Macrolides are a class of antibiotics that contain a macrocyclic lactone ring and attached sugars. The commonly used macrolides are erythromycin, clarithromycin, roxithromycin, and azithromycin. They act by inhibiting bacterial protein synthesis by combining with the 50s ribosomal subunits and preventing translocation. Macrolides are bacteriostatic at low concentrations and bactericidal at high concentrations, with a narrow spectrum covering many gram-positive bacteria and some gram-negatives. Newer macrolides include roxithromycin, clarithromycin, azithromycin, and spiramicin.