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PubMed1977

Comparison of erythromycin base and estolate in gonococcal urethritis.

A randomized double-blind trial of 152 men with gonococcal urethritis compared the therapeutic efficacy of erythromycin estolate and erythromycin base. Twenty-one of 86 (24%) men treated with the estolate and 15 of 66 (23%) treated with the base had recurrent or persistent gonococcal infection when seen after a 9-g course of erythromycin. The serum erythromycin activity among estolate-treated patients (3.57 +/- 0.84 microgram/ml) was nearly twice that for base-treated patients (1.76 +/- 0.80 microgram/ml). Our findings do not support routine use of erythromycin for treatment of pregnant, penicillin-allergic patients.

Clinical Trials as Topic↗
PubMed1990

Penicillin tolerance and erythromycin resistance of group A beta-hemolytic streptococci in Hawaii and the Philippines.

Penicillin remains the drug of choice for the treatment of streptococcal pharyngitis, with erythromycin as an alternative drug for individuals who cannot take penicillin. Two areas of concern in the management of streptococcal pharyngitis are (1) the prevalence of penicillin-tolerant group A beta-hemolytic streptococci reported in recent studies and (2) the high prevalence of erythromycin resistance in some geographic areas. We tested 305 isolates of group A beta-hemolytic streptococci from Hawaii and the Philippines for penicillin minimum inhibitory concentrations and minimum bactericidal concentrations and erythromycin minimum inhibitory concentrations. There was no evidence of penicillin resistance or tolerance. The prevalence of erythromycin-resistant and moderately susceptible isolates was 3.6% and 2.3%, respectively. There was a trend toward greater erythromycin resistance levels among Hawaiian isolates, but this was not statistically significant.

Drug Resistance, Microbial↗
PubMed1994

Decline of erythromycin resistance of group A beta-hemolytic streptococci in Japan. Comparison with worldwide reports.

OBJECTIVE: To determine the current prevalence of erythromycin resistance and penicillin tolerance of group A beta-hemolytic streptococci (GABHS) in Japan. RESEARCH DESIGN: One hundred four isolates of GABHS from the civilian community in Tokyo and 101 isolates from the military population at the US Air Force Base in Yokota, Japan, were tested for erythromycin susceptibility and penicillin susceptibility and tolerance. SETTING: US Army Medical Center. RESULTS: Of the Japanese civilian isolates, two were moderately susceptible and none were resistant to erythromycin; of the military isolates, none were moderately susceptible and one was resistant, for an overall resistance rate of 0.49%. All isolates were exquisitely susceptible to penicillin, and no evidence of penicillin tolerance was found. CONCLUSIONS: Comparison with similar studies world-wide shows that erythromycin susceptibility of GABHS in Japan is now among the lowest in the world, while just over a decade ago it was the highest. These observations mandate constant monitoring of erythromycin resistance of GABHS wherever this drug is used to treat patients with infections due to this organism.

Drug Resistance, Microbial↗
PubMed1993

Erythromycin improves emptying of the denervated stomach after oesophagectomy.

Oesophagectomy, necessitating vagotomy, is associated with delayed gastric emptying. Cisapride and erythromycin have prokinetic effects and improve emptying of the innervated stomach. Their effect on the denervated stomach following oesophagectomy is unknown. The effect of pyloroplasty, cisapride and erythromycin on the rate of gastric emptying after oesophagectomy was studied using a radiolabelled meal. Oesophagectomy was associated with a marked delay in gastric emptying (56 per cent of the test meal remaining after 4 h) compared with age- and sex-matched normal controls (16 per cent; P < 0.001). Erythromycin improved the rate of gastric emptying to preoperative control values (18 per cent). Cisapride had no significant effect on gastric emptying. After pyloroplasty, 32 per cent of the label remained at 4 h (P = 0.065). The mean(s.e.m.) half-emptying time in patients receiving erythromycin was 94(29) min, which was similar to control values, 55(3) min (P = 0.26). Erythromycin may have a role in the treatment of gastric stasis following oesophagectomy or truncal vagotomy.

Aged↗
PubMed1976

Erythromycin and clindamycin absorption and elimination in pregnant women.

Thirty-nine pregnant women admitted for therapeutic abortions during early or mid pregnancy were given erythromycin estolate, erythromycin base, or clindamycin hydrochloride orally in single or multiple doses. Peak serum levels of clindamycin were 3.4 to 9.0 mug/ml following a single dose of 450 mg, whereas peak serum levels of erythromycin were 0.29 to 7.2 mug/ml following 500 mg in a single dose. The individual variability of serum concentrations of erythromycin was greater than that reported in normal men and nonpregnant women, whereas the serum levels of clindamycin were rather uniform, and similar to what has been reported in nonpregnant individuals. Following multiple doses of each antibiotic, high serum levels were obtained in virtually all subjects, and urine levels were also higher. Following single doses the mean urinary recovery was 2% for erythromycin and 16.8% for clindamycin.

Abortion, Therapeutic↗
PubMed1990

Effect of concurrent sucralfate administration on the absorption of erythromycin.

To determine the influence of sucralfate on the absorption of erythromycin, prior to evaluating its efficacy in decreasing erythromycin-associated gastrointestinal (GI) intolerance, we assessed pharmacokinetic parameters in six healthy adult volunteers. Erythromycin ethylsuccinate administered alone or with sucralfate as a single dose was compared. Sucralfate did not significantly alter the elimination rate constant, half-life, or area under the curve for erythromycin ethylsuccinate. It is therefore unlikely that efficacy of erythromycin ethylsuccinate will be altered when sucralfate is coadministered.

Adult↗
PubMed1976

Intestinal secretion of erythromycin base.

Erythromycin fluxes into rabbit midjejunal segments were studied. When erythromycin was infused into the jugular vein of anesthetized rabbits, the antibiotic was secreted into the segments at a rate of 0.0136 +/- 0.0023 mg/min. Preloading of the segments with five and 20 times the plasma concentration did not diminish this secretion. Protein binding of the antibiotic within the lumen could not explain this secretion, since both ultrafiltration and chromatography of luminal solutions indicated that the biological activity was free erythromycin. Moreover, the transmural potential across the intestinal mucosa is likely to be theprincipal driving force, since greater than 80 mv would be required to sustain the observed secretion against an imposed 20-fold concentration difference between blood and lumen. The best explanation for the intestinal secretion of erythromycin appears to be an active transport pathway capable of concentrating erythromycin in the lumen. It is not clear what endogenous substances are transported by this pathway.

Animals↗
PubMed1978

Bioavailability of erythromycin stearate: influence of food and fluid volume.

The influence of various test meals and coadministered water volumes on erythromycin stearate bioavailability from orally dosed film-coated tablets was studied in healthy human subjects. Serum erythromycin levels were uniformly reduced by all test meals, with the reduction in mean peak serum levels varying from 47 to 60%. Serum erythromycin levels also were reduced significantly in fasted individuals when the accompanying water volume was reduced from 250 to 20 ml. The apparent drug absorption rate constant was not influenced by treatments. This result is probably due to rapid degradation of solubilized, unabsorbed drug in the GI tract. Higher and more uniform serum erythromycin levels are obtained when erythromycin stearate tablets are given on an empty stomach together with an adequate water volume.

Adult↗
PubMed1978

Pharmacokinetics of intravenous erythromycin.

Erythromycin pharmacokinetics were examined following intravenous infusion to male subjects. The biological half-life of erythromycin in serum was 2 hr in individuals with normal renal function. The half-life varied in cases of reduced renal function, with values of 3.9 and 7.0 hr occurring in two subjects with severe renal impairment. Postinfusion serum erythromycin levels were adequately described by two-compartment model kinetics, and values for the distribution volume of the central compartment and the overall distribution are described. Estimated erythromycin distribution volumes in normal individuals may facilitate calculation of absorption efficiencies of erythromycin and its salts after oral doses.

Adult↗
PubMed1996

Mutations in domain II of 23 S rRNA facilitate translation of a 23 S rRNA-encoded pentapeptide conferring erythromycin resistance.

Mutations in domain II of Escherichia coli 23 S rRNA that cause resistance to erythromycin do so in a manner fundamentally different from mutations at the drug binding site in domain V of the 23 S rRNA. The domain II mutations are located in a hairpin structure between nucleotides 1198 and 1247. This is close to a short open reading frame in the 23 S rRNA that encodes a pentapeptide (E-peptide) whose expression in vivo renders cells resistant to erythromycin. Therefore, a possible mechanism of resistance caused by domain II mutations may be related to an increased expression of the E-peptide. To test this hypothesis, a range of point mutations was generated in domain II of 23 S rRNA in the vicinity of the E-peptide open reading frame. We find a correlation between erythromycin resistance of the mutant clones and increased accessibility of the ribosome binding site of the E-peptide gene. Furthermore, the erythromycin resistance determinant in the mutants was shown to be confined to a small 23 S rRNA segment containing the coding region and the ribosome binding site of the E-peptide open reading frame. It thus appears that the domain II mutations mediate erythromycin resistance by increasing expression of the 23 S rRNA-encoded E-peptide.

Base Sequence↗
PubMed1995

A double-blind controlled evaluation of the sebosuppressive activity of topical erythromycin-zinc complex.

In a double-blind randomised study, 14 volunteers applied 4% erythromycin plus 1.2% zinc (Zineryt lotion) and 4% erythromycin lotions, each on half of the forehead twice daily for 3 months. The sebum output was evaluated at 3-week intervals using the photometric and the lipid-sensitive film methods. Evaluations of casual level (CL) and sebum excretion rate (SER) were made with a Sebumeter, and total area of lipid spots (TAS) was measured on Sebutapes. Compared to baseline values, the formulation of the erythromycin-zinc complex induced significant reductions in SER after 6 and 9 weeks, and in CL and TAS at 3, 6, 9 and 12 weeks. The mean reduction in TAS was over 20% for four successive 1-h samplings on completion of the study. Significant reductions in CL, SER and TAS were observed for the erythromycin-zinc formulation compared to the control lotion at 6 and 9 weeks, and also at 3 weeks for SER and TAS, and at 12 weeks for CL and TAS. This study indicates that sebum output is significantly reduced by the erythromycin-zinc complex. This reduction is theoretically beneficial for the acneic patient.

Acetates↗
PubMed1994

Erythromycin, lincosamides, peptidyl-tRNA dissociation, and ribosome editing.

Inaccurate protein synthesis produces unstable beta-galactosidase, whose activity is rapidly lost at high temperature. Erythromycin, lincomycin, clindamycin, and celesticetin were shown to counteract the error-inducing effects of streptomycin on beta-galactosidase synthesized in the antibiotic-hypersensitive Escherichia coli strain DB-11 Met-. Newly synthesized beta-galactosidase was more easily inactivated by high temperatures when synthesized by bacteria partially starved for arginine, threonine, or methionine. Simultaneous treatment with erythromycin or lincomycin yielded beta-galactosidase that was inactivated by high temperatures less easily than during starvation alone, an effect attributed to stimulation of ribosome editing. When synthesized in the presence of canavanine, beta-galactosidase was inactivated by high temperature more easily but this effect could not be reversed by erythromycin. The first arginine in beta-galactosidase occurs at residue 13, so the effect of erythromycin during arginine starvation is probably to stimulate dissociation of erroneous peptidyl-tRNAs of at least that length. Correction of errors induced by methionine starvation is probably due to stimulation of dissociation of erroneous peptidyl-tRNAs bearing peptides at least 92 residues in length. All the effects of erythromycin or the tested lincosamides on protein synthesis are probably the result of stimulating the dissociation from ribosomes of peptidyl-tRNAs that are erroneous or short.

Anti-Bacterial Agents↗
PubMed1996

Investigation on the chemical stability of erythromycin in solutions using an optimization system.

Erythromycin, an antibiotic commonly used topically in the treatment of acne, is unstable in solution. The stability is influenced by the pH and by the presence of water. The influence of the pH on the stability of erythromycin was investigated even with the use of dimethyl isosorbide as co-solvent instead of water. The addition of zinc was attempted to ameliorate erythromycin stability as suggested in the literature. To investigate these three factors and their interactions, an optimization technique was carried out consisting of a 2(3) factorial analysis and a rotative central composite design. The erythromycin solutions were analysed with an HPLC method. The pH and the concentration of dimethyl isosorbide had a significant influence on the stability of erythromycin but the addition of zinc was not a significant factor. Moreover, there was a significant interaction between the pH and dimethyl isosorbide.

Anti-Bacterial Agents↗
PubMed1979

Erythromycin resistance in mouse L cells.

The sensitivity of mouse cell lines in culture to the macrolide antibiotic, erythromycin stearate, was investigated. Both resistant and sensitive lines were found. Experiments indicated that in sensitive cells erythromycin stearate inhibits mitochondrial protein synthesis. Mutants resistant to erythromycin stearate were selected from the line LM(TK-), and these are also less sensitive to other macrolide antibiotics such as carbomycin and spiramycin. Attempts to transfer the erythromycin resistance of either the mutants or naturally resistant lines by fusion of cytoplasts with sensitive cells were unsuccessful, and it is concluded that resistance to erythromycin stearate is controlled by nuclear genetic factors.

Animals↗
PubMed1978

Effect of erythromycin and amoxycillin on Bordetella pertussis in the nasopharynx.

The effectiveness of oral erythromycin and amoxycillin in eradicating Bordetella pertussis from the nasopharynx was compared. Erythromycin in a dosage of 40--50 mg/kg/day was significantly more effective than amoxycillin in a dosage of 25--30 mg/kg/day. The organism did not disappear in three cases receiving a lower dosage of erythromycin. As antibiotic treatment does not affect the clinical course of fully-developed whooping cough, erythromycin is indicated primarily when particularly susceptible individuals are threatened by exposure. In such cases erythromycin should be given as soon as whooping cough is suspected.

Adult↗
PubMed1988

Comparative studies on the effects of erythromycin A and azithromycin upon extracellular release of lysosomal enzymes in inflammatory processes.

In the present studies the in vivo and in vitro effects of erythromycin A and azithromycin, a new type of macrolide (Fig. 2.), were investigated upon extracellular release of lysosomal enzymes, beta-glucuronidase (beta-Gluc) and beta-N-acetylglucosaminidase (beta-Glm) by using two experimental model systems: in vivo-adjuvant-induced arthritis in rats and in vitro- human polymorphonuclear leucocytes (PMNL) exposed to bovine serum albumin/anti-bovine serum albumin (BSA/anti-BSA), immune complex. Administrations of erythromycin A or azithromycin at doses of 5, 10 and 15 mg/kg into rats one day prior and 2, 4, 6, 8 and 10 days after a single subplantar injection of Freund's complete adjuvant significantly (p less than 0.01) inhibited extracellular release of lysosomal enzymes tested in the synovial fluid of injected left hind paw. These effects were dose-dependent. Further, erythromycin A and azithromycin at concentrations of 10(-7) M, 10(-6) M and 10(-5) M significantly (p less than 0.01) reduced excocytosis of both lysosomal enzymes, beta-Gluc and beta-Glm from human PMNL initiated by BSA/anti-BSA in a dose-related fashion. However, azithromycin was by far more effective (p less than 0.01) in decreasing extracellular release of beta-Gluc and beta-Glm either in the in vivo or in vitro experiments in comparison with erythromycin A. Appropriate control experiments excluded the possibilities that erythromycin A or azithromycin interfered with activities of lysosomal enzymes or with test reagents. Also, in no instances was there enhanced release of a cytoplasmic enzyme LDH.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylglucosaminidase↗
PubMed1996

Effects of erythromycin in chronic idiopathic intestinal pseudo-obstruction.

The prokinetic effects of erythromycin, a macrolide antibiotic, on the gastrointestinal tract as a motilin receptor agonist and its potential value for the treatment of gastrointestinal motility disorders have recently attracted interest. The effects of erythromycin on the clinical symptoms and gastrointestinal motility of patients with chronic idiopathic pseudo-obstruction have not been investigated extensively. We presented a case of chronic idiopathic intestinal pseudo-obstruction, in a 67-year-old man in whom oral erythromycin (900 mg/day) dramatically improved postprandial abdominal distention, nausea, and vomiting. Other agents with prokinetic effects on intestinal motility, i.e., cisapride, domperidone, metoclopramide, and trimebutine maleate did not have a favorable effect. Gastric emptying, measured by the sulfamethizole method; and intestinal transit, evaluated using radio-opaque markers, were markedly improved by treatment with erythromycin. Our experience suggests that the prokinetic effects of erythromycin may be of therapeutic value in chronic idiopathic intestinal pseudo-obstruction.

Administration, Oral↗
PubMed2004

Effect of erythromycin on metabolism of quetiapine in Chinese suffering from schizophrenia.

OBJECTIVE: To study the effect of erythromycin on metabolism of quetiapine in Chinese suffering from schizophrenia. METHODS: Nineteen patients received multiple doses of quetiapine (200 mg, twice daily) with or without co-administered erythromycin (500 mg, three times daily). Blood samples were collected at specified time intervals for determination of plasma concentrations of quetiapine and some of its metabolites. RESULTS: With erythromycin co-administration: for quetiapine, maximal plasma concentration (Cmax), area under concentration-time curve of 0-infinity h (AUC0-infinity) and terminal-phase elimination half-life time (t1/2) increased 68, 129 and 92%, respectively, and clearance (CL) and terminal elimination rate constant (Ke) decreased 52% and 55%, respectively; for quetiapine sulfoxide (QTP-SF), Cmax, AUC0-infinity and AUC ratio decreased 64, 23, and 70%, respectively, and t1/2 increased 211%; for 7-hydroxy-quetiapine (QTP-H), Ke and AUC ratio decreased 61% and 45%, respectively, and t1/2 increased 203%; for 7-hydroxy-N-desalkyl-quetiapine (QTP-ND), Cmax, AUC0-infinity and AUC ratio decreased 36, 40 and 71%, respectively. CONCLUSION: Erythromycin has a noticeable effect on the metabolism of quetiapine. When quetiapine is co-administered with CYP3A inhibitors such as erythromycin, the dosing regimen should be modified according to quetiapine TDM.

Adolescent↗