Macrolides

[BAC] Topical azithromycin or erythromycin; part of hyperacute combinations. StatPearls: "Topical erythromycin has been a therapeutic choice for years; however, microbial resistance has limited its usefulness." Hyperacute gonococcal or meningococcal treatment "includes systemic and topical antibiotics (eg, ceftriaxone, azithromycin, fluoroquinolones)." Adult chlamydial (inclusion) conjunctivitis "does not respond to standard antibiotic therapies" and needs systemic treatment with partner treatment.

The partner drug and the atypical-coverage class — Legionella is treated with macrolides. β-lactam + macrolide is the core inpatient regimen for both non-severe and severe CAP. Monotherapy for healthy outpatients is allowed only where local pneumococcal macrolide resistance is < 25% (IDSA/ATS 2019, via StatPearls — still the CAP guideline IDSA lists; IDSA declined to endorse the 2025 update issued by the ATS alone).

Azithromycin has three different statuses on one page, and the contrast is the teaching. Preferred: a macrolide is what a pregnant patient with chlamydia receives, which is the exact reversal of the non-pregnant order — and the reason is that tetracyclines are avoided in pregnancy, so the class changes rather than the dose. The pregnancy regimen itself belongs to this class page. Alternative: outside pregnancy it is an alternative first-line for chlamydia, behind doxycycline, and azithromycin is half of the cephalosporin-allergy gonorrhea regimen, paired with gentamicin. Forbidden: for syphilis, "azithromycin should not be used as treatment for syphilis" because of macrolide resistance — so a penicillin-allergic non-pregnant patient gets doxycycline, tetracycline or ceftriaxone, never a macrolide. Holding all three positions at once is what prevents the two commonest errors, which are reaching for azithromycin as the universal single-dose answer and reaching for it when penicillin cannot be used. The disorder-side value of a single observed dose in pregnancy is adherence: it is given and watched rather than dispensed and hoped for, which matters in a population being treated to protect a fetus. Macrolide pharmacokinetics, QT effects and the interaction profile belong to the class page.

The original β-lactams — bactericidal cell-wall inhibitors. The defining nursing job is screening for and recognizing allergy, from rash to anaphylaxis.

β-lactam cousins of penicillin, organized by generation — each generation trades some gram-positive reach for broader gram-negative coverage.

Powerful, broad-spectrum DNA-synthesis blockers — but a boxed warning for disabling tendon, nerve, and CNS effects means they’re reserved when alternatives exist.

Suppress viral replication rather than kill viruses outright. The nursing essentials: hydrate with acyclovir, start early (flu within 48 h), and remember most antivirals suppress — they don’t cure.

Powerful IV drugs for serious Gram-negative infection — but nephrotoxic and ototoxic. Levels matter.

Broad-spectrum 30S inhibitors. Generally avoided in pregnancy and in children 8 or younger (permanent tooth staining) unless the infection is serious — doxycycline is still first-line for Rocky Mountain spotted fever at any age — and kept apart from dairy/antacids.