Antibiotic Use and Management

Antibiotic Classification and Mechanism

Macrolide antibiotics, including erythromycin, clarithromycin, and azithromycin, inhibit RNA-dependent protein synthesis by binding to the 50S subunit of the bacterial ribosome, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 1, 2
Fluoroquinolone antibiotics, such as ciprofloxacin, levofloxacin, and moxifloxacin, exert bactericidal activity by binding to DNA gyrase and topoisomerase IV, inhibiting DNA synthesis, according to the American Academy of Otolaryngology-Head and Neck Surgery 1

Healthcare providers should select antibiotics based on the suspected pathogen, local resistance patterns, patient allergies, and patient comorbidities to ensure optimal outcomes, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery and Clinical Infectious Diseases 1, 2
Erythromycin is generally bacteriostatic, but can be bactericidal against certain species, and is used systemically for respiratory infections, skin infections, and as an alternative for penicillin-allergic patients, according to the American Academy of Otolaryngology-Head and Neck Surgery and the American Thoracic Society 1, 3
The American Gastroenterological Association notes that there is limited data on the efficacy and resistance of certain antibiotics, such as nitrofuran derivatives and combinations of neomycin with bacitracin or erythromycin 4

Macrolide resistance is increasing, with approximately 5-8% of Group A Streptococcus in the US showing resistance, as reported by the Infectious Diseases Society of America 5
Cross-resistance is not expected between different antibiotic classes, and allergic reactions to one class do not predict reactions to others, as stated by the American Academy of Otolaryngology-Head and Neck Surgery 1