Editing Macrolide (section)

==Side-effects==
A 2008 ''[[British Medical Journal]]'' article highlights that the combination of some macrolides and [[statins]] (used for lowering cholesterol) is not advisable and can lead to debilitating [[myopathy]].<ref>{{cite journal | vauthors = Sathasivam S, Lecky B | title = Statin induced myopathy | journal = BMJ | volume = 337 | pages = a2286 | date = November 2008 | pmid = 18988647 | doi = 10.1136/bmj.a2286 | s2cid = 3239804 }}</ref> This is because some macrolides (clarithromycin and erythromycin, not azithromycin) are potent [[enzyme inhibitor|inhibitors]] of the [[cytochrome P450]] system, particularly of [[CYP3A4]]. Macrolides, mainly erythromycin and clarithromycin, also have a class effect of [[QT prolongation]], which can lead to [[torsades de pointes]]. Macrolides exhibit [[enterohepatic recycling]]; that is, the drug is absorbed in the gut and sent to the liver, only to be excreted into the [[duodenum]] in bile from the liver. This can lead to a buildup of the product in the system, thereby causing nausea. In infants the use of erythromycin has been associated with pyloric stenosis.<ref>{{cite journal | vauthors = SanFilippo A | title = Infantile hypertrophic pyloric stenosis related to ingestion of erythromycine estolate: A report of five cases | journal = Journal of Pediatric Surgery | volume = 11 | issue = 2 | pages = 177–80 | date = April 1976 | pmid = 1263054 | doi = 10.1016/0022-3468(76)90283-9 }}</ref><ref>{{cite journal | vauthors = Honein MA, Paulozzi LJ, Himelright IM, Lee B, Cragan JD, Patterson L, Correa A, Hall S, Erickson JD | title = Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromcyin: a case review and cohort study | journal = Lancet | volume = 354 | issue = 9196 | pages = 2101–5 | year = 1999 | pmid = 10609814 | doi = 10.1016/S0140-6736(99)10073-4 | s2cid = 24160212 }}</ref>

Some macrolides are also known to cause [[cholestasis]], a condition where bile cannot flow from the liver to the duodenum.<ref>{{cite journal | vauthors = Hautekeete ML | title = Hepatotoxicity of antibiotics | journal = Acta Gastro-Enterologica Belgica | volume = 58 | issue = 3–4 | pages = 290–6 | year = 1995 | pmid = 7491842 }}</ref> A study reported in 2019 found an association between erythromycin use during infancy and developing IHPS (Infantile hypertrophic pyloric stenosis) in infants.<ref name=":0">{{cite journal | vauthors = Abdellatif M, Ghozy S, Kamel MG, Elawady SS, Ghorab MM, Attia AW, Le Huyen TT, Duy DT, Hirayama K, Huy NT | title = Association between exposure to macrolides and the development of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis | journal = European Journal of Pediatrics | volume = 178 | issue = 3 | pages = 301–314 | date = March 2019 | pmid = 30470884 | doi = 10.1007/s00431-018-3287-7 | s2cid = 53711818 }}</ref> However, no significant association was found between macrolides use during pregnancy or breastfeeding.<ref name=":0" />

A Cochrane review showed gastrointestinal symptoms to be the most frequent adverse event reported in literature.<ref>{{cite journal |last1=Hansen |first1=Malene Plejdrup |last2=Scott |first2=Anna M |last3=McCullough |first3=Amanda |last4=Thorning |first4=Sarah |last5=Aronson |first5=Jeffrey K |last6=Beller |first6=Elaine M |last7=Glasziou |first7=Paul P |last8=Hoffmann |first8=Tammy C |last9=Clark |first9=Justin |last10=Del Mar |first10=Chris B |title=Adverse events in people taking macrolide antibiotics versus placebo for any indication |journal=Cochrane Database of Systematic Reviews |volume=1 |pages=CD011825 |date=18 January 2019 |issue=1 |doi=10.1002/14651858.CD011825.pub2|pmid=30656650 |pmc=6353052 }}</ref>