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PubMed1980

Effects of topical erythromycin on aerobic and anaerobic surface flora.

The contents of acne lesions from 30 men with inflammatory acne vulgaris, obtained before and at the conclusion of 4 weeks of topical 2% erythromycin therapy, were cultured on aerobic and anaerobic plates. Sensitivity testing of cultures was performed with discs containing 50 mg erythromycin, in order to ascertain the prevalence of erythromycin-resistant strains of Propionibacterium acnes and aerobic micrococci. The percentages of patients in whom erythromycin-resistant micrococci could be isolated increased from 3 to 60% during topical erythromycin therapy, but no resistant P. acnes strains were isolated either before or after therapy. Considering the widespread use of topical antibiotics, long-term studies on their ecological effects are desirable.

Acne Vulgaris↗
PubMed1982

Comparison of topical erythromycin 1.5 percent solution versus topical clindamycin phosphate 1.0 percent solution in the treatment of acne vulgaris.

Commercial topical solutions of erythromycin 1.5 percent and clindamycin phosphate 1.0 percent were evaluated in a randomized, double-blind, twelve-week comparison in sixty-six patients with moderate acne. Both treatment groups showed significant reductions of total lesions, inflammatory lesions, and papules. Additionally, the group using erythromycin 1.5 percent showed significant decreases in total noninflammatory lesions and closed comedones, and the group using clindamycin phosphate 1.0 percent showed significant reductions in pustules. The only statistically significant differences between the treatments were the greater reductions in closed comedones for those patients using erythromycin 1.5 percent and greater reductions in pustules for those patients using clindamycin 1.0 percent. Nearly two thirds of the patients in each group had a good or excellent overall response after twelve weeks. One erythromycin-treated patient discontinued treatment because his wife became sensitized to it. This reportedly also occurred with the use of topical clindamycin. Other side effects were minor or transient. In this study, topical erythromycin 1.5 percent and clindamycin 1.0 percent appeared to be clinically equivalent for treating moderate facial acne.

Acne Vulgaris↗
PubMed1982

[Topical treatment of acne vulgaris with erythromycin and benzoylperoxide (author's transl)].

16 healthy persons were treated for 7 weeks with a 1% erythromycin containing ointment. Another 25 persons (among them 10 acne patients) were treated during the same period of time with a combination therapy consisting of erythromycin (1% in an unspecific ointment base) and benzoylperoxide (5% in a gel base). The combined therapy reduces the micrococcaceae in the pilosebaceous ducts significantly. On the other side the therapy consisting only of erythromycin causes only initially a decrease and then an increase in the number of micrococcaceae. Induction of resistance to erythromycin is in both cases considerable. In both cases a reduction of propionibacteria which are most important for the pathogenesis of acne must be assumed. Because of the probable pathogenetic role of staphylococci in acne vulgaris an additional improvement of the therapeutical results can be expected in the case of combination therapy. In vitro experiments demonstrate further that an erythromycin treatment leads to considerable resistance induction in S. aureus, regardless of whether it is applied alone or in combination with benzoyl peroxide.

Acne Vulgaris↗
PubMed1984

Treatment of tick-bite fever with erythromycin.

Because of the occasional need for an alternative drug for the treatment of tick-bite fever, a study of the value of erythromycin for the variety of tick-borne typhus fever occurring in southern Africa was undertaken. In guinea-pigs erythromycin 125 mg/kg for 5 days largely prevented the fever and other signs of the infection, but did not prevent the serological reaction as determined by the rickettsial complement fixation test. A series of 17 human patients were treated for 4 days with erythromycin 500 mg 6-hourly for adults and 30-50 mg/kg/d in 4 divided doses for children. Eleven patients appeared to respond favourably. It was concluded that erythromycin does not have as specific a value as tetracycline in the treatment of tick-bite fever, but that when tetracycline is contraindicated erythromycin is a useful alternative drug.

Adolescent↗
PubMed1982

Erythromycin and bromhexine in acute exacerbations of chronic bronchitis. A study on sputum penetration and clinical effectiveness.

A group of 22 patients with acute purulent exacerbations of chronic bronchitis were treated with 1 g erythromycin ethyl succinate granules twice daily orally for 10 days. Half the patients were given bromhexine additionally and the other half received placebo instead. Serum and sputum erythromycin concentrations were measured microbiologically at intervals after the first dose. The clinical results in both treated groups were rather poor, with many patients becoming infected again immediately after the chemotherapy. Blood and sputum concentrations of erythromycin did not greatly differ in the two patient groups. The sputum concentration of erythromycin was often higher than the blood concentration at the same time. The MIC's of erythromycin (in particular, those for the Haemophilus influenzae strains) were often higher than the drug concentrations attained in the sputum.

Bromhexine↗
PubMed1982

[Effect of a secretolytic agent (bromhexine) on the penetration of erythromycin into bronchial secretions].

The authors report the results of a double blind study in 22 patients on the penetration of erythromycin into bronchial secretion. The antibiotic erythromycin was administered in combination with bromhexine, which is known to disrupt mucopolysaccharide fibers in respiratory secretions. The objective of the study was to demonstrate the possible increase of the rate of penetration of erythromycin when combined with bromhexine. The study was carried out in a double blind experiment; bronchial secretions were obtained from patients with bronchial hypersecretion by means of fiberoptic bronchoscopy. The assessment of erythromycin concentrations in all samples was performed by means of microbiological agar diffusion method. The results of the investigation show a significant increase of the ratios between bronchial levels and simultaneous serum concentrations of erythromycin when administered in combination with bromhexine. The results of this preliminary study suggest the continuation of similar investigations with other antibiotics usually administered for the treatment of respiratory infections.

Bromhexine↗
PubMed1980

Erythromycin ointment for ocular prophylaxis of neonatal chlamydial infection.

We compared the efficacy of erythromycin ophthalmic ointment vs 1% silver nitrate drops for the prevention of neonatal conjunctivitis or respiratory tract infection from Chlamydia trachomatis. The organism was isolated from the cervix of 67 (12%) of 572 pregnant women. They gave birth to 559 infants who were randomly assigned to either prophylaxis immediately after birth. Thirty-six of 60 infants born to Chlamydia-positive women received silver nitrate; 24 received erythromycin. Twelve (33%) of the 36 infants who received silver nitrate had chlamydial conjunctivitis, but none of the 24 infants who received erythromycin did. Ten (29%) of 36 infants receiving silver nitrate had chlamydial nasopharyngeal infection (three later had pneumonia), as opposed to five (21%) of 24 who received erythromycin (one had pneumonia). Thus, erythromycin ointment is effective in prevention of chlamydial conjunctivitis, but it may not reduce nasopharyngeal infection or subsequent pneumonia.

Antibodies, Bacterial↗
PubMed1994

[Clinical study of erythromycin action on gallbladder motility in patients with non-ulcer dyspepsia].

Thirty-two patients of non-ulcer dyspepsia (NUD) with gallbladder hypokinesia treated by oral erythromycin administration 0.125g three times daily for two weeks. Before and after oral erythromycin administration, gallbladder volumes were determined by ultrasound, and plasma motilin concentration were determined by radioimmunoassay. The results showed that before and after oral erythromycin administration, maximal percentage emptying of gallbladder were 48.24 +/- 8.30ml vs 69.74 +/- 10.78ml (P < 0.01), plasma motilin were 361.28 +/- 87.92ng/L vs 394.97 +/- 134.27ng/L (P > 0.05). It is indicated that erythromycin could reduce fasting and postprandial residual gallbladder volumes and increases maximal percentage emptying of gallbladder. It suggests that erythromycin might have an agonist action on the motilin receptor as an agonist action on the motilin receptor as an exogenously administrated motilin.

Adult↗
PubMed1994

Erythromycin induced Torsades de Pointes: case report and review of the literature.

We report a case of an 82 year old woman with bilateral pneumonia who developed repeated episodes of polymorphic ventricular tachycardia with QT prolongation (Torsades de Pointes) after intravenous infusion of erythromycin. After discontinuation of erythromycin, the QT interval returned to normal and there was no recurrence of this arrhythmia. The association of intravenous erythromycin and this potentially fatal ventricular arrhythmia has been described in 15 similar cases reported in the literature. Both in vitro and in vivo studies have shown that erythromycin exerts electrophysiologic effects on the cardiac muscle similar to that of class IA antiarrhythmic drugs and that cross sensitivity may exist between this class of drugs and erythromycin. The definition, pathophysiology, etiology, clinical and electrocardiographic feature, and prevention and treatment of "Torsades de Pointes" are described in this article.

Aged↗
PubMed1993

[Comparative clinical effectiveness and tolerance of azithromycin (sumamed) and erythromycin in patients with sinusitis].

Clinical efficacy of azithromycin and erythromycin was compared in an open trial in 32 and 18 patients with acute sinusitis respectively. The following pathogens were isolated: Haemophilus influenzae (29.8 per cent), Streptococcus pneumoniae (19.1 per cent), Staphylococcus aureus (10.6 per cent), Streptococcus faecalis (8.5 per cent) and other microbes (8.5 per cent). Azithromycin was administered in a dose of 500 mg on day 1. During the following 4 days it was administered in a dose of 250 mg. Erythromycin was administered in a dose of 500 mg 4 times a day for 8 to 10 days. 91.2 per cent of the aerobic microflora were sensitive to azitromycin and 85.3 per cent were sensitive to erythromycin. One of 14 strains of H. influenzae proved to be resistant to azithromycin, 3 strains were resistant to erythromycin. Complete recovery was stated in 90.6 per cent of the cases treated with azithromycin and 66.7 per cent of the cases treated with erythromycin.

Acute Disease↗
PubMed1994

[Pure red cell aplasia induced by erythromycin and furosemide effects on in vitro erythroid colony forming unit (CFU-E)].

A 84-year-old man was treated with antibiotics including erythromycin and a diuretic (furosemide) because of acute heart failure and pneumonia. During the treatment, he developed moderate anemia (Hb 8.7g/dl). His anemia improved after the treatment. He again developed marked anemia (Hb 6.3g/dl) during the second treatment with erythromycin and furosemide and received blood transfusions. Bone marrow aspiration study revealed severe erythroid hypoplasia (0.2%). He was referred to our hospital, but he was not treated because his hemoglobin levels and reticulocyte count increased (80%) and his bone marrow showed increased erythroblasts (41.5%). His anemia gradually improved without any treatment. We diagnosed the case as drug-induced pure red cell aplasia (PRCA). We cultured bone marrow cells obtained from the present case and four normal healthy volunteers by a plasma clot method to determine the effects of two drugs on the number of erythroid colony forming unit (CFU-E). Furosemide strongly inhibited the CFU-E colony formation in the patient, but the inhibition effect of erythromycin was moderate. Furthermore, CFU-E was markedly suppressed by a combination of erythromycin and furosemide in both patient and control materials. These results indicate that both furosemide and erythromycin were related to the occurrence of PRCA in this patient.

Aged↗
PubMed1994

[Usefulness of erythromycin in severe postoperative gastroparesis].

Erythromycin has recently been shown to exert a great effect on gastroduodenal motor activity. This prokinetic action may be clinically useful in patients with gastrointestinal hypomotility such as diabetic or postsurgical gastroparesis. The case of a diabetic patient who underwent antrectomy Billroth II for gastric cancer is presented. Severe gastroparesis appeared after surgery and nasogastric aspiration could not be removed, although the patient was treated with metoclopramide, and glucose levels, hydroelectrolytic balance and nutritional status were corrected. Forty-one days after the first operation, a second gastrectomy with Bilroth II reconstruction was performed because of supposed anastomotic narrowing, which was not confirmed at surgery. Fourteen days later, i.v. erythromycin (200 mg/4h) was started owing to gastroparesis persistence. Six days after treatment the patient tolerated oral ingestion. Prokinetic drugs constitute the specific therapy for gastroparesis. Metoclopramide is the most used, although its efficacy is limited. In the last few years, erythromycin has proved to have a powerful effect on gastroduodenal motility. This effect is mediated, at least in part, by its motilin stimulating activity accelerating gastric emptying. Our patient completely recovered from gastroparesis after erythromycin treatment. Recent results of erythromycin therapy in these patients have been promising, despite the difficult management involved.

Aged↗
PubMed1994

Erythromycin-induced torsades de pointes and ventricular fibrillation in a patient with Legionella pneumonia.

Several case reports of erythromycin-induced torsades de pointes (TDP) arrhythmia have been reported in the literature. However, this potentially lethal side-effect of a frequently prescribed drug is not generally known. We report a patient who developed TDP followed by ventricular fibrillation during rapid infusion of erythromycin lactobionate. Although the patient used diuretics, probably predisposing her to arrhythmias due to hypokalaemia, several ECG abnormalities predisposing to TDP, all related to erythromycin infusion, occurred during observation in the ICU, establishing the precipitating role of erythromycin. The diagnosis was made only after QT prolongation, TDP and ventricular fibrillation were observed during rapid intravenous infusion of erythromycin lactobionate, one of the reasons no doubt being the assumed lack of serious side-effects of this frequently prescribed drug.

Aged↗
PubMed1996

[Antibiotic resistance to erythromycin, clindamycin and tetracycline of 573 strains of Streptococcus pyogenes (1992-1994)].

BACKGROUND: The aim of this study was to know the antibiotic resistence of Streptococcus pyogenes to erythromycine, clindamycine and/or tetracycline in community samples. The second aim was to determine the existence of multiresistant strains and to know the relationship between resistant strains, clinical samples and age of the patient. METHOD: A retrospective analysis was performed in all the strains of S. pyogenes isolated from January 1992 to December 1994. Antibiotic sensitivity was studied by MIC by the microdilution method using the Pasco semiautomatic system. RESULTS: During the study period 573 beta hemolytic streptococci were identified as S. pyogenes. The global resistance to erythromycine (2.8%), clindamycine (1.4%) and tetracycline (7.3%) remains at low levels but has significantly increased in the case of erythromycine (p < 0.05) and tetracycline (p < 0.05) over these 3 years. The incidence of strains resistant to clindamycine has also increased slowly although this rise is not significant. Five strains (0.9%) were not sensitive to the three antibiotics studied, 4 being isolated in the last trimester of 1994 in pharyngeal exudates. S. pyogenes resistant to erythromycine was most frequently isolated from cutaneous lesions and in pediatric patients (under the age of 14 years). CONCLUSIONS: These results confirm the trend towards an increase in the number of strains of S. pyogenes resistant to erythromycine, clindamycine and/or tetracycline, being most often found in cutaneous lesions and pediatric patients.

Anti-Bacterial Agents↗
PubMed1996

Influence of the antibiotics erythromycin and azithromycin on the pharmacokinetics and pharmacodynamics of midazolam.

The pharmacokinetic and pharmacodynamic interaction between azithromycin (CAS 83905-01-5), an azalide antibiotic, and midazolam (CAS 59467-70-8), a short-acting hypnotic agent, was investigated in an open, three-way cross-over study, including erythromycin (CAS 114-07-8) as a positive control. Twelve healthy male and female subjects had standard doses of azithromycin (500 mg o.d. over 3 days), or erythromycin (500 mg t.i.d. over 5 days), or no pretreatment. On the day of the last dose, they ingested 15 mg midazolam. Blood samples were collected and psychometric tests performed. Erythromycin pretreatment (E) significantly changed the pharmacokinetics of midazolam compared to control (C), whereas azithromycin (A) had no such effect. The parameters are summarized as follows: area under the concentration-time curve, AUC (C) 173.8 h.ng.ml-1 vs. (E) 662.7 h.ng.ml-1*+ and (A) 220.0 h.ng.ml-1; concentration maxima (C) 67.2 ng.ml-1 vs. (E) 182.3 ng.ml-1*+ and (A) 86.7 ng.ml-1; elimination half-life (C) 2.21 h vs. (E) 4.85 h* and (A) 2.41 h (* p < 0.05 vs. (C), +p < 0.05 vs. (A)). Pharmacodynamic tests (digit symbol substitution test; critical flicker fusion test; subjective analog scale for rating of alertness; duration of sleep) consistently showed significant differences after erythromycin pretreatment compared to control, but not after azithromycin. Erythromycin, but not azithromycin, causes clinically significant changes in the pharmacokinetics and pharmacodynamics of midazolam.

Adult↗
PubMed1996

Evidence of antibodies to erythromycin in serum of a patient following an episode of acute drug-induced hepatitis.

BACKGROUND: A patient who had taken erythromycin orally developed mild signs of hepatocellular damage and appeared to became sensitized. After a fortuitous oral intake of the antibiotic, 18 months later, the patient developed an extensive intrahepatic cholestasis. OBJECTIVE: To confirm the allergic nature of this form of hepatitis by demonstrating the presence of serum antibodies directed at the drug. METHODS: Primary cultured human hepatocytes were used to investigate whether erythromycin can covalently bind to hepatocytes; and to demonstrate the presence of drug-directed immunoglobulins in the serum of the patient. RESULTS: As a consequence of its metabolism by hepatocytes, a small percentage of erythomycin remained bound to hepatocyte proteins. The extent of covalent binding varied among hepatocytes from different donors, and was not observed in metabolically inactive hepatocytes. Antibodies able to bind erythromycin were detected in the serum of the patient. When this serum was added to a human hepatocyte culture that had been previously incubated with the drug, binding of immunoglobulins was observed around the cell membrane and close to pseudo-bile canaliculi, thus indicating the presence of antibodies able to recognize erythromycin-labelled hepatocytes. CONCLUSIONS: The existence of serum antibodies directed at erythromycin haptens in this patient strongly suggests an allergic mechanism for this drug-induced hepatitis.

Adult↗
PubMed1996

[Effects of erythromycin on surfactant synthesis, secretion, and recycling by rat alveolar type II cells].

Effects of erythromycin on surfactant synthesis, secretion, and recycling by rat alveolar type II cells were examined. Type II cells were isolated from rat lungs and incubated with 3H-choline, a precursor of surfactant. Synthesis was quantified from the amount of 3H-phosphatidylcholine and from the distribution to lamellar body fractions as measured with sucrose density gradients. Secretion was quantified from the percent of synthesized 3H-phosphatidylcholine released into the medium over 3 hr. Recycling was quantified from the percent uptake over 1 h of 3H-labeled synthetic liposomes. Type II cells incubated with erythromycin (5-50 micrograms/ml) for 22 hrs secreted less surfactant in response to PMA and ATP than did control cells. Erythromycin did not affect synthesis or recycling of surfactant by type II cells. These results show that erythromycin inhibits surfactant secretion from type II cells, and suggest that erythromycin may be effective in surfactant-excess states such as alveolar proteinosis.

Animals↗
PubMed1997

The comparative efficacy of benzoyl peroxide 5%/erythromycin 3% gel and erythromycin 4%/zinc 1.2% solution in the treatment of acne vulgaris.

This randomized 10-week study compared the efficacy of benzoyl peroxide 5%/erythromycin 3% gel with erythromycin 4%/zinc 1.2% solution in 72 acne vulgaris patients. Physician global evaluations were significantly more improved (P < or = 0.05) in the benzoyl peroxide 5%/erythromycin 3% gel treatment group compared to erythromycin 4%/zinc 1.2% solution at week 2 and at each subsequent biweekly clinical visit. Inflammatory lesions (papules/pustules) were significantly more reduced (P < or = 0.005) in the benzoyl peroxide 5%/erythromycin 3% gel treatment group than the erythromycin 4%/zinc 1.2% solution at weeks 4 and 10. Comedones were significantly more reduced (P < or = 0.001) in the benzoyl peroxide 5%/erythromycin 3% gel treatment group than in the erythromycin 4%/zinc 1.2% solution group at weeks 8 and 10. Patient efficacy evaluations significantly (P < or = 0.001) favoured benzoyl peroxide 5%/erythromycin 3% gel to erythromycin 4%/zinc 1.2% solution.

Acne Vulgaris↗