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PubMed1998

Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin.

OBJECTIVE: To determine both the frequency of reported penicillin allergy in parturients and the frequency of resistance in vitro of clinical isolates of group B streptococci to clindamycin and erythromycin. METHODS: One hundred clinical isolates of group B streptococci were tested to determine the frequency of resistance to clindamycin, erythromycin, penicillin G, vancomycin, and cefazolin. The frequency of beta-lactam allergy and reported allergic reaction also were recorded for all consecutive laboring women during the 4-month study. RESULTS: The frequency of group B streptococcal resistance to clindamycin was 15% and to erythromycin was 16%. No isolates were resistant to penicillin G, vancomycin, or cefazolin. Twelve percent of the 963 women who delivered during the study reported a penicillin allergy, but only 30% of those could describe their allergic reaction. CONCLUSION: In vitro resistance of group B streptococci to clindamycin and erythromycin occurred frequently in this population. Whereas the importance of this finding in vivo is uncertain, it raises concern about the possibility of inadequate prophylaxis using currently recommended alternatives in penicillin-allergic patients. Artful questioning of women reporting penicillin allergy may lessen the likelihood of using these less desirable agents in the setting of intrapartum antimicrobial prophylaxis.

Adult↗
PubMed1982

Measurement of pulmonary erythromycin concentration in patients with lobar pneumonia by means of positron tomography.

The concentration achieved in the infected tissue is of fundamental importance in the use of antibiotics. Erythromycin labelled with the positron-emitting nuclide carbon-11 and positron tomography were used to compare local concentrations of this antibiotic in the pneumonic and unaffected lungs of five patients with lobar pneumonia. The time course of uptake of erythromycin into the extravascular compartment (i.e., the intracellular, interstitial, and alveolar compartments) of the pneumonic lung was measured. The mean extravascular concentrations obtained during the first hour after an intravenous injection of 270 mg erythromycin lactobionate were similar in the pneumonic lung and the unaffected lung (5.5 +/- 2.2 and 6.6 +/- 2.2 micrograms/g, respectively). An effective concentration of erythromycin was reached in the pneumonic lung within 10 min of the injection and was maintained throughout the period of measurement (60 min).

Acute Disease↗
PubMed1983

Erythromycin compared with a combination of ampicillin and amoxycillin as initial therapy for adults with pneumonia including Legionnaires' disease.

In a double blind trial erythromycin was compared with a combination of ampicillin and amoxycillin for treating adults admitted to hospital with primary pneumonia. The clinical course of 42 patients treated with ampicillin and amoxycillin was similar to that of the 49 in the erythromycin group. Fall in temperature, symptomatic recovery and radiographic improvement were similar (two-thirds made an uncomplicated recovery). Infusion-related phlebitis was more common with erythromycin. Otherwise adverse reactions were unusual. The outcome was related principally to the cause of the pneumonia with bacteraemic/antigenaemic pneumococcal pneumonia, Legionnaires' disease, other bacterial pneumonias and psittacosis having a poor prognosis. Both forms of antibiotic therapy gave similar results but we suggest that a combination of erythromycin with ampicillin may be logical initial treatment for severe pneumonia of unknown cause.

Adult↗
PubMed1994

A comparative study of dirithromycin and erythromycin in bacterial pneumonia.

Dirithromycin, a new once-daily macrolide, was studied in a multicentre, randomised, double-blind trial in community-acquired bacterial pneumonia. A total of 591 patients received either a single daily dose of dirithromycin, 500 mg, or erythromycin, 250 mg, four times daily. Clinical response rates were similar in both treatment groups (127 dirithromycin-treated and 118 erythromycin-treated patients): at the time of the final consultation, the clinical and bacteriological response rates for dirithromycin-treated patients were 94.5% and 93.0%, while for erythromycin-treated patients, they were 92.1% and 90.3%, respectively. The nature and frequency of treatment-emergent events were comparable. We conclude that dirithromycin, 500 mg, once daily, is safe and effective in the treatment of community-acquired bacterial pneumonia. The once daily dose is likely to improve compliance, making it preferable to erythromycin.

Adolescent↗
PubMed2000

Erythromycin in pityriasis rosea: A double-blind, placebo-controlled clinical trial.

BACKGROUND: The study stemmed from an incidental observation of improvement in 2 patients with pityriasis rosea while receiving erythromycin. OBJECTIVE: The purpose of the study was to evaluate the efficacy of erythromycin in patients with pityriasis rosea. METHODS: A double-blind, placebo-controlled clinical study was performed in an outpatient setting in a major hospital. Ninety patients over a period of 2 years were alternatively assigned to treatment group or placebo group. Patients in the treatment group received erythromycin in divided doses for 14 days. The response was categorized as complete response, partial response, or no response. All patients were followed up for 6 weeks. RESULTS: Both groups were comparable with regard to age at presentation, sex, and average duration of disease at the time of reporting to the clinic. Upper respiratory tract infection before the appearance of skin lesions was reported in 68.8% of all patients. Complete response was observed in 33 patients (73.33%) in the treatment group and none in the placebo group (P <.0001). CONCLUSION: Oral erythromycin was effective in treating patients with pityriasis rosea.

Administration, Oral↗
PubMed1980

Topically applied erythromycin in inflammatory acne vulgaris.

We evaluated the effectiveness of 2% erythromycin and its alcohol/propylene glycol vehicle in the treatment of three hundred forty-eight patients with inflammatory acne vulgaris. A significantly greater reduction was noted in the papulopustule count for the erythromycin-treated group compared to the vehicle-treated group. Additionally, clinical improvement, as measured by physician global ratings, was significantly greater in the erythromycin-treated group. A lower adverse reaction rate observed in the erythromycin-treated patients may result from previously demonstrated anti-inflammatory properties of this antibiotic.

Acne Vulgaris↗
PubMed1989

Skin-isolated, community-acquired Staphylococcus aureus: in vitro resistance to methicillin and erythromycin.

During a 10-month period, skin culture specimens were taken from 1680 healthy outpatients with a variety of community-acquired skin infections. Staphylococcus aureus was found in 1035 (61.6%) of these patients. In vitro resistance to methicillin and erythromycin was 1.0% and 42.9%, respectively. Resistance rates to erythromycin in patients with furunculosis and impetigo were 51.5% and 26.2%, respectively (p less than 0.001). The emergence of erythromycin-resistant strains may be the result of widespread use of this drug in our geographic area. There is also the possibility that certain bacteriologic features associated with erythromycin resistance may foster the development of furunculosis.

Adolescent↗
PubMed2002

Effects of erythromycin on pregnancy duration and birth weight in lipopolysaccharide-induced preterm labor in pregnant rats.

OBJECTIVE: The aim of this study was to investigate the effects of erythromycin on pregnancy duration and on live birth weight in lipopolysaccharide (LPS)-induced preterm labor model in rats. STUDY DESIGN: Total of 60 pregnant rats on day 16 of gestation was intraperitoneally injected with 25 microg/kg LPS. Animals were randomly divided into six groups and 20mg/kg (n=10), 40 mg/kg (n=10), 60 mg/kg (n=10), 80 mg/kg (n=10), and 100mg/kg (n=10) erythromycin and equal volume of physiological saline (n=10) were given intraperitoneally. Injection of LPS-to-vaginal bleeding interval, vaginal bleeding-to-delivery interval, LPS injection-to-delivery interval was monitored and live birth weight of neonates was determined. Statistical analysis was performed using Kruskal-Wallis, Mann-Whitney U-test and Spearman correlation analysis. RESULTS: Intraperitoneal injection of erythromycin to LPS-administered rats caused significant increase in latent period, labor period, total period and live birth weight in a dose dependent manner. CONCLUSION: These data shows that erythromycin causes prolongation of pregnancy period and increases live birth weight in LPS-induced preterm labor of pregnant rats.

Animals↗
PubMed2002

In vitro development of resistance to enrofloxacin, erythromycin, tylosin, tiamulin and oxytetracycline in Mycoplasma gallisepticum, Mycoplasma iowae and Mycoplasma synoviae.

The in vitro emergence of resistance to enrofloxacin, erythromycin, tylosin, tiamulin, and oxytetracycline in three avian Mycoplasma species, Mycoplasma gallisepticum, Mycoplasma synoviae and Mycoplasma iowae was studied. Mutants were selected stepwise and their MICs were determined after 10 passages in subinhibitory concentrations of antibiotic. High-level resistance to erythromycin and tylosin developed within 2-6 passages in the three Mycoplasma species. Resistance to enrofloxacin developed more gradually. No resistance to tiamulin or oxytetracycline could be evidenced in M. gallisepticum or M. synoviae after 10 passages whereas, resistant mutants were obtained with M. iowae. Cross-sensitivity tests performed on mutants demonstrated that mycoplasmas made resistant to tylosin were also resistant to erythromycin, whereas mutants made resistant to erythromycin were not always resistant to tylosin. Some M. iowae tiamulin-resistant mutants were also resistant to both macrolide antibiotics. Enrofloxacin and oxytetracycline did not induce any cross-resistance to the other antibiotics tested. These results show that Mycoplasma resistance to macrolides can be quickly selected in vitro, and thus, providing that similar results could be obtained under field conditions, that development of resistance to these antibiotics in vivo might also be a relatively frequent event.

Animals↗
PubMed1999

Physico-chemical characterization of interactions between erythromycin and various film polymers.

In this study the interactions between erythromycin and various polymers (Eudragit L100, shellac, polyvinyl acetate phthalate (PVAP), cellulose acetate phthalate (CAP), hydroxypropyl methylcellulose acetate phthalate (HPMCP), and hydroxypropyl methylcellulose (HPMC)) were investigated. The polymer films containing drugs were prepared and characterized by the use of infrared spectroscopy, powder X-ray diffraction analysis, thermal analysis, thin layer chromatography, and nuclear magnetic resonance (NMR) spectroscopy. Preliminary studies of pure drug powders recrystallized in various organic solvent systems suggested a mixture of amorphous and crystalline forms whereas those recrystallized in water and organic solvent-water mixture led to the dihydrate form. Erythromycin in drug-polymer mixtures exhibited molecular dispersions in all six polymers studied. The amine salt interaction between the carboxyl group of the acid polymers and N-atom of erythromycin was indicated by the NMR technique. The solid solution of erythromycin in all polymer films studied was physically stable under stress conditions (8 degrees C/3 days and 40 degrees C/3 days for six cycles).

Anti-Bacterial Agents↗
PubMed1998

Study of the stability of erythromycin in a hydrophilic creme basis by liquid chromatography.

The stability of the macrolide antibiotic erythromycin, incorporated at a 2% m/m concentration in a hydrophilic creme basis containing 2% m/m of chlorocresol, was monitored over a period of 2 months using liquid chromatography as the analytical method. Extracts of the creme were analysed using wide-pore poly(styrene-divinylbenzene) PLRP-S 1000 A as the stationary phase and a mixture of 2-methyl-2-propanol-acetonitrile-potassium phosphate buffer (pH 11.0; 0.02 M)-water (165:30:50:755, v/v/v/v) as the mobile phase. The method showed good selectivity towards chlorocresol, erythromycin A, its related substances and degradation products. As the pH of the creme containing erythromycin was 8.6, alkaline degradation products were expected to be formed. The presence of pseudoerythromycin A enol ether was observed after storage of the creme for 1 week at a temperature of 25 degrees C. After 1 month the content of erythromycin was still more than 95%.

Anti-Bacterial Agents↗
PubMed1999

Microbiological bioassay of erythromycin thiocyanate: optimisation and validation.

The validation of an analytical method for the quantitative determination of erythromycin thiocyanate formulated in an antibiotic preparation for veterinary use was carried out. This method is based on the microbiological method described in the European Pharmacopoeia to analyze erythromycin thiocyanate as a raw material. This erythromycin thiocyanate preparation is presented as a powder for oral administration after mixing with feed. For that reason, it was planned to validate the method for the quantitative determination of erythromycin thiocyanate incorporated both in the medicated premix and the mixture with feed. The microbiological method followed a linear model and was not proportional. The number of replicates needed to obtain a valid result was less than four in all cases. The small difference in concentration, expressed in natural logarithm detected by the method, was 0.1.

Administration, Oral↗
PubMed1996

Clindamycin resistance among erythromycin-resistant Streptococcus pneumoniae.

The increasing proportion of Streptococcus pneumoniae isolates with reduced susceptibility to penicillin has created an urgent need for therapeutic alternatives to some beta-lactam agents. Clindamycin is an antimicrobial agent with excellent bioavailability after oral administration which has been considered for the therapy of community-acquired pneumococcal otitis media. Using the Etest methodology, we have studied the in vitro susceptibility of 59 erythromycin-resistant strains of S. pneumoniae to clindamycin, penicillin, trimethoprim-sulfamethoxazole, and rifampin. The study also addressed the impact of the susceptibility test medium [Mueller-Hinton (MH) vs IsoSensitest (Iso), both 5% blood supplement] on the results. A total of 20 isolates (37%) displayed constitutive clindamycin resistance on Iso blood agar, compared with only 11 (22%) on MH blood agar. The remaining nine strains found to be clindamycin susceptible on MH manifested resistance only with erythromycin induction. Resistance to penicillin, rifampin, and trimethoprim-sulfamethoxazole in erythromycin-resistant isolates was 83%, 2%, and 85%-89% (medium dependent), respectively. These results indicate that the choice of susceptibility test medium affects the expression (constitutive or inducible) of macrolide-lincosamide-streptogramin (MLS) resistance in S. pneumoniae. In addition, the common assumption that erythromycin resistance in S. pneumoniae implies clindamycin resistance may need to be reconsidered and routine susceptibility tests (including induction if MH medium is used) should be considered for MLS-class drugs.

Clindamycin↗
PubMed1999

Incidence of erythromycin resistance in Streptococcus pyogenes: a 10-year study.

We studied the evolution of susceptibility of Streptococcus pyogenes isolated in our hospital from 1987 to 1996. Susceptibility to penicillin, ampicillin, cefotaxime, cefuroxime, imipenem, erythromycin, clindamycin, tetracycline, vancomycin, ciprofloxacin, rifampin, and chloramphenicol was determined by the National Committee for Clinical Laboratory Standards broth microdilution method. Differentiation of phenotypes of erythromycin-resistant strains was performed using the double-disc method. All isolates remained very susceptible in vitro to penicillin and all of the other beta-lactam agents tested. Between 1987 and 1995 the incidence of erythromycin resistant strains remained below 5%; the difference in the resistance rate between 1995 (2.6%) and 1996 (17.1%) was statistically significant. The macrolide resistance M phenotype was the most frequent. The isolation rates of tetracycline-resistant strains increased from 2.2% in 1987 to 11.2% in 1988. The marked increase in the incidence of erythromycin resistance observed in our area warrants periodic surveillance of antibiotic susceptibility of S. pyogenes isolates and emphasizes the need to control outpatient antibiotics. The preponderance of the M phenotype may have implications in the choice of antibiotic.

Anti-Bacterial Agents↗
PubMedDate not supplied

Heterogeneity of genes conferring high-level resistance to erythromycin by inactivation in enterobacteria.

We have constructed a probe specific for the gene ereA of plasmid pIP1100, which confers high-level resistance to erythromycin in Escherichia by production of an erythromycin esterase. The distribution of the gene ereA in enterobacteria highly resistant to erythromycin isolated from human faeces was studied by colony hybridization. The gene ereA was detected in strains of E. coli belonging to various biotypes, in Klebsiella pneumoniae, in Enterobacter agglomerans and in one strain of a "coliform". Moreover, our results indicated the existence of at least two classes of genes specifying resistance to erythromycin by inactivation of the antibiotic in enterobacteria.

Culture Media↗
PubMed1990

In vitro susceptibility of Campylobacter jejuni and Campylobacter coli isolated in Austria to erythromycin and ciprofloxacin.

More than 200 strains of Campylobacter (C.) jejuni/coli isolated in 1985 and 1987/88 from human fecal specimens were tested for their susceptibility to erythromycin and ciprofloxacin. Their MIC90 as assessed by agar dilution tests was 2.0 and 0.5 mg/l, respectively. Thus, all strains were regarded as susceptible to ciprofloxacin. With 2 out of 55 strains of C. coli the MIC of erythromycin was 8.0 mg/l. Therefore, only 3.6% of the C. coli strains were resistant to erythromycin. All 209 strains of C. jejuni proved to be susceptible to erythromycin.

Austria↗
PubMed1999

Densitometric thin layer chromatographic analysis of tretinoin and erythromycin in lotions for topical use in acne treatment.

A TLC-method was developed to analyse tretinoin and erythromycin in a lotion in the presence of several excipients. Erythromycin was separated on a silica gel plate and a mobile phase with dichloromethane, methanol and ammonia 25% (60:6:1 (v/v/v)), tretinoin on a C(18) RP plate with acetonitrile and water (50:25 (v/v)) as mobile phase, adding 1 ml acetic acid for the separation of the excipients and erythromycin. The derivatization for both was done with a dipping reagent, consisting of anisaldehyde, sulphuric acid and acetic acid (respectively 1, 2 and 10% (v/v/v)) and dissolved in chloroform/alcohol 94% v/v (60:30 (v/v)) for erythromycin and alcohol 94%/water (50:40 (v/v)) for tretinoin. These TLC-systems were quantitatively evaluated in terms of stability of the colour, precision, accuracy and calibration, proving the utility in the analysis of the lotion.

Acne Vulgaris↗
PubMed1998

The crystal structure of ribosomal protein L22 from Thermus thermophilus: insights into the mechanism of erythromycin resistance.

BACKGROUND: . The ribosomal protein L22 is one of five proteins necessary for the formation of an early folding intermediate of the 23S rRNA. L22 has been found on the cytoplasmic side of the 50S ribosomal subunit. It can also be labeled by an erythromycin derivative bound close to the peptidyl-transfer center at the interface side of the 50S subunit, and the amino acid sequence of an erythromycin-resistant mutant is known. Knowing the structure of the protein may resolve this apparent conflict regarding the location of L22 on the ribosome. RESULTS: . The structure of Thermus thermophilus L22 was solved using X-ray crystallography. L22 consists of a small alpha+beta domain and a protruding beta hairpin that is 30 A long. A large part of the surface area of the protein has the potential to be involved in interactions with rRNA. A structural similarity to other RNA-binding proteins is found, possibly indicating a common evolutionary origin. CONCLUSIONS: . The extensive surface area of L22 has the characteristics of an RNA-binding protein, consistent with its role in the folding of the 23S rRNA. The erythromycin-resistance conferring mutation is located in the protruding beta hairpin that is postulated to be important in L22-rRNA interactions. This region of the protein might be at the erythromycin-binding site close to the peptidyl transferase center, whereas the opposite end may be exposed to the cytoplasm.

Amino Acid Sequence↗