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PubMed1984

Warfarin interaction with erythromycin.

The drug interaction between warfarin and erythromycin is not well known. We report a case in which erythromycin was observed to markedly potentiate warfarin anticoagulation, resulting in hemorrhage in a patient treated for Legionella pneumonia. The morbidity of this drug interaction is enhanced in elderly patients who have infection accompanied by anorexia and/or fever and who are receiving intravenous erythromycin. The well-documented, temporal relationship established erythromycin as the interacting drug.

Drug Interactions↗
PubMed1983

[Action of erythromycin on its own producer in cultivation on broth media].

The effect of erythromycin on the growth, morphogenesis and antibiotic production capacity of the organism producing it or Str. erythreus was studied. Erythromycin was added to the medium in concentrations comparable to the productivity of the organism. It was shown that at the cell level Str. erythreus was highly resistant to its own antibiotic. Still, erythromycin had a significant effect on the developmental cycle of the culture. It inhibited the growth of the mycelium capable of the antibiotic production and induced an increase in reproduction. On long-term subculturing or in the presence of erythromycin the culture showed a pronounced tendency for fragmentation similar to that in proactinomycetes, whereas under the usual conditions the mycelial growth was not disturbed. However, the structure of the septa in Str. erythreus is typical of the streptomycetes. It is concluded that Str. erythreus occupies an intermediate position between Nocardia and Streptomyces.

Culture Media↗
PubMed1982

[Effect of penicillin and erythromycin on immunity in angina].

The number of T- and B-lymphocytes in the blood of patients with quinsy was practically the same with the use of either penicillin (101 persons) or erythromycin (115 persons). The immunoglobulin concentration in the patients treated with penicillin at the beginning of the disease was normal, while during the period of reconvalescence the concentration of IgA and IgM increased. The concentration of IgA in the patients treated with erythromycin decreased at the beginning of the disease, especially when the disease was repeated. During the reconvalescence period it came to normal, while the level of IgM increased. When the patients were treated with penicillin, the increase in the titers of antistreptolysine-0- and antistreptokinase in the course of the disease was observed in 17.5 and 33.3 per cent of the patients, respectively. When the patients were treated with erythromycin the respective figures were 29.1 and 53.0 per cent. The shifts in the count of blood neutrophils including the functionally active ones in both groups of the patients were the same. It is concluded that penicillin prevented formation of humoral immunity in patients with quinsy because of its rapid antibacterial effect eliminating stimulation of the host immunocompetent cells. Erythromycin in addition inhibited production of IgA. The antibiotics had no effect on the number of T- and B-lymphocytes and neutrophils in the blood and function of T-lymphocytes and microphages.

Adolescent↗
PubMed1980

Erythromycin ototoxicity.

Erythromycin is considered one of the safest antibiotics in common use today. In its otolaryngologic use, the authors have found it effective in treating acute suppurative sinusitis and occasionally otitis media, when combined with sulfonamides. There are few complications of erythromycin administration. Probably the least generally acknowledged of these is ototoxicity. There have been three reports of six cases with ototoxic complications from erythromycin, primarily from administration of its intravenous form. The authors present a case study of an 18 year old girl in severe renal failure, who suffered a reversible sensorineural hearing loss from high doses of an oral erythromycin preparation. The clinical manifestations of this case are compared to those previously reported.

Adolescent↗
PubMed1995

Effect of 4 x 250 mg erythromycin on human gastrointestinal transit.

The motilin agonist erythromycin affects gastrointestinal motility. We studied its influence on gastric, intestinal, and colonic transit of indigestible solids. Ten healthy volunteers measured the gastrointestinal transit of a 6-8 mm metal sphere by metal detector with oral intake of 250 mg erythromycin q.i.d. or placebo in randomized order. Postprandial gastric emptying of the sphere after a standard meal was measured after a single i.v. dose of 250 mg erythromycin, subsequently followed by determination of small and large bowel transit. Motilin serum levels were measured for one hour. Gastric transit of the sphere was shortened from 243 +/- 34 to 72 +/- 46 min (mean +/- SD) (p = 0.002) and shifted from the interdigestive to the digestive phase. Small and large bowel transit were not influenced, and gastric transit times and motilin serum levels were not correlated. In conclusion, 250 mg erythromycin shortened postprandial gastric emptying of indigestible solids, most likely due to overcoming of pyloric sieving function by strong gastric antral contractions without effecting the transit through the lower part of the gastrointestinal tract.

Adult↗
PubMed1995

Effects of intravenous erythromycin on antroduodenal motility in humans: non-invasive observations with real-time ultrasound.

Erythromycin has been shown to act on motilin receptors on gastrointestinal smooth muscle in vitro and to accelerate gastric emptying in normal subjects as well as in patients with diabetic mellitus. To evaluate the motor pattern that accounts for this accelerated emptying, the effects of 12.5 mg/min erythromycin vs. placebo on postprandial motility of the antroduodenum was examined with real-time ultrasound in 15 normal subjects. During 10 minutes of observation, erythromycin significantly increased forward transpyloric flow episode (1.04 +/- 0.19 vs. 0.37 +/- 0.41; p < 0.05), forward transpyloric flow duration (5.79 < 4.49 vs. 3.19 < 1.72 seconds; p < 0.05) and improved antro-pyloro-duodenal coordination (0.43 +/- 0.23 vs. 0.21 +/- 0.17; p < 0.05). However, no significant differences were found for gastric peristaltic cycle (22.62 +/- 3.06 vs. 23.40 +/- 2.14 seconds; p > 0.05), retrograde transpyloric flow episode (0.13 +/- 0.16 vs. 0.18 +/- 0.29; p > 0.05), and retrograde transpyloric flow duration (1.24 +/- 0.30 vs. 1.38 +/- 0.58 seconds; p > 0.05). We conclude that erythromycin increases episode and duration of forward transpyloric flow, and improves antro-pyloro-duodenal coordination, which may play a role in accelerating gastric emptying.

Adult↗
PubMed1994

[Electron microscopic studies of the action of erythromycin, doxycycline and ofloxacin on the growth cycle of Chlamydia trachomatis].

The aim of this work is to realise an ultra structural study of the action of antibiotics (doxycycline, erythromycin and ofloxacin) on the intracellular growth cycle of chlamydia. All assays were done on McCoy cells. Antibiotics were added to the culture medium two hours after inoculation with C. trachomatis. 24 and 48 hours, cells were removed and treated by standard procedure for transmission electron microscopy. No difference between control-cells and cells treated with doxycycline, erythromycin (0.015 mg/l) and ofloxacin (0.15 mg/l), was observed in the inclusions (number and size). However 48 hours, the quantity of elementary bodies (E.B.) was lower in treated culture. The organisms were not morphologically different from those seen in untreated culture. At higher concentrations of doxycycline and erythromycin (0.03 mg/l - 0.06 mg/l), the inclusions were smaller. Reticulate bodies (RB) were each in separate inclusion indicating that no fission has taken place. At 48 hours, no infectious forms (EB) were observed. Small or large RBs appeared with an apparent normal cytoplasmic membrane within an inflated cell wall. With ofloxacin (0.3 - 0.6 mg/l), inclusions contained enlarged and sometimes empty bacterial cells. Doxycycline and erythromycin (0.03 mg/l) inhibit the division of RBs and there maturation to EBs Ofloxacin (0.3 mg/l) induces the production of large abnormal forms which may not be able to revert towards viable bacteria.

Cell Division↗
PubMed1993

A randomized, open, comparative study of brodimoprim versus erythromycin in patients with acute tonsillitis or bronchitis.

UNLABELLED: The objective of the study was the comparison of the efficacy and tolerability of brodimoprim to those of erythromycin in children with acute tonsillitis or bronchitis. 50 children aged 0.5 to 9.3 years were included in the study, 25 treated either with brodimoprim or with erythromycin. The evaluation of the therapeutic response was based exclusively on clinical criteria. In the brodimoprim group the therapy was successful in 24 patients (one failure), in the erythromycin group the therapy was also successful in 24 children (one failure). Side effects: three patients treated with brodimoprim reported adverse reactions (stomatitis, vomiting, skin rash), whereas only one patient in the erythromycin group developed a skin rash. CONCLUSION: both therapeutic regimens were equally effective against bronchitis and tonsillitis in children. The tolerability was good in both groups.

Acute Disease↗
PubMedDate not supplied

Impact of compliance and side effects on the clinical outcome of patients treated with oral erythromycin.

STUDY OBJECTIVE: To determine the relationship among compliance, side effects, and self-reported outcome for patients in an erythromycin trial. DESIGN: A retrospective analysis of data from a multicenter, prospective, single-blind, randomized trial. SETTING: Five metropolitan ambulatory care offices. PATIENTS: The 252 adults (> 18 yrs) were prescribed oral erythromycin 1.0 g/day (base equivalent) for infectious disorders. INTERVENTION: Subjects received erythromycin for 10 days and reported compliance, drug efficacy, and side effects in a daily diary. Compliance was measured by tablet count. RESULTS: A negative correlation was found between gastrointestinal symptom severity score and percentage of tablets taken (p < 0.001). A significant positive correlation was seen between compliance and outcome (p < 0.001). Subjects who took greater than 80% of the drug achieved the treatment goal more frequently than those taking 80% or less (94% vs 59%, p < 0.001). CONCLUSIONS: Side effects of erythromycin adversely affected compliance. Compliance had a positive effect on self-reported outcome.

Administration, Oral↗
PubMedDate not supplied

Agonist effect of erythromycin and its analogues on motilin receptors. A new family of prokinetics? Clinical interest.

It has been known since long that erythromycin may cause unpleasant gastro-intestinal side-effects such as nausea and vomiting. Recent studies however show that at low doses erythromycin may have a beneficial effect. Erythromycin induces the migrating motor complex in the fasted state and after a meal it accelerates gastric emptying. Although largely preliminary, its effects on esophageal, small intestinal, colonic and biliary tract motility have now been studied in several pathological conditions. Erythromycin is certainly a powerful gastrokinetic. Its antibiotic properties are a disadvantage, but more powerful derivatives devoid of antibacterial properties may soon become available. They form a new family of prokinetics.

Erythromycin↗
PubMed1978

Treatment of acne vulgaris with topically applied erythromycin and tretinoin.

A twice daily application of 2% erythromycin base in hydroalcoholic solution accompanied by once daily use of 0.05% tretinoin (retinoic acid) solution was substantially more effective than tretinoin or erythromycin alone for treatment of inflammatory acne of moderate severity. Therapeutic enhancement by this combination can be attributed to the different modes of action, erythromycin acting chiefly by suppressing Propionibacterium acnes, while tretinoin is comedolytic. In addition, by altering the horny layer barrier, tretinoin doubtless increases the penetration of erythromycin.

Acne Vulgaris↗
PubMed1993

Postoperative gastroparesis and tachygastria--response to electric stimulation and erythromycin.

BACKGROUND: The purpose of this study was to correlate clinical course, gastric emptying, and gastric myoelectric activity in a patient after gastric operation and to determine the effect of electric stimulation and the administration of erythromycin on the patient's gastric rhythm. METHODS: Daily myoelectric recordings were obtained through implanted gastric electrodes after truncal vagotomy and gastroenterostomy for an obstructing duodenal ulcer. RESULTS: The patient had acute postoperative delayed gastric emptying, accompanied initially by stomal edema but subsequently associated with persistent tachygastria. The gastric rhythm was only transiently slowed by multiple attempts at electroversion but appeared to respond dramatically to intravenous erythromycin therapy. Although delayed gastric emptying persisted on radionuclide gastric emptying studies, the patient slowly improved clinically with continued erythromycin therapy. CONCLUSIONS: Disturbances in gastric rhythm may accompany postoperative gastroparesis, although in our patient the dysrhythmias appeared to occur secondary to gastric outlet obstruction. Although his stomach could be paced, pacing was not effective in restoring a normal gastric rhythm. In contrast, intravenous erythromycin therapy was associated with rapid restoration of a normal gastric rhythm and slow improvement in gastric function.

Anastomosis, Surgical↗
PubMed1977

The effect of erythromycin and its thiocarbamide derivative on the induction of meiotic chromosome rearrangements in irradiated male mice.

Antibiotics, erythromycin and a thiocarbamide derivative of erythromycin were tested for their ability to induce chromosome translocations in whole-body irradiated mice with a dose of 600 r. The aim of the present paper was to determine whether these antibiotics might induce by themselves, chromosomal translocations and whether these agents have a protective effect against X-rays-induced chromosomal translocations in the spermatocytes at the first meiotic metaphase. The incidence of translocations in irradiated animals was 9.07%; in animals treated with erythromycine after irradiation it was 3.80%; and in those treated with a thiocarbamide derivative of erythromycin following irradiation was 3.20%. Not a single chromosome rearrangement was scored among the non-irradiated animals, treated with the mentioned antibiotics.

Animals↗
PubMed1993

Erythromycin: a motilin agonist and gastrointestinal prokinetic agent.

Erythromycin, a commonly used antibiotic, has recently emerged as a potential gastrointestinal prokinetic agent. This follows a decade of research into the mechanism of well-recognized gastrointestinal side effects of erythromycin. Early investigations demonstrated that erythromycin increased gastrointestinal motility, and more recent studies suggest that it fortuitously binds to and stimulates the receptor for the gastrointestinal peptide motilin. From this work it appears that a new and powerful class of gastrointestinal prokinetic agents will evolve from erythromycin and its derivatives. The role of motilin in the genesis of the fasting and fed patterns of gastrointestinal motility is emerging through the study of these motilin agonists.

Animals↗
PubMedDate not supplied

Gallbladder contraction induced by intravenous erythromycin administration. Relation to body mass index.

BACKGROUND/AIMS: To study the action of intravenously administered erythromycin lactobionate on human gallbladder volume, as a possible preventive method against gallbladder stone formation, in high risk patients such as those in sepsis, long standing fasting periods or those receiving prolonged total parenteral nutrition or octreotide. MATERIALS AND METHODS: Twenty-two volunteers randomized to receive intravenously either erythromycin lactobionate 7 mg per kg (study group) or normal saline (controls). We measured ultrasonographically the gallbladder volume before and at 5, 15, 35, 55, 90, 120 and 180 min after the infusion. RESULTS: Erythromycin induced a biphasic gallbladder contraction, with maximum contractility at 15 min (10.2%) and between 120 and 180 min (22.6%), compared to normal saline controls. Late contractility was correlated to body mass index (BMI). CONCLUSIONS: Erythromycin activity on gallbladder contraction is proved. Its biphasic action needs further investigation to find the involved mechanism(s). Long term administration is also necessary to test its efficacy in preventing gallbladder dilatation.

Adult↗
PubMed1977

Tetracyclines, chloramphenicol, erythromycin, and clindamycin.

Tetracyclines are active in vitro against most urinary tract pathogens, Chlamydia, Mycoplasma pneumoniae, Brucella, rickettsiae, and Nocardia. Chloramphenicol is used primarily for anaerobic infections, Haemophilus influenzae meningitis, and infections due to Salmonella typhi. Erythromycin is active in vitro against M. pneumoniae, Streptococcus pneumoniae, and group A beta-hemolytic streptococci. Erythromycin may be used as prophylactic therapy for subacute bacterial endocarditis and for recurrence of acute rheumatic fever in patients who are allergic to penicillin. Clindamycin should be used only for the treatment of anaerobic infections. Tetracycline may cause gastrointestinal upset; phototoxic dermatitis; hepatitis, especially in pregnant females; discoloration of teeth and bone dysplasia in the human fetus and children; and suprainfections, especially oral and anogenital candidiasis. Tetracycline should be used with caution in patients with renal insufficiency. The most important toxic effect of chloramphenicol is bone marrow suppression, which is dose related and idiosyncratic. The incidence of undesirable side effects associated with the use of erythromycin is low. Gastrointestinal irritation is the most common; cholestatic hepatitis may occur with erythromycin estolate. Pseudomembranous colitis is the most important toxic effect associated with clindamycin.

Anaerobiosis↗
PubMedDate not supplied

QT prolongation and development of torsades de pointes with the concomitant administration of oral erythromycin base and quinidine.

Torsades de pointes is a polymorphic ventricular tachycardia characterized by marked QT prolongation on the electrocardiogram. It can be induced by both antiarrhythmic and nonantiarrhythmic drugs, such as quinidine and erythromycin. No extensive literature documents an interaction between quinidine and erythromycin when the agents are administered orally. A 95-year-old man received oral quinidine and erythromycin for the treatment of atrial fibrillation and community-acquired pneumonia. He developed torsades de pointes and subsequently cardiac arrest. Since erythromycin and quinidine are known to cause arrhythmias individually, caution and close monitoring are necessary when the drugs are administered concomitantly.

Aged↗
PubMed1998

Erythromycin, a motilin agonist, increases postprandial gallbladder emptying during therapy with ursodeoxycholic acid.

Sufficient gallbladder emptying accelerates early gallstone clearance after extracorporeal shock wave lithotripsy (ESWL). Litholytic therapy with ursodeoxycholic acid (UDC) subsequent to ESWL increases fasting volume (FV) and postprandial residual volume (RV) of the gallbladder. This may lead to retention of cholesterol crystals and small fragments within the gallbladder. In order to find out whether erythromycin, a motilin agonist, improves gallbladder emptying, we tested gallbladder motility after administration of ursodeoxycholic acid with and without oral application of erythromycin. Ten healthy males (age 26-35 years) obtained 10 mg/kg/d of UDCA as a single bedtime dose for three weeks. Prior and after UDCA administration, gallbladder FV was determined sonographically after overnight fasting. After a test meal (490 kcal), gallbladder volume was measured every 5 min until the gallbladder had reached its minimal RV. The next day the same procedure was repeated with 500 mg erythromycin p.o. 45 min prior to test meal application. FV, RV, ejection volume (EV = FV-RV) and ejection fraction (EF = EV/FV x 100) were calculated and differences were compared by the student's t-test. FV (29 ml +/- 8 ml vs. 38 ml +/- 10 ml), RV (12 ml +/- 6 ml vs. 17 ml +/- 6 ml) and EV (17 ml +/- 5 ml vs. 21 ml +/- 6 ml) increased significantly during therapy with UDCA (p < 0.05). EF did not change significantly. After erythromycin application RV decreased to its original values (13 ml +/- 6 ml), whereas EV (24 ml +/- 6 ml) and EF (58% +/- 9% vs. 66% +/- 11%) increased significantly (p < 0.05). Thus, administration of a motilin agonist blunts unwanted effects on gallbladder motility during litholytic therapy with UDC.

Administration, Oral↗