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Clarithromycin Pharmacology

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On this episode, I discuss clarithromycin pharmacology, adverse effects, and drug interactions.

Clarithromycin is a macrolide antibiotic that can be used for many similar indications as azithromycin.

Clarithromycin has numerous drug interactions as it can inhibit CYP3A4. This limits its use in practice.

Clarithromycin can be used in the treatment of H. pylori in combination with other antibiotics and a PPI.

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Fosfomycin Pharmacology

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Fosfomycin is an antibacterial agents that can be utilized in the management of uncomplicated UTIs.

Uniquely, fosfomycin comes as a packet that needs to be mixed with COOL water. I discuss this further on the podcast.

Typhoid and Cholera vaccine effectiveness may be reduced when used with fosfomycin.

When there is kidney or systemic infection involvement, it is recommended to avoid the use of fosfomycin.

I discuss important drug interactions on the podcast, be sure to check out my latest project which is a 200+ page book on managing drug interactions in primary care.

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Metronidazole Pharmacology

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Metronidazole (Flagyl) is an antibiotic that is used for various infections.

Metronidazole can certainly cause GI upset like most antibiotics, but uniquely may also cause a metallic taste.

Metronidazole is also rarely associated with CNS changes and can induce the potential for peripheral neuropathy.

Patients should avoid alcohol with the use of metronidazole and this is on account for the possibility of a disulfiram reaction. I discuss some of the symptoms of this reaction in the podcast.

Metronidazole can substantially raise the concentrations of warfarin. INR monitor and a reduction in dose of warfarin may be necessary.

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Erythromycin Pharmacology

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Erythromycin uniquely has some potential benefit in the setting of gastroparesis. Azithromycin you will likely not see used for this indication.

Erythromycin binds the 50s subunit and ultimately prevents protein synthesis which is necessary for bacteria to grow and replicate.

QTc prolongation is a risk with all macrolide antibiotics (erythromycin included).

By inhibiting CYP3A4, erythromycin can be responsible for numerous drug interactions.

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Azithromycin Pharmacology

Azithromycin Pharmacology

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On this episode, I cover azithromycin pharmacology. This drug primarily acts by inhibiting protein synthesis. It binds to the 50s ribosomal subunit.

GI adverse effects like nausea and diarrhea are going to be the most common with azithromycin.

Azithromycin has been associated with prolonging the QT interval. Drugs like amiodarone, ondansetron, citalopram, antipsychotics, and quinolone antibiotics can also prolong the QT interval.

One major advantage that azithromycin has over other antibiotics is that it has a long half life which allows for once daily dosing.

Azithromycin has numerous uses like pneumonia, MAC, alternative for ear infections in patients with a beta-lactam allergy, certain STD’s, and also is rarely used in long term COPD exacerbation prevention.

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Nitrofurantoin Pharmacology

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On this episode I breakdown nitrofurantoin pharmacology. Nitrofurantoin is an antibiotic that is used in the treatment of UTI’s.

Nitrofurantoin has activity by creating reactive metabolites that can disrupt protein synthesis and ultimately kills the bacteria causing the infection.

It is important to remember with nitrofurantoin, that in the setting of systemic infection and/or kidney involvement, the drug may not be very effective.

Nitrofurantoin can potentially reduce the effectiveness of certain vaccines. Be sure to look this up prior to administration.

Nitrofurantoin can cause pulmonary symptoms as well as neuropathy. This is very important to monitor for.

Be sure to check out our free Top 200 study guide – a 31 page PDF that is yours for FREE!