Macrolides- Binds bacterial ribosomal unit (50s) → blocks protein synthesis; alternative for PCN-allergic patients; spectrum: GP/GN bacteria, spirochetes, atypical mycobacteria
- Adverse effects: cholestatic hepatitis (estolate form of erythromycin), nausea, diarrhea
- Inhibits cytochrome p450: ↑ levels of p450 substrates like cyclosporine, anticonvulsants, warfarin, digoxin, benzodiazepines, HMG-CoA reductase inhibitors, theophylline (latter combination can cause cardiac arrhythmias); erythromycin + lovastatin → rhabdomyolysis; clarithromycin + CCBs → bradycardia, hypotension
- Pregnancy category C (clarithromycin), category B (erythromycin, azithromycin)
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