and azithromycin, which
is also known as the Z-Pack.
These guys are also broad spectrum,
which is why they're prescribed
often when a culture isn't done because
they're so broad spectrum.
They hit most gram-positive bacteria,
some of them are gram-negative,
like whooping cough and
But basically, it hits most of the
Now, someone's allergic to penicillin G,
we can also use a macrolide like
erythromycin to fix that too.
Now, this is a very unusual side effect,
and so we want to point it out.
We're not asking you
to read cardiac rhythm strips. Although,
that's a really important skill,
that's not part of what we're
doing in pharmacology.
Well, GI distress is the most
common side effect,
and I know we say that with
a lot of medications,
but if you've ever taken macrolides,
they are really, really hard on your gut.
But this one is a rare risk, but
it's a life-threatening risk.
What it does is prolong part of the
natural electricity of the heart.
So the QT interval becomes prolonged.
And that can lead to sudden cardiac death
from a heart rhythm called
Torsades de pointes.
Now, you'll see a picture
of what that looks like.
All you want to remember is
that this medication has a rare side effect.
It extends the QT interval on their 12-lead,
and the longer that makes that, that
puts the heart at risk to go into this
life-threatening rhythm called
Torsades de pointes.
So, if I already know that the patient has
a known history of QT prolongation,
like they've had an ECG,
we know that their QT interval is already
too long or longer than normal,
and they're on particular
erythromycin is not a safe drug for them.
The next drug in this family is clindamycin.
Now, it really has some cool activity.
It's active against most anaerobic organisms.
I mean, gram-positive and gram-negative.
And it's also active against most
so that's a pretty impressive drug.
It's a great option if your patient
can't take penicillin.
It's widely used as an alternative
We also use it for 2 other categories.
So, we can use clindamycin for
serious anaerobic infections
that are outside of the central
and severe group A streptococcus.
Now, the adverse effects are similar
to some of the other drugs
we talked about in this family.
There's a high rate of C. diff
Yuck. And superinfections that may start up
to 4 to 6 weeks after
we've stopped the medication
for the patient.
Okay, that is worth pausing and
reflecting on for just a minute.
So, not only can it develop C. diff
for your patient from a superinfection,
it can develop
up to 4 to 6 weeks after you've already
stopped the medication.
So you want to educate your patient
to be aware of that
and to notify their health care provider
if they have any of those symptoms.
And this is another one of those medications
that can cause erosive esophagitis.
Same thing as the rest of the
members of their family.
So the erosive esophagitis --
I want you to take a minute,
pause, and write in your notes,
what are the things that we need
to educate your patient on
to prevent the possibility of them
getting erosive esophagitis?
Okay, remember, erosive esophagitis
is that excruciating sore throat,
so we want to educate the patient
that they cannot lay down after
they take the medication.
So recommend that they do not
take the medication at night,
and they stay upright after they
take a dose of clindamycin.