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PubMed1996

Erythromycin and trimethoprim-sulphamethoxazole in the treatment of cholera in children.

To evaluate the efficacy of erythromycin and trimethoprim-sulphamethoxazole (TMP-SMX) in the treatment of cholera in children aged 1-8 years, a randomised clinical trial was conducted at a diarrhoea treatment centre in Bangladesh from December 1991 to June 1992. Fifteen children received erythromycin, 50 mg/kg per day, in four equally divided doses, 18 children received 10 mg/kg per day of trimethoprim and 50 mg/kg per day of sulphamethoxazole in two equally divided doses (12 hourly) for five days, and 15 children received no antibiotic; children in all three groups received intravenous cholera saline for severe dehydration and for mild to moderate dehydration, a rice-based oral rehydration solution. The mean stool volumes in mL/kg body weight in the two treatment groups were less than that of the control group, and there were no significant differences in stool volume among the two treatment groups. However, 67% of the children in the erythromycin group and 82% in the TMP-SMX group recovered within 72 hours compared to 33% in the control group (p < 0.01). Similarly, the bacteriological cures were 80% in the erythromycin group and 83% in the TMP-SMX group compared to only 27% in the control group (p < 0.001). These results confirm that both erythromycin and trimethoprim-sulphamethoxazole are effective antimicrobials in the treatment of cholera. These drugs are of value specially in younger children in whom tetracycline is contraindicated or when the infecting Vibrio cholerae are resistant to tetracycline.

Anti-Bacterial Agents↗

PubMed1997

Erythromycin: drug interactions.

The purpose of this article is to provide the dental hygienist with an understanding of potential drug interactions that can occur between the antimicrobial agent, erythromycin, and other medications. Erythromycin is the drug-of-choice against oral infections and to prevent infective endocarditis in patients who are allergic to penicillin. Erythromycin has the potential to interact with many medications by inhibiting drug metabolism in the liver. Several reports and controlled studies have shown that erythromycin may interact with theophylline, carbamazepine, cyclosporin, tacrolimus, warfarin, digoxin, terfenadine, astemazole, cisapride, lovastatin, triazolam, and disopyramide. During data collection, the hygienist can identify potential drug interactions with erythromycin. The majority of these interactions can be safely managed by using another antimicrobial with a similar spectrum of activity. If this cannot be done, the patient's physician should be consulted.

Anti-Bacterial Agents↗

PubMed1998

Effect of different doses of erythromycin on colonic motility in patients with slow transit constipation.

BACKGROUND: Erythromycin has been proposed as a therapeutic agent for the treatment of functional motor disorders of the upper gastrointestinal tract. Moreover, some data exist showing a potential effect on colonic motility. AIMS: Since no data are available concerning erythromycin effects in chronically constipated patients, we investigated the effects of three different doses of the drug (50, 200, and 500 mg i. v.) on colonic intraluminal pressures in such patients. PATIENTS AND METHODS: 18 severely constipated women were studied by a colonoscopically-positioned manometric probe, and were randomized to receive one of three doses of erythromycin. Proximal and distal colonic motility was recorded basally, then during placebo infusion for 60 min and for a further 60 min after the drug had been infused. RESULTS: Analysis of the tracings showed that, except for the lowest dose in the distal colon, erythromycin failed to stimulate colonic motility in constipated patients. CONCLUSIONS: It is concluded that erythromycin cannot be considered a colokinetic agent, at least at doses commonly employed in the upper gut.

Adult↗

PubMed2005

HERG K+ channel expression-related chemosensitivity in cancer cells and its modulation by erythromycin.

PURPOSE: Previous studies have found that the HERG K+ channel is highly expressed in some cancers. In the study reported here, we investigated HERG expression in various cancer cell lines, its correlation with chemosensitivity to vincristine, paclitaxel, and hydroxy-camptothecin, and its biochemical modulation. METHODS: The MTT assay and clonogenic assay were used to detect the cytotoxicity of anticancer drugs in vitro. HERG expression was analyzed by Western blotting or immunocytochemistry. Gene transfection was used to examine the changes in HERG-related chemosensitivity. Cell cycle phase distribution was detected by flow cytometry and drug combinations were evaluated by the MTT assay. RESULTS: HERG expression levels differed widely between various human cancer cell lines and HT-29 cells expressing high levels of HERG were more sensitive than A549 cells expressing low levels of HERG to vincristine, paclitaxel, and hydroxy-camptothecin. In terms of IC50, the chemosensitivities of herg-transfected A549 cells to vincristine, paclitaxel and hydroxy-camptothecin were significantly increased. However, for cisplatin and 5-fluorouracil, no significant difference between herg-transfected A549 cells and parent A549 cells was detected. Erythromycin, a HERG K+ channel blocker, suppressed the growth of various cancer cells and the potency was correlated with HERG expression levels. Combinations of erythromycin and vincristine, paclitaxel or hydroxy-camptothecin showed synergy in cytotoxicity to HT-29 cells. Erythromycin also enhanced the G2/M arrest induced by vincristine in HT-29 cells. There were synergistic effects between erythromycin and vincristine, paclitaxel, and hydroxy-camptothecin, and chemosensitivity was correlated with HERG expression level. CONCLUSIONS: HERG expression levels and chemosensitivity were positively correlated for vincristine, paclitaxel, and hydroxy-camptothecin. Erythromycin was active as a modulator. These results suggest that HERG may serve as a molecular marker and modulating target for individualized cancer therapy.

Adenocarcinoma↗

PubMed2004

Erythromycin as a potential precipitating agent in the onset of Leber's hereditary optic neuropathy.

A 23-years-old male entered a safety clinical trial for cetirizine (a selective histamine H(1)-receptor antagonist) in combination with the antibiotic erythromycin. Within a few weeks of finishing the trial, the patient reported bilateral vision loss with optic nerve atrophy. Genetic studies showed that he had a mitochondrial DNA (mtDNA) mutation at position 11778 (within the gene for subunit 4 of NADH-coenzyme Q oxidoreductase), commonly associated with Leber's hereditary optic neuropathy. To test if erythromycin could worsen the mitochondrial respiratory chain defect associated with the 11778 mtDNA mutation, we transferred the patient's mtDNA to cultured mtDNA-less osteosarcoma cells. Erythromycin inhibited proliferation of the patient's transmitochondrial cybrids in conditions that required mitochondrial respiration for growth. We confirmed that erythromycin is a potent inhibitor of mitochondrial translation in these cells. Taken together, these results suggest that erythromycin may have hastened a bioenergetics crisis in the optic nerve of this patient. This association underscores the importance of being cautious with the use of drugs that interfere with cellular respiration in individuals with an underlying mitochondrial dysfunction.

Journal Article↗

PubMed1983

Treatment of Campylobacter-associated enteritis with erythromycin.

Twenty-six infants and young children with acute dehydrating diarrhea associated with Campylobacter jejuni participated in a randomized, double-blind, placebo-controlled therapeutic trial. Of 25 patients who completed the study, 11 were treated for five days with oral erythromycin ethylsuccinate (40 mg/kg/day in divided doses), and the rest received matched placebo. Although erythromycin significantly shortened the duration of C jejuni excretion, it appeared to exert no effect on the clinical course of the illness. This failure may be explained on the grounds that most patients' symptoms were resolving spontaneously when they were admitted to the trial. However, as all but eight children were infected with at least one erythromycin-resistant enteropathogen in addition to C jejuni, the clinical failure of antibiotic therapy may have been due to erythromycin's inability to eliminate these organisms.

Campylobacter Infections↗

PubMed1982

Analysis of oral suspensions containing sulfonamides in combination with erythromycin ethylsuccinate.

The sulfonamides and erythromycin ethylsuccinate in combination oral suspensions were determined by high-performance liquid chromatography and automated turbidimetry, respectively. The chromatographic procedure was rapid, specific, and stability-indicating for sulfisoxazole acetyl and the trisulfapyrimidines using a reversed-phase system with UV detection at 254 nm. Erythromycin ethylsuccinate did not interfere with the sulfonamide analysis and these compounds were assayed with relative standard deviations (RDS) ranging from +/- 2.1 to +/- 3.1%. Erythromycin ethylsuccinate was determined as erythromycin with RSD values of +/- 1.3 or 3.5% without interference by the sulfonamides present.

Chemical Phenomena↗

PubMed1980

Nonantibiotic effects of macrolide antibiotics of the oleandomycin-erythromycin group with special reference to their "steroid-sparing" effects.

Certain macrolide antibiotics, such as troleandomycin (TAO), oleandomycin, and erythromycin estolate (Ilosone), can lower the maintenance dose of glucocorticoids required by severely asthmatic patients. These effects were postulated to be caused by an as yet undefined steroid-sparing effect. In this study, TAO in combination with methylprednisolone, when compared with methylprednisolone alone, was demonstrated to significantly increase liver glycogen deposition in adrenalectomized mice, intact mice, and adrenalectomized rats; protect histamine-sensitized mice following beta adrenergic blockade or adrenalectomy; further decrease the steroid-lowered glucose tolerance of mice and significantly increase the plasma corticosteroid levels in rats. TAO alone did not have these effects. TAO plus betamethasone, and erythromycin estolate plus methylprednisolone also increased liver glycogen deposition. However, TAO did not appear to potentiate the effects of hydrocortisone. Erythromycin stearate and to a lesser degree erythromycin ethylsuccinate when combined with methylprednisolone also decreased histamine lethality in mice. Leucomycin and tetracycline did not enhance the effects of methylprednisolone. TAO, alone or with methylprednisolone, did not alter serum glutamic oxaloacetic transaminase (SGOT) levels in rats. Thus, TAO and some other macrolides did not exert their effects on corticosteroids as antimicrobial agents, adrenocorticotropic hormone (ACTH)--like compounds, or quasisteroids, but as steroid-sparing agents by some undefined mechanism.

Anaphylaxis↗

PubMed1989

Clinical and microbiological evaluation of miocamycin activity against group A beta-hemolytic streptococci in pediatric patients. Three years' incidence of erythromycin-resistant group A streptococci.

The authors have evaluated the incidence of Group A streptococci, and the prevalence of erythromycin-resistant strains in the years 1985/86/87 at the I.C.P. of Milan. The minimum inhibitory concentrations (MICs) for erythromycin, penicillin and miocamycin of 40 erythromycin-resistant strains were also studied (MIC50-MIC90 = 4.5-8, 0.015-0.015, 0.041-0.186 micrograms/ml respectively). A clinical trial with miocamycin vs. erythromycin in the elimination of Group A streptococci (67 patients) showed good and comparable efficacy for both the antibiotics.

Child↗

PubMed1977

Hepatotoxicity of erythromycin estolate during pregnancy.

Women in the second half of pregnancy, who were infected with genital mycoplasmas and who gave written informed consent, were randomly assigned to receive capsules of identical appearance containing erythromycin estolate, clindamycin hydrochloride, or a placebo for 6 weeks. Levels of serum glutamic oxalacetic transaminase (SGOT) were determined before and during treatment by a fluorometric method. All pretreatment levels of SGOT were normal (<41 units). Participants who received erythromycin estolate had significantly more abnormally elevated levels of SGOT (16/161, 9.9%) than did those who received clindamycin (4/168, 2.4%, P < 0.01) or those who received placebo (3/165, 1.8%, P < 0.01). Elevated levels of SGOT ranged from 44 to 130 U. Serum bilirubin levels were normal. Gamma-glutamyl transpeptidase activity was abnormal in six of six participants who had abnormal levels of SGOT while receiving erythromycin estolate. There were few associated symptoms, and all levels of SGOT returned to normal after cessation of treatment. The treatment of pregnant women with erythromycin estolate may be inadvisable.

Aspartate Aminotransferases↗

PubMed1984

Relative bioavailability of enteric coated pellets, stearate and ethylsuccinate formulations of erythromycin.

In a randomized three-phase crossover study, 12 healthy male volunteers were given three 12-hourly 500-mg doses of erythromycin base, as enteric coated pellets in capsules (2 X 250 mg), erythromycin stearate tablet (1 X 500 mg), or erythromycin ethylsuccinate sachet (1 X 500 mg). The reaction time after administration of the pellets is significantly longer than after the stearate or ethylsuccinate formulations. The peak serum concentrations are higher for the pellets after both the 1st and 3rd dose. The time to reach peak concentrations is significantly longer for the pellets than for the stearate and ethylsuccinate formulations. The area under the serum concentration/time curve during 0-8 h after both doses is highest for the pellets. In conclusion, these findings indicate that despite the longer lag (1.8-1.2 h), the extent of gastrointestinal absorption and bioavailability of erythromycin is apparently greater for the base pellets than for the stearate and ethylsuccinate formulations.

Adult↗

PubMed1986

Effects of a new fluorinated macrolide (P-0501A) and other erythromycins on drug metabolizing enzymes in rat liver.

The effects of a new fluorinated macrolide (P-0501A) on drug metabolizing enzymes of rat liver were compared with three erythromycins--the base, the stearate and the estolate--after 7 days of dosing (1.36 mmol/kg po daily). The three erythromycins induced the synthesis of microsomal enzymes, but the products of their metabolism inactivated cytochrome P-450 in the order base less than or equal to stearate less than estolate. N-Demethylation of erythromycin and aminopyrine increased, while O-demethylation of 4-nitroanisole was reduced and hydroxylation of aniline was not changed after in vivo treatment. Pentobarbital sleeping time was prolonged and liver glutathione levels were lower in treated rats than in controls. In contrast to the three erythromycins, P-0501A did not induce the synthesis of microsomal enzymes, did not form an inactive complex with cytochrome P-450 and did not affect mono-oxygenase activities or pentobarbital narcosis.

Administration, Oral↗

PubMed1988

Erythromycin in acute pharyngitis: a comparison of efficacy and patient tolerance of two twice-daily preparations.

Two hundred sixty-five adult and adolescent patients with possible streptococcal pharyngitis were treated with either erythromycin ethylsuccinate or an enteric-coated erythromycin in a twice-daily dosage schedule. In patients with group A beta-hemolytic streptococcal infection, both preparations achieved a cure rate of 93%. Patients receiving the enteric-coated erythromycin reported significantly more gastrointestinal adverse effects than did the patients receiving erythromycin ethylsuccinate.

Acute Disease↗

PubMed1984

Topical erythromycin v clindamycin therapy for acne. A multicenter, double-blind comparison.

The efficacy and safety of topical 1.5% erythromycin solution and 1% clindamycin phosphate solution were compared in the treatment of acne. The number of inflammatory lesions was significantly reduced at 12 weeks by 62% and 59% and the number of noninflammatory lesions by 43% and 39% in the erythromycin and clindamycin groups, respectively. The reduction in lesions was also reflected in the clinical evaluation of the overall facial condition; 73% of the 74 patients treated with erythromycin solution and 62% of the 80 patients treated with clindamycin solution had excellent or good responses at 12 weeks. The results of this study show that topically applied 1.5% erythromycin and 1.0% clindamycin solutions are both effective and comparable in reducing the clinical manifestation of acne in patients with moderate disease.

Acne Vulgaris↗

PubMed1993

Erythromycin therapy for otitis media with effusion in sinobronchial syndrome.

Chronic sinusitis is frequently associated with chronic lower respiratory tract diseases, and the association is referred to as sinobronchial syndrome (SBS). This study was carried out to determine the incidence of otitis media with effusion in the patients with sinobronchial syndrome and to investigate the efficacy of low-dose and long-term erythromycin therapy for otitis media with effusion associated with sinobronchial syndrome. We have found a high incidence of otitis media with effusion in patients with sinobronchial syndrome, the morbidity rate being 54% in 50 cases studied. This ear disease seems to be the major cause of hearing disturbance in patients with sinobronchial syndrome. Sixteen patients with both sinobronchial syndrome and otitis media with effusion were given low-dose and long-term erythromycin therapy (erythromycin base, 600 mg/d for more than 4 months); of these, 13 became effusion-free and most subjects showed improvement in the symptoms of sinobronchial syndrome. The erythromycin therapy thus seems to be exceedingly effective for the treatment of sinobronchial syndrome and associated otitis media with effusion.

Administration, Oral↗

PubMed1998

Enhancement of gastric emptying of solids by erythromycin in patients with Roux-en-Y gastrojejunostomy.

BACKGROUND: Roux-en-Y reconstruction is sometimes associated with symptoms that suggest food stasis, as a result of dysmotility of either the gastric remnant and/or the efferent jejunal limb. OBJECTIVE: To study the possible effect of intravenous erythromycin lactobionate on gastric emptying of solids in patients who have undergone a Roux-en-Y procedure. PATIENTS: Twenty-four patients with a Roux-en-Y procedure participated in the study. Ten of them had undergone truncal vagotomy with pyloroplasty; the remaining 14 had undergone a Billroth II subtotal gastrectomy as the initial antiulcer procedure. Sixteen healthy subjects served as controls. METHODS: All healthy subjects and patients underwent assessment of gastric emptying of a standard radiolabeled solid meal after administration of placebo or 200 mg of erythromycin lactobionate intravenously. Scanning was done with a gamma camera, and emptying curves were constructed. From these curves the half-time of gastric emptying was calculated. RESULTS: Patients with severe symptoms of gastric stasis had a significantly longer half-time than did patients with mild or no symptoms (P=.002). Patients with a Billroth II subtotal gastrectomy as the initial antiulcer procedure had a significantly worse grade of symptoms (P=.01) and a significantly prolonged half-time (P=.02) compared with patients with a truncal vagotomy with pyloroplasty as the initial antiulcer procedure. Erythromycin significantly reduced the half-time in the controls (P<.001) and all patients after Roux-en-Y procedure (P<.001). CONCLUSION: Erythromycin could be a useful prokinetic drug in patients with Roux stasis syndrome.

Adult↗

PubMed1986

Carbamazepine-erythromycin interaction. Case studies and clinical significance.

Because of significant and seemingly haphazard fluctuations in serum carbamazepine concentrations, we decided to investigate the possible link between erythromycin administration and potential changes in serum carbamazepine concentration. We studied four cases involving this combination. In every case, serum carbamazepine concentrations either rose dramatically (doubled or tripled previous steady-state concentrations) or dropped precipitously once erythromycin therapy was discontinued. In all cases, we report serum carbamazepine concentrations obtained before, during, and after concurrent erythromycin administration. We conclude that the combination of erythromycin and carbamazepine represents a clinically significant drug interaction and should be avoided where possible.

Adult↗

PubMed1999

Structural elucidation studies of erythromycins by electrospray tandem mass spectrometry.

Erythromycin A (EryA) was studied by electrospray ionisation tandem mass spectrometry (ESI-MS/MS) with the aim of developing a methodology for the structural elucidation of novel erythromycins developed by biological synthetic methods. Skimmer dissociation along with sequential mass spectrometry studies (up to MS5) have been employed in this study. In the low-resolution MS/MS analysis of the polyketides, there are several fragment ions that are easily assigned to various neutral losses. These have all been confirmed by accurate-mass measurements. There is also a series of peaks due to ring opening and fragmentation that can only be assigned by high-resolution MSn analysis. Further experiments were performed in deuterated media (D2O/CD3OD 50%) which, along with the high-resolution MSn of erythromycin analogues, has enabled us to identify some of the steps in the ring fragmentation, particularly the loss of the polyketide starter acid. This is an essential step for determining structural alterations in the novel polyketides, but further labelling experiments and studies on more erythromycin analogues are required before the complete fragmentation pathway can be confirmed.

Anti-Bacterial Agents↗