Macrolides and Drug-Drug Interactions
Macrolides have various effects on other medications. Therefore, the nursing
assessment should include obtaining a history of all drugs (OTC or prescribed) or
herbals the patient may be taking. Macrolides can increase the therapeutic levels
of alfentanil (Alfenta), carbamezepine (Tegretol), and cyclosporine (Sandimmune),
resulting in the patient experiencing a toxic effect.
Terfenadine (Seldane) or astemizole (Hismanal) given with macrolides might
cause toxicity to the heart. The patient is also at risk for hemorrhage if the patient
takes both warfarin (Coumadin) and marolides within the same time period. The
patient may also experience increased theophylline levels which can lead to
toxicity when theophylline is given along with zanthines such as aminophylline
and caffeine.Macrolides, Nursing Diagnosis,
and Collaborative Problems
Here are the common nursing diagnoses that are related to a patient who is
receiving marolides.- Altered bowel elimination pattern
- Impaired tissue integrity related to inflammation or phlebitis at the injec-
tion site - Fluid volume deficit related to nausea and vomiting
- Alteration in comfort related to abdominal cramping
- Sensory-perceptual disturbance related to hearing loss
- Altered protection related to loss of normal flora
LINCOSAMIDES
Lincomycin (Lincocin) has been used in the past to treat serious streptococci,
pneumococci, and staphylococci infections but has generally been replaced by
safer and more effective antibiotics. Clindamycin (Cleocin) is a semisynthetic
derivative of lincomycin and has a similar mechanism but is more effective. It is
indicated for the treatment of bone and joint infections, pelvic (female) and
intraabdominal infections, bacterial septicemia, pneumonia, and skin and soft
tissue infections. In a normal dose, lincosamides prevent the growth of bacteria
(bacteriostatic). In larger doses, it kills bacteria (bacteriocidal).(^224) CHAPTER 13 Antimicrobials—Fighting Infection