Classifications: macrolide antibiotic; Therapeutic: antibiotic
Pregnancy Category: C
250 mg capsules
Binds to the 50S ribosomal subunit, resulting in inhibition of bacterial protein synthesis. Action is mainly bacteriostatic
but can be bacteriocidal depending on bacterial sensitivity.
Effective against susceptible strains of Clostridium, Haemophilus, Neisseria, Staphylococcus, Streptococcus, and pneumonia.
Acute, severe infections of upper respiratory tract caused by susceptible strains of pneumococci and group A beta-hemolytic
History of hypersensitivity to any of the macrolide antibiotics; bacteriemia; concurrent use with ergot derivatives, pimozide,
astemizole, or cisapride; use for prophylaxis or for minor infections; pregnancy (category C); porphyria.
Impaired liver function; lactation.
Route & Dosage
|Upper Respiratory Tract Infections
Adult: PO 250500 mg q6h
Child: PO 6.611 mg/kg (125250 mg) q6h
- Give on an empty stomach (1 h before or 2 h after meals).
- Give in evenly spaced intervals throughout the day, preferably around the clock, in order to maintain effective blood levels.
Adverse Effects (≥1%) GI: Abdominal cramps and discomfort, nausea,
, cholestatic jaundice
. Body as a Whole:
Allergic reactions (urticaria, skin rash, anaphylaxis
Diagnostic Test Interference
Troleandomycin may cause false elevations of urinary 17-ketosteroids (Drekter), and 17-hydroxycorticosteroids (Porter-Silver method).
May increase levels of carbamazepine, cyclosporines
, and theophylline
and their toxicity
; oral contraceptives
may cause cholestatic jaundice; warfarin
may increase prothrombin time (PT); ergotamine
may induce ischemia and peripheral vasospasm. Food: Grapefruit juice
(>1 qt/d) may increase plasma
concentrations and adverse effects.
Incompletely from GI tract. Peak:
2 h. Distribution:
Distributed throughout body fluids
; diffusion into CSF is poor unless meninges are inflamed. Metabolism:
In liver. Elimination:
In bile and urine.
Assessment & Drug Effects
- Lab tests: Obtain periodic liver function tests in patients receiving drug longer than 10 d or in repeated courses.
- Some patients develop an allergic type of hepatitis with right upper quadrant pain, fever, nausea, vomiting, jaundice, eosinophilia,
and leukocytosis. Liver changes are reversible if drug is discontinued immediately.
- Be aware that superinfections are most likely to occur in patients on prolonged or repeated therapy. Withdraw if symptoms
present (see Appendix F), and start appropriate therapy.
Patient & Family Education
- Report signs of jaundice: Clay-colored stools, pruritus, yellow sclerae.
- Do not stop drug before full course of therapy is completed. Do not interrupt and then restart therapy or increase or decrease
dose or interval.