Macrolide antibiotics (macrolides) are among the most commonly prescribed antibiotics worldwide and are used for a wide range of infections. However, macrolides also put people at risk of side effects.
Because adverse events are treatment dependent and not disease dependent, it is possible to increase the number of adverse events available for analysis by pooling randomized controlled trials of the same treatment for different diseases.
A Cochrane data analysis was performed to quantify the number of reported adverse events in people taking macrolide antibiotics compared to placebo. In the article estet-portal.com you can see the results of the systematic review from 2019.
Macrolides: confirmed adverse events
Authors included randomized clinical trials comparing a macrolide antibiotic (azithromycin, clarithromycin, erythromycin, or roxithromycin) with placebo.
Included 183 studies with 252,886 participants. Most studies have used macrolides for the treatment or prevention of acute respiratory tract infections, cardiovascular disease, chronic respiratory disease, gastrointestinal disease, or urogynecological problems.
Gastrointestinal adverse events were the most commonly reported type of adverse events. Compared to placebo, macrolides caused more diarrhea (72 people out of 1000), abdominal pain (62/1000) and nausea (47/1000), vomiting (23/1000) and gastrointestinal disorders (85/1000.
There was no clear difference in gastrointestinal adverse events between different types of macrolides or route of administration.
Taste disturbances were more frequently reported in participants taking macrolide antibiotics, although there were wide confidence intervals and moderate heterogeneity (low-quality evidence).
Compared to participants taking placebo, those taking macrolides were more likely to experience hearing loss, however, only four studies reported this result (low-quality evidence).
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Macrolides: disproved adverse events
The authors found no evidence that macrolides caused more cardiovascular events (odds ratio (OR) 0.87, 95% confidence interval (CI) 0.54 to 1.40; very low-quality evidence); hepatobiliary disorders (OR 1.04, 95% CI 0.27 to 4.09; very low-quality evidence); or changes in liver enzymes (OR 1.56, 95% CI 0.73 to 3.37; very-low-quality evidence) compared with placebo.
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The authors found no evidence that participants who received macrolides were more likely (compared to placebo) to report loss of appetite, dizziness, headache, respiratory symptoms, blood disorders, skin and soft tissue infections, itching, or rash.
There was no increase in mortality among participants taking macrolides compared to placebo (low-quality evidence).
Macrolides: advantages over placebo
Macrolides caused less coughing and fewer respiratory tract infections (moderate-quality evidence) compared with placebo. Reductions in febrile days (moderate-quality evidence) were also reported by participants taking macrolides compared with placebo, although these results were not significant.
Thus, macrolides clearly increased the incidence of gastrointestinal side effects. Therefore, it is optimal to prescribe antibiotics of this group for the most optimal period (maximum reduction in the period of drug therapy) and prescribe drugs to reduce the manifestation of side effects from the gastrointestinal tract.
It is also worth noting the safety of macrolides in terms of their effect on the cardiovascular, hepatobiliary, and hematopoietic systems.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Infectology" section. You may be interested in A new antibiotic of the tetracycline group has been synthesized
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