Macrolide and Polypeptide Antibiotics 333- Skin/skin structure infections: Fu-
runculosis, pyoderma and impetigo
due to Staphylococcus aureus, S.
pyogenes or S. agalactiae.
Adverse reactions include vomiting,
dyspepsia, flatulence, jaundice, palpita-
tions, chest pain. Allergic reactions include
rash, photosensitivity and angioedema.
CNS side effects are headache, dizziness,
vertigo and fatigue.
CLARITHROMYCIN
It is a macrolide antibiotic obtained by
substitution of hydroxyl group by a CH 3 O
group in the erythromycin lactone ring. It
is found to be 2 to 10 times more active than
erythromycin.
Clarithromycin is readily and rapidly
absorbed after oral administration and is
metabolized significantly in liver. Active
metabolite is excreted by kidney and other
routes.
It is indicated in the treatment of lower
respiratory tract infection e.g. bronchitis
and pneumonia, upper respiratory tract
infections e.g. pharyngitis and sinusitis,
infections due to chlamydia, legionella and
mycoplasma, skin and soft tissue infections
and eradication of H. pylori with acid
suppressants.
The most frequently reported side
effects are GI-related complaints i.e.
nausea, dyspepsia, abdominal pain and
diarrhoea. Other side effects include
headache, skin rash and transient elevation
of liver enzymes, hepatic dysfunction with
or without jaundice and psychosis.
CLINDAMYCIN
It is a lincosamide and act by binding ex-
clusively to 50S submit of the bacterial ri-
bosomes and hence suppresses protein
synthesis. It is 7-chloro-7-deoxylincomycin,
a semisynthetic derivative of lincomycin.
It inhibits most of the gram positive
cocci e.g. streptococci, staphylococci and
pneumococci, C. diphtheriae, Actinomyces,
Nocardia and Toxoplasma.
It is used in the treatment of severe
anaerobic infections caused by bacteroides
and other anaerobes. It is also used in
combination with aminoglycoside in the
treatment of abdomen and GIT wounds,
infections of female genital tract, pelvic
abscesses, aspiration pneumonia and septic
abortion. It is also used for prophylaxis of
endocarditis. It is also used along with
primaquine in Pneumocystis carinii
pneumonia in AIDS patients and with
pyrimethamine for toxoplasmosis.
Oral absorption is good. It is largely
metabolized and metabolites are excreted
in urine and bile.
Adverse effects include pain at
injection site, stomatitis, glossitis,
angioneurotic edema, serum sickness,
vertigo, tinnitus, aplastic anaemia.
Hypotension and cardiac arrest after rapid
IV use. Anorexia, metallic taste,
oesophagitis, abdominal pain.LINCOMYCIN
It is mainly bacteriostatic and inhibits
the growth of gram positive organisms
which includes staphylococci, streptococci,
pneumococci, C. diphtheriae and B.
anthracis. Like erythromycin it act by
interfering with protein synthesis.
Adverse effects include nausea,
vomiting, diarrhoea, abdominal pain,