Antibacterial macrolide

Clarithromycin is a macrolide antibacterial agent that should be used with caution in patients with renal impairment. The dose should be reduced if creatinine clearance is less than 30 mL/minute and the modified-release oral preparation should be avoided in this scenario. 

Tegretol consists of carbamazepine, which is an anti-epileptic drug. There is a clinically significant drug interaction between carbamazepine and clarithromycin (macrolide antibacterial agent) resulting in higher plasma concentrations of carbamazepine. 

The macrolide antibacterials (including erythromycin, clarithromycin and telithromycin) are often implicated in interactions, most frequently as a result of inhibition of the CYP3A4 enzyme system in the liver and enterocytes. Erythromycin inhibits the metabolism of carbamazepine, ciclosporin and theophylline significant increases in serum levels and features of toxicity have been documented. Careful clinical and pharmacokinetic monitoring are required in a patient taking any of these drugs who requires concomitant erythromycin. 

Community-acquired pneumonia PO 500 mg once a day for 14 days. Contraindications Flypersensitivity to other macrolide antibacterials... 

Reboxetine Reboxetine should not be given, even after termination of MAOI therapy. Care must be exercised when treating with antihypertensive drugs, antiar-rhythmics, cyclosporin, antipsychotics, tricyclics, fluvoxamine, antidepressants, azole antifungals, and macrolide antibacterials. 

Periti P, Mazzei T, Mini E, Novelli A. Adverse effects of macrolide antibacterials. Drug Saf 1993 9(5) 346-64. 

Macrolide antibacterials An isolated case report describes what appeared to be acute fluoxetine intoxication in a man brought about by the addition of clarithromycin. 

Agouridas, C., Benedetti, Y, Denis, A., LeMartret, O., and Chantot, J. F. (1995). Ketolides A new distinct class of macrolide antibacterials—Synthesis and structural characteristics of RU (X)4. Presented at 35th Intersci. Conf. Antimicrob. Agents Chemother. (Sept. 17-20, San Francisco), Abstr. No. F-157. 

Mallams, A. K., and Rossman, R. R. (1989). Semisynthetic macrolide antibacterials derived tylosin. Synthesis of 23-O-demycinosyl tylosin and related compounds. J. Chem. Soc. Perkin Trans. /, 775-785. 

Von Rosenstiel, N. A., and Adam, D. (1995). Macrolide antibacterials Drug interactions of clinical significance. Drug Safety 13, 105-122. 

J. McFarland, C. Berger, S. Froshauer, S. Hayashi, S. Hecker, B. Jaynes, M. Jefson, B. Kamicker, C. Lipinski, K. Lundy, C. Reese and C. Vu, Quantitative structure-activity relationships among macrolide antibacterial agents In vitro and in vivo potency against PasteureUa multodda, /. Med. Chem., 1997,40,1340-1346. 

It has been suggested that ergot alkaloids should be avoided with azithromycin, because clinically important interactions have been seen between these driMS and other macrolide antibacterials related to azithromycm," ""md the UK manufacturers of both ergotamine and azithromycin contraindicate the combination." " However, there seems so far to be no direct evidence of any adverse interactions between ergot alkaloids and azithromycin, and the US manufacturers say that concurrent use can be undertaken with careful monitoring.""... 

Cases of acnte rhabdomyolysis have been reported between lovas-tatin and azithromycin, clarithromycin, or erythromycin and between simvastatin and clarithromycin or roxithromycin. Macrolide antibacterials have also been potentially implicated in cases of rhabdomyolysis with atorvastatin and pravastatin. Pharmacokinetic stndies sn est that the macrolides increase the levels of the statins metabolised by CYP3A4 (namely atorvastatin, Iovastatin and simvastatin). 

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