Macrolide antibiotics--does problem with one automatically rule out others?

Question

I can't take zithromax, but I have taken another macrolide several times in the last few years (clarithromycin?), and don't recall having any trouble with it.  But now they say I can't take it any more.  I have had so many drug reactions in the past that there are very few antibiotics I can take, and don't want to cut this one off the list unless it's absolutely necessary.  It's good for bronchitis, which I tend to get two or three times a year at least.

My reaction to zithromax years ago was chest pain.  The urgent care doctor I saw at the time (I was out of town) diagnosed pleurisy caused by the medicine.  This sounds a little odd to me now that I think about it, but I suppose it's possible.

Do you know anything about this kind of drug reaction?  Can you give me information or intelligent questions to ask my doctor and pharmacist to get to the bottom of this?

Thanks so much for your help.

Anonymous · Accepted Answer

Having had pleurisy twice, I know how painful it is!  I was uncertain, however, about its being caused by medicines because both times mine developed from a bad case of bronchitis.  Here is what I found, with the part I doubted marked with *****: 

What causes pleurisy?

Pleurisy can be caused by any of the following conditions:

*    Infections: bacterial (including those that cause tuberculosis), fungi, parasites, or viruses
*   Inhaled chemicals or toxic substances: exposure to some cleaning agents like ammonia
*    Collagen vascular diseases: lupus, rheumatoid arthritis
*   Cancers: for example, the spread of lung cancer or breast cancer to the pleura
*    Tumors of the pleura: mesothelioma or sarcoma
*    Congestion: heart failure
*    Pulmonary embolism: blood clot inside the blood vessels to the lungs. These clots sometimes severely reduce blood and oxygen to portions of the lung and can result in death to that portion of lung tissue (termed lung infarction). This, too, can cause pleurisy.
*    Obstruction of lymph channels: as a result of centrally located lung tumors
*   Trauma: rib fractures or irritation from chest tubes used to drain air or fluid from the pleural cavity in the chest

*****  Certain drugs: drugs that can cause lupus-like syndromes (such as hydralazine [Apresoline], Procan [Pronestyl, Procan-SR, Procanbid - these brands no longer are available in the U.S.], phenytoin [Dilantin], and others)

*    Abdominal processes: such as pancreatitis, cirrhosis of the liver, gallbladder disease, and damage to the spleen.
*    Pneumothorax: air in the pleural space, occurring spontaneously or from trauma.

? · Answer

It sounds like you need to talk with your pharmacist. I very often find myself correcting misconceptions about antibiotic allergies from my physician/NP/PA colleagues -- your pharmacist is well-positioned to get to the bottom of the issues and figure out what can/should be used for you.

Macrolide antibiotics--does problem with one automatically rule out others?

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