Macrolides; Types, Indications, Side Effects, Interactions

Last updated: February 7, 2026Reviewed date: February 7, 2026Reading time: 6 min read
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Macrolides are groups of antibiotics that are bacteriostatic agents & inhibit bacterial protein synthesis by binding reversibly to 50S ribosomal subunits of sensitive micro-organisms. It is a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria. Macrolides inhibit protein synthesis in bacteria by reversibly...

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বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

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Article Summary

Macrolides are groups of antibiotics that are bacteriostatic agents & inhibit bacterial protein synthesis by binding reversibly to 50S ribosomal subunits of sensitive micro-organisms. It is a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria. Macrolides inhibit protein synthesis in bacteria by reversibly binding to the P site of the 50S unit of the ribosome prototypic macrolide is erythromycin; other clinically important macrolides include clarithromycin and azithromycin....

Key Takeaways

  • This article explains Types of Macrolides in simple medical language.
  • This article explains Mechanism of action of Macrolides in simple medical language.
  • This article explains Indications/Uses of Macrolides in simple medical language.
  • This article explains Contraindications of Macrolides in simple medical language.
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Definition

Macrolides are groups of antibiotics that are bacteriostatic agents & inhibit bacterial protein synthesis by binding reversibly to 50S ribosomal subunits of sensitive micro-organisms. It is a class of antibiotics derived from Saccharopolyspora erythraea (originally called Streptomyces erythreus), a type of soil-borne bacteria. Macrolides inhibit protein synthesis in bacteria by reversibly binding to the P site of the 50S unit of the ribosome prototypic macrolide is erythromycin; other clinically important macrolides include clarithromycin and azithromycin.

Types of Macrolides

bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">Antibiotic macrolides

US FDA-approved 

  • Azithromycin
  • Clarithromycin
  • Erythromycin
  • Fidaxomicin
  • Telithromycin

Non-US FDA-approved

  • Carbomycin A
  • Josamycin
  • Kitasamycin
  • Midecamycin/midecamycin acetate
  • Oleandomycin
  • Solithromycin
  • Spiramycin – approved in the EU, and in other countries
  • Troleandomycin – used in Italy and Turkey
  • Tylosin/tyrosine – used in animals
  • Roxithromycin

Ketolides

Ketolides are a class of antibiotics that are structurally related to the macrolides. They are used to treat respiratory tract infections caused by macrolide-resistant bacteria. Ketolides are especially effective, as they have two ribosomal binding sites.

Ketolides include:

  • Telithromycin – the first and only approved ketolide
  • Cethromycin
  • Solithromycin

Fluoroketolides

Fluoroketolides are a class of antibiotics that are structurally related to the ketolides. The fluoroketolides have three ribosomal interaction sites. Fluoroketolides include:

  • Solithromycin – the first and currently the only fluoroketolide (not yet approved)

Non-bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">antibiotic macrolides

The drugs tacrolimus, pimecrolimus, and sirolimus, which are used as immunosuppressants or immunomodulators, are also macrolides. They have similar activity to cyclosporin.

Antifungal drugs

Polyene antimycotics, such as amphotericin B, nystatin etc., are a subgroup of macrolides. Cruentaren is another example of an antifungal macrolide.

Toxic macrolides

A variety of toxic macrolides produced by bacteria have been isolated and characterized, such as the mycolactones.

Follow chart 

Macrolides
  • Azithromycin
  • Boromycin
  • Clarithromycin
  • Dirithromycin
  • Erythromycin
  • Flurithromycin
  • Josamycin
  • Midecamycin
  • Miocamycin
  • Oleandomycin
  • Rokitamycin
  • Roxithromycin
  • Spiramycin
  • Troleandomycin
  • Tylosin
Ketolides
  • Telithromycin
  • Cethromycin
  • Solithromycin
Lincosamides
  • Clindamycin
  • Lincomycin
  • Pirlimycin
Streptogramins
  • Pristinamycin
  • Quinupristin/dalfopristin
  • Virginiamycin

Mechanism of action of Macrolides

Antibacterial

Macrolides are protein synthesis inhibitors. The mechanism of action of macrolides is inhibition of bacterial protein biosynthesis, and they are thought to do this by preventing peptidyltransferase from adding the growing peptide attached to tRNA to the next amino acid (similarly to chloramphenicol) as well as inhibiting ribosomal translation. Another potential mechanism is premature dissociation of the peptidyl-tRNA from the ribosome. Macrolide antibiotics do so by binding reversibly to the P site on the 50S subunit of the bacterial ribosome. This action is considered to be bacteriostatic. Macrolides are actively concentrated within leukocytes and thus are transported into the site of infection.

Immunomodulation

Diffuse panbronchiolitis

The macrolide antibiotics erythromycin, clarithromycin, and roxithromycin have proven to be an effective long-term treatment for the idiopathic, Asian-prevalent lung disease diffuse panbronchiolitis(DPB). The successful results of macrolides in DPB stems from controlling symptoms through immunomodulation (adjusting the immune response), with the added benefit of low-dose requirements. With macrolide therapy in DPB, a great reduction in bronchiolar infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation and damage is achieved through suppression of not only bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।" data-rx-term="neutrophil" data-rx-definition="Neutrophil is a white blood cell important for fighting bacterial infection. সহজ বাংলা: ব্যাকটেরিয়ার বিরুদ্ধে লড়াই করা শ্বেত রক্তকণিকা।">neutrophil granulocyte proliferation but also lymphocyte activity and obstructive secretions in airways. The antimicrobial and bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।" data-rx-term="antibiotic" data-rx-definition="An antibiotic is a medicine used to treat bacterial infections. সহজ বাংলা: ব্যাকটেরিয়ার সংক্রমণের ওষুধ।">antibiotic effects of macrolides, however, are not believed to be involved in their beneficial effects toward treating DPB. This is evident, as the treatment dosage is much too low to fight infection, and in DPB cases with the occurrence of the macrolide-resistant bacterium Pseudomonas aeruginosa, macrolide therapy still produces substantial infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।" data-rx-term="anti-inflammatory" data-rx-definition="Anti-inflammatory means reducing inflammation, pain, or swelling. সহজ বাংলা: প্রদাহ/ফোলা/ব্যথা কমায়।">anti-inflammatory results.

Indications/Uses of Macrolides

  • Ear, nose and throat infections – such as otitis media (infection of the middle ear), labyrinthitis (infection of the inner ear), sinusitis (infection of the sinuses), tonsillitis (infection of the tonsils) and laryngitis (infection of the voice box).
  • Chest infections – such as pneumonia (infection of the lining of the lung), bronchitis (infection of the airways of the lung) and whooping cough.
  • Skin infections – such as eczema, psoriasis or acne that has become infected.
  • Mouth and dental infections – such as gingivitis (infection of the gums) and a tooth abscess (infection in the root of a tooth).
  • Sexually transmitted infections – such as chlamydia.
  • Dental Abscess
  • Sinusitis
  • Bronchitis
  • Bacterial Endocarditis Prevention
  • Follicular Lymphoma
  • Helicobacter Pylori Infection
  • Legionella Pneumonia
  • Mycobacterium avium-intracellular,
  • Mycoplasma Pneumonia
  • Nongonococcal Urethritis
  • Otitis Media
  • Pertussis
  • Pharyngitis
  • Pneumonia
  • Skin and Structure Infection
  • Skin or Soft Tissue Infection
  • Strep Throat
  • Tonsillitis/Pharyngitis
  • Toxoplasmosis
  • Upper Respiratory Tract Infection
  • Acute Bacterial Exacerbation of Chronic Bronchitis
  • Acute maxillary sinusitis
  • Bacterial Infections
  • Bartonellosis
  • Community-Acquired Pneumonia
  • A duodenal ulcer caused by Helicobacter pylori
  • Infective Endocarditis
  • Lyme Disease
  • Mycobacterial Infection
  • Otitis Media (OM)
  • Streptococcal Pharyngitis
  • Streptococcal tonsillitis
  • Uncomplicated skin and subcutaneous tissue bacterial infections

Contraindications of Macrolides

  • You should not take macrolide antibiotics  if you are allergic to other macrolides or the ingredients in the tablets which include microcrystalline cellulose, croscarmellose sodium, magnesium stearate, and povidone
  • Macrolide antibiotics should not be used in people with a history of cholestatic jaundice and/or liver dysfunction associated with prior
  •  macrolide antibiotics use.
  • or if you have hypokalemia (low blood potassium)
  • Use of macrolide antibiotics with the following medications: cisapride, pimozide, astemizole, terfenadine, ergotamine, ticagrelor, ranolazine or dihydroergotamine is not recommended.
  • It should not be used with colchicine in people with kidney or liver impairment.
  • Concomitant use with cholesterol medications such as lovastatin or simvastatin.
  • Hypersensitivity to macrolide antibiotics or any component of the product, erythromycin, or any macrolide antibiotics.
  • QT prolongation or ventricular cardiac arrhythmias, including torsade de pointes.

Side Effects of Macrolides

The most common

Common

  • Swelling of the face, throat, eyes, hands, lips, ankles, feet, or lower legs
  • Rash
  • Hoarseness
  • Difficulty swallowing or breathing
  • Peeling or blistering skin
  • Yellowing of the skin or eyes
  • Extreme tiredness
  • Lack of energy
  • Loss of appetite
  • Unusual bleeding or bruising

Less common

  • Cough
  • fever or chills
  • hoarseness
  • lower back or side pain
  • painful or difficult urination
  • fast or chaotic heartbeats
  • skin reactions such as painful rash, red or purple spots on the skin, or blisters
  • trouble breathing
  • swelling of your face, lips, tongue, or throat

Rare

  • Fever with or without chills
  • nausea and vomiting
  • severe stomach cramps and pain
  • skin rash and itching
  • stomach tenderness
  • unusual bleeding or bruising
  • watery and severe diarrhea, which may also be bloody
  • yellow eyes or skin

Drug Interactions of Macrolides

References

Macrolides; Types, Indications, Side Effects, Interactions

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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
  • Write allergies, pregnancy status, diabetes, kidney/liver disease, and major past illnesses.
  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
  • Which tests are necessary now, and which can wait?
  • How should I take medicines safely and what side effects should I watch for?
  • When should I come for follow-up?

Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Drink safe fluids and monitor temperature.
  • In dengue-prone areas, discuss CBC and platelet count when fever persists or warning signs appear.
  • Use tepid sponging for high fever discomfort; avoid ice-cold bathing.

OTC medicine safety

  • For fever, common fever medicine may be discussed with a clinician or pharmacist.
  • Avoid aspirin/ibuprofen-like medicines in suspected dengue unless a doctor says it is safe.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Fever with breathing difficulty, confusion, repeated vomiting, bleeding, severe weakness, stiff neck, or dehydration needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

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Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Medicine doctor / pediatrician for children / qualified clinician
Tests to discuss with doctor
  • Temperature chart and hydration assessment
  • CBC with platelet count if fever persists or dengue/other infection is possible
  • Urine test, malaria/dengue tests, chest evaluation, or blood culture only when clinically indicated
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Do I need antibiotics, or is this more likely viral?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Macrolides; Types, Indications, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Write your symptom story. A health professional or site editor can review it before any answer is prepared. This box is not for emergency care.

Emergency first: Severe chest pain, breathing trouble, unconsciousness, stroke signs, severe injury, heavy bleeding, or rapidly worsening symptoms need urgent local medical care now.

Frequently Asked Questions

Is this article a replacement for a doctor?

No. It is educational content only. Patients should consult a qualified clinician for diagnosis and treatment.

When should I seek urgent care?

Seek urgent care for severe symptoms, rapidly worsening condition, breathing difficulty, severe pain, neurological changes, or any emergency warning sign.

References

Add references, clinical guidelines, textbooks, journal articles, or trusted medical sources here. You can edit this area from the RX Article Professional Blocks panel.

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