Formulary

5.1.5 Macrolides

First Line
Second Line
Specialist
Hospital Only

MHRA Drug Safety Update (February 2022): Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions

  • An observational study has shown that co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis is associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and cardiovascular mortality
  • Carefully consider the benefits and risks before prescribing systemic azithromycin or other systemic macrolide antibiotics (erythromycin or clarithromycin) to patients being treated with hydroxychloroquine or chloroquine
  • See the safety update for advice to give to patients
Azithromycin
  • Tablets 250mg (£1.13 = 4 tablets), 500mg (£1.08 = 3 tablets)
  • Oral suspension 200mg/5ml (£4.06 = 15ml)

Indications

    Clarithromycin
    • Tablets 250mg, 500mg (£2.62, £5.87 = 14 tablets)
    • Oral suspension 125mg/5ml, 250mg/5ml (£3.54, £4.90 = 70ml)

    Indications

    Erythromycin
    • Gastro-resistant tablets 250mg (£1.96 = 28 tablets)

    Indications

    Notes:

    1. MHRA Drug Safety Update (December 2020): Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis
      1. an increased risk of infantile hypertrophic pyloric stenosis following exposure to erythromycin in infancy has been reflected in the product information for some time
      2. data from three recent meta-analyses has led to updates for the magnitude of increased risk with erythromycin use during infancy in general, and to reflect that the risk is highest in the first 14 days after birth
      3. consider the benefit of erythromycin therapy against the potential risk of developing infantile hypertrophic pyloric stenosis
      4. advise parents to seek advice from their doctor if vomiting or irritability with feeding occurs in infants during treatment with erythromycin