‫البقرة آية ‪32‬‬

A group of antibiotics whose activity stems from

the presence of a macrolide ring.
 The antimicrobial spectrum of macrolides is
slightly wider than that of penicillin.

Three waves of macrolides Objectives

1st Erythromycin
A Oleandomycin
Spiramycin Naturally produced

2d
Roxithromycin
Clarithromycin
 Atypical microorganisms.
Azithromycin  Improve of pharmacokinetics.
Dirithromycin

 Overcome resistance to erythromycin A.

3d Ketolides  Enhance activity against Gram-positive
bacteria.
1- ErythromycinA

2- Spiramycin
It is often used to treat toxoplasmosis in
pregnant women

3- Oleandomycin
Experimental drug and the full applications are
under research.
The first 14-membered ring macrolid developed
for clinical use.
Available forms
2. Enteric-coated tablets(base compound)

3. Oral suspensions (esteolate,ethyl succinate

& stearate)

4. Parentrally(lactobionate&glucoceptate)
 Increase absorption.

 Good stability in acid conditions.

 No enhancement of in vitro activity against

common pathogens.
 Increase in vitro activity against atypical
pathogens.
Clarithromycin
Internal ketalization

Pseudoclarithr
omycin
Aprodrug of 9S- erythromycyclamine.

More acid stable

Has less drug-drug interaction

But less active against anaerobes

15-membered macrolides
 Advantage
s

Active against
Taken once daily
G-ve bacteria
 Same pharmacokinitic profile of macrolides.

 Activity against erythromycin A resist

isolets.
The ketolides, of which telithromycin is the
first to reach clinical development, represent a
new generation of antimicrobials that have
been developed with a view to overcoming the
problem of macrolide resistance.
1. Post-transcriptional methylation of the 23S
bacterial ribosomal RNA.

2. Production of drug-inactivating enzymes

3. Production of active ATP-dependent efflux

proteins
1. Affect the metabolism of many different drugs.
2. Gastrointestinal disturbances, such as
diarrhea, nausea, abdominal pain, and
vomiting

Treatment of infections such as

respiratory tract infection.
Pneumonia is a lung parenchyma/alveolar
inflammation and (abnormal) alveolar
filling. Pneumonia can result from a variety
of causes, including infection with bacteria,
viruses, fungi, or parasites, and chemical or
physical injury to the lungs.
 The combined clinical classification of
pneumonia result in two broad categories which
are:

Community acquired Hospital acquired

pneumonia pneumonia
Is a disease in which
individuals who have not
recently been hospitalized
develop an infection of the
lungs (pneumonia). CAP is a
common illness and can
affect people of all ages.
 Coughing that produces
Problems breathing greenish or yellow
sputum

a high fever accompanied

with sweating, chills, and Sharp or stabbing chest pain
uncontrollable shaking
 Less common symptoms
include

Headaches
The coughing up of
(including migraine
blood (hemoptysis)
headaches)

Loss of appetite Excessive fatigue

1. Physical examination by a health provider

2. X-rays of the chest

3. Examination of the blood and sputum for

infectious microorganisms, and blood
tests.
1- Infants
Newborn infants Group B Streptococcus
Older infants include Streptococcus pneumoniae,
E coli, Klebsiella pneumoniae,
2-Children
Children older than one month of life are at risk
for the same microorganisms as adults.
Children and teenagers Mycoplasma pneumoniae
and Chlamydophila pneumoniae
3-Adults
Obstruction Lung disease

Immune problems
 Adult: Macrolides

 Newborn infants: intravenous ampicillin

and gentamicin

 Children

1. Non-hospitalized:

2. Hospitalized:
1. Treating any underlying illness which can
increase a person's risk for CAP
2. Smoking cessation
3. Vaccinations against
A. Haemophilus influenzae and Streptococcus
pneumoniae in the first year of life
B. Streptococcus pneumoniae is also available
for adult
C. Influenza vaccines