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PubMed1985

Separation of erythromycin and related substances by high-performance liquid chromatography on poly(styrene-divinylbenzene) packing materials.

A comparative evaluation of three brands of poly(styrene-divinylbenzene) copolymers, Hamilton PRP-1 (10 micron), Rogel (8 micron) and TSK-Gel (10 micron), as column packing materials for high-performance liquid chromatographic separation of erythromycins is presented. Erythromycins A, B and C, anhydroerythromycin A, erythromycin A enol ether, N-demethylerythromycin A, anhydro N-demethylerythromycin A and N-demethylerythromycin A enol ether were chromatographed. The effects of column temperature, concentration of organic modifier in the mobile phase, concentration of phosphate buffer, the addition of quaternary ammonium salts and pH are described. The best separations were obtained on TSK-Gel with the mobile phase acetonitrile-methanol-0.2 M tetramethylammonium hydroxide pH 8.0-0.2 M phosphate buffer pH 8.0-water (30:15:25:5:25). PRP-1 and Rogel gave equally good separations but with higher retention volumes.

Animals↗
PubMed1987

Optimization of the separation of erythromycin and related substances by high-performance liquid chromatography.

An improved high-performance liquid chromatographic method for analysis of erythromycin is described. The separation can be performed under mild conditions of pH (6.5) and temperature (35 degrees C) on C8 and C18 silica-based reversed-phase materials of different origins. The mobile phase, with a flow-rate of 1.5 ml/min, contained various amounts of acetonitrile (25-40%, v/v), 5% (v/v) 0.2 M ammonium phosphate buffer pH 6.5, 20% (v/v) 0.2 M tetramethylammonium phosphate and water. UV detection at 215 nm allows quantitation of erythromycins A, B and C, N-demethylerythromycin A, erythromycin A enol ether and anhydroerythromycin A. The column history plays a major role, older columns often giving better separations.

Chromatography, High Pressure Liquid↗
PubMed1987

Erythromycin.

Erythromycin is the only macrolide antibiotic to have gained widespread use in the United States. Introduced in 1952, it rapidly gained a popularity that it enjoys to this day. Numerous other antimicrobial agents have been marketed since that time: Whole new classes of antibiotics, both natural and synthetic, have been discovered, studied, and released for general use. Many of these newer agents boast a broader spectrum of antimicrobial activity, yet erythromycin's place in the clinician's arsenal is unthreatened because erythromycin remains the drug of first choice for a number of pathogens against which the new drugs are inactive. It is one of the safest antibiotics available for use today and when used against susceptible organisms and in indicated clinical situations, its effectiveness is unquestioned.

Bacterial Infections↗
PubMed2001

[Phlebitis due to intravenous administration of macrolide antibiotics. A comparative study of erythromycin versus clarithromycin].

BACKGROUND: To know and to compare the incidence of phlebitis due to intravenous administration of macrolide antibiotics erythromycin and clarithromycin. PATIENTS AND METHOD: Non-randomized prospective study of consecutive patients who were diagnosed of community pneumonia and treated with intravenous macrolides (19 with erythromycin and 25 with clarithromycin). RESULTS: The cumulative incidence of phlebitis in patients treated with erythromycin was 78.9% (incidence rate of 0.40 episodes/patient-day) and in those treated with clarithromycin 76% (incidence rate of 0.35 episodes/patient-day). CONCLUSIONS: The risk of phlebitis is high and similar with intravenous administration of both macrolides.

Anti-Bacterial Agents↗
PubMed2003

[Pneumococcal pneumonia in hospitalized patients. Therapeutic implications of resistances to penicillin and erythromycin].

BACKGROUND AND OBJECTIVE: Streptococcus pneumoniae is the main etiological agent of community-acquired pneumonia. The aim of this work was to ascertain the resistance profiles of pneumococcus to penicillin and erythromycin and to analyse whether such profiles lead to different disease developments. PATIENTS AND METHOD: A retrospective analysis was carried out in 75 cases of pneumococcal pneumonia corresponding to hospitalized patients. Comorbidity factors were evaluated including their influence on the appearance of resistance. RESULTS: 67 patients (89.3%) presented comorbidity factors. 49.3% isolates displayed some type of resistance: 38.6% to penicillin, 36% to erythromycin and 13.3% to cefotaxime. No relationship was observed between the severity of the pneumonia and antibiotic resistance. Complications and mortality were not influenced by the susceptibility of pneumococcus to antibiotics. CONCLUSION: The increase in the resistance to antibiotics, especially erythromycin, makes betalactams the best choice for the treatment of pneumococcal pneumonia.

Adult↗
PubMed1998

Solution conformation of methylated macrolide antibiotics roxithromycin and erythromycin using NMR and molecular modelling. Ribosome-bound conformation determined by TRNOE and formation of cytochrome P450-metabolite complex.

Conformational study of methylated derivatives of macrolide antibiotics roxithromycin (6-OMe-roxithromycin and 6,11-OMe-roxithromycin) has been achieved by NMR in solution and molecular dynamics (MD) simulations and compared to 6-OMe-erythromycin (clarithromycin). A complete conformational study by NMR has been led by determination of homonuclear coupling constants and NOEs. Heteronuclear 1H-13C coupling constants were also measured to investigate the orientation of the sugar moieties with respect to the erythronolide. MD simulations were performed using the crystallographic coordinates as the starting conformation. For each compound, experimental results were compared to calculated conformations in order to identify eventual conformational equilibrium in solution. It is shown that the effect of the methylation is opposite for roxithromycin compared to erythromycin especially on motional properties as the roxithromycin derivatives gain in mobility while the erythromycin derivatives behaves as a more restrained molecule. The study of macrolide-ribosome interactions has been investigated using transferred NOESY 1H NMR experiments and the conformations weakly bound to bacterial ribosomes were determined. Biological interactions of these compounds with membranar liver protein cytochrome P450 was also discussed with regard to their structural properties.

Anti-Bacterial Agents↗
PubMed2003

Randomized, open-label, parallel-group, multicenter study of the efficacy and tolerability of IV gatifloxacin with the option for oral stepdown gatifloxacin versus IV ceftriaxone (with or without erythromycin or clarithromycin) with the option for oral stepdown clarithromycin for treatment of patients with mild to moderate community-acquired pneumonia requiring hospitalization.

BACKGROUND: Empiric therapy for community-acquired pneumonia (CAP) requires the use of antibiotics with activity against a broad spectrum of respiratory pathogens and suitable pharmacokinetic properties to simplify IV-to-oral step-down therapy switches. OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of IV gatifloxacin with the option for oral stepdown gatifloxacin with a standard regimen of IV ceftriaxone (with or without erythromycin or clarithromycin) with the option for oral stepdown clarithromycin in patients with mild to moderate CAP requiring hospitalization. METHODS: In a randomized, open-label, parallel-group, multicenter study, adults with CAP received 7 to 14 days of treatment with either IV gatifloxacin 400 mg QD with the stepdown option or IV ceftriaxone 1 or 2 g QD (with or without erythromycin 0.5 or 1 g QID or clarithromycin 500 mg BID) with the stepdown option. RESULTS: One hundred seventy adults with CAP were included in the study. IV gatifloxacin was stepped down to oral gatifloxacin in 90.6% (7785) of patients; IV ceftriaxone was stepped down to oral clarithromycin in 87.1% (7485) of patients. Among clinically evaluable patients (n = 153), cure rates at 1 to 3 days after treatment were 97.4% in the gatifloxacin group (7476) and 90.9% in the ceftriaxone group (7077), with a 95% CI for the difference (-3.7% to 19.1%) indicating statistical equivalence. In patients in whom pathogens were isolated from pretreatment sputum cultures, bacteriologic eradication rates were 100.0% (2929) and 90.9% (3033), respectively. Both regimens were well tolerated; treatment-related adverse events occurred in 27.1% (2385) and 21.2% (1885) of patients, respectively. CONCLUSIONS: In the population studied, treatment with IV gatifloxacin with an option for oral stepdown gatifloxacin was as effective for achieving clinical cure as IV ceftriaxone (with or without concomitant IV erythromycin or clarithromycin) with an option for oral stepdown clarithromycin. Both regimens were well tolerated.

Administration, Oral↗
PubMed1982

Erythromycin therapy in bullous pemphigoid: possible anti-inflammatory effects.

Two patients with bullous pemphigoid treated with erythromycin demonstrated improvement. This response suggests that erythromycin may be a fairly safe supplemental drug which may allow a lower dose of systemic steroid, or may be of benefit when used alone or in combination with topical steroids in treating patients who are not ideal candidates for a systemic steroid. Erythromycin appears to have a significant anti-inflammatory effect, and possible mechanisms for this effect are proposed. One of the patients was a 4 1/2-year-old girl whose disease manifested several unusual features, making diagnosis difficult. A brief summary of differential immunofluorescent findings in childhood bullous diseases is also presented.

Aged↗
PubMed1983

A double-blind study of the effectiveness of a 3% erythromycin and 5% benzoyl peroxide combination in the treatment of acne vulgaris.

One hundred sixty-five subjects completed a 10-week, double-blind controlled study comparing the following: (1) a combination of 3% erythromycin and 5% benzoyl peroxide in a gel, (2) 5% benzoyl peroxide gel, (3) 3% erythromycin gel, and (4) the gel vehicle. The benzoyl peroxide gel and the erythromycin gel were superior to the control gel; however, the combination product was more effective than any of the others. This was true for both pustular and papular lesions, but the most dramatic effect was on combined inflammatory lesions, i.e., papules and pustules.

Acne Vulgaris↗
PubMed1986

Pityriasis lichenoides in children: therapeutic response to erythromycin.

Fifteen of twenty-two children with pityriasis lichenoides were treated with oral erythromycin. Eleven (73%) had a remission, usually within 2 months. Two others showed partial improvement, and two were unimproved. Seven of the children who experienced a remission were off erythromycin and free of lesions after 2 to 5 months of therapy. A trial of erythromycin as described herein should be considered in children with pityriasis lichenoides before other, possibly more toxic, measures are instituted.

Adolescent↗
PubMed1987

Erythromycin 2% gel in comparison with clindamycin phosphate 1% solution in acne vulgaris.

One hundred two patients with mild to moderate facial acne vulgaris completed a 12-week, investigator-masked, randomized, parallel-group comparison of a gel formation of erythromycin (2%) with clindamycin phosphate 1% solution. Patients were evaluated at a baseline visit and after 4, 8, and 12 weeks of twice-daily treatment. Both medications significantly reduced the numbers of papules and open and closed comedones. No significant differences in lesion count reductions were detected between the treatment groups after 8 and 12 weeks of treatment. By the end of 12 weeks, 48% of the patients in the erythromycin group and 47% in the clindamycin group had good or excellent responses to treatment. No patient was terminated from the study for side effects. Most patients, 65% in the erythromycin 2% gel group and 67% in the clindamycin phosphate 1% solution group, had a favorable impression of the overall cosmetic characteristics of their study medication.

Acne Vulgaris↗
PubMed1990

Erythromycin failure with subsequent Pasteurella multocida meningitis and septic arthritis in a cat-bite victim.

We report the case of a 75-year-old woman who developed Pasteurella multocida meningitis and septic arthritis while being treated for a cat-bite wound infection with erythromycin. Review of the literature revealed that erythromycin has poor in vitro activity against this bacterium and has been associated with serious clinical failures. We recommend that erythromycin not be prescribed for empiric therapy of established animal-bite infections. Suggestions for optimal empiric therapy of animal-bite infections and the differential diagnosis of severe cat-bite-associated sepsis are discussed.

Aged↗
PubMed1978

Concentrations of azidocillin, erythromycin, doxycycline and clindamycin in human mandibular bone.

Postoperative complications after surgery in the mandible are still a clinical problem. Levels of four antibiotics--azidocillin, erythromycin, doxycycline and clindamycin--were measured in serum, dental alveolar serum, saliva and mandibular bone in 24 patients undergoing surgical removal of mandibular third molars. The concentration in mandibular bone for azidocillin was 0.8 microgram/g +/- 0.4 microgram/g, erythromycin 0.2 microgram/g +/- 0.1 microgram/g, doxycycline 2.6 microgram/g +/- 2 microgram/g and clindamycin 0.6 microgram/g +/- 0.4 microgram/g. No saliva levels were achieved with azidocillin and erythromycin, whereas doxycycline and clindamycin gave measurable saliva levels.

Adolescent↗
PubMed1997

Effects of erythromycin on chemoattractant-activated human polymorphonuclear leukocytes.

1. Erythromycin (2-100 micrograms ml-1) produced a concentration-related inhibition of superoxide generation and elastase release induced by in vitro exposure of human polymorphonuclear leukocytes (PMNs) to the chemotactic peptide N-formylmethionyl-leucyl-phenylalanine (FMLP; 30 nM). 2. By contrast, erythromycin (100 micrograms ml-1) did not alter the leukotriene B4 production elicited by FMLP (30 nM; in the presence of thimerosal 20 microM) or the intracellular calcium changes promoted by FMLP (30 nM; in the absence or presence of thimerosal 20 microM). 3. These results indicate that by reducing chemoattractant-triggered release of oxidative and proteolytic mediators from human PMNs, erythromycin may have clinically useful antiinflammatory effects.

Anti-Inflammatory Agents↗
PubMed1983

Analysis of erythromycin in biological fluids by high-performance liquid chromatography with electrochemical detection.

A simple and sensitive high-performance liquid chromatographic assay was developed for the quantitative determination of major erythromycin components and their potential metabolites or degradation products in plasma and urine. An ether extract of alkalized plasma sample was chromatographed on a reversed-phase column and the components in the column effluent were monitored by an electrochemical detector. The recovery of the drug from extraction was virtually 100%. The detection limits for erythromycin A in plasma were 5-10 ng/ml and 30 ng/ml using 1 and 0.2 ml of sample, respectively. For urine samples, a simple one-step deproteinization with two volumes of acetonitrile was satisfactory for analysis. The method has been evaluated in plasma and urine from dogs receiving oral or intravenous erythromycin A. The standard curves for potential metabolites or degradation products were not constructed due to the lack of sufficient samples.

Animals↗
PubMed1997

Susceptibility of twenty penicillin-susceptible and -resistant pneumococci to levofloxacin, ciprofloxacin, ofloxacin, erythromycin, azithromycin, and clarithromycin by MIC and time-kill.

This study uses MIC and time-kill methodology to examine the antipneumococcal activity of levofloxacin, ciprofloxacin, ofloxacin, erythromycin, azithromycin, and clarithromycin against 20 pneumococci. Ten strains had levofloxacin MICs of 1.0 microgram/ml, and ten levofloxacin MICs of 2.0 micrograms/ml. Five strains in each group were macrolide susceptible, and five were macrolide resistant. MICs for ciprofloxacin and ofloxacin ranged from 0.5 to 4.0 micrograms/ml and 1.0 to 8.0 micrograms/ml, respectively. MICs of erythromycin, azithromycin, and clarithromycin were similar for macrolide susceptible strains, ranging between 0.004 to 0.06 microgram/ml, and were > or = 128.0 micrograms/ml for macrolide resistant strains. The three quinolones were bactericidal (99.9% killing) for all macrolide-susceptible strains at 2 x MIC at 24 h. The three quinolones yielded 99% killing of all strains after 12 h at 2 x MIC, and 90% killing of all strains after 6 h at the MIC of levofloxacin and ciprofloxacin and 2 x MIC for ofloxacin. Levofloxacin yielded 90% killing of all strains after 4 h at 2 x MIC and ofloxacin at 4 x MIC. For macrolide-susceptible strains, erythromycin and clarithromycin were bactericidal for 9 of 10 strains after 24 h at 4 x and 2 x MIC, respectively, and azithromycin was bactericidal after 24 h at 2 x MIC for 8 of 10 strains. All three macrolides were bactericidal after 12 h only, while 90% killing occurred in 9 of 10 strains at 8 x MIC after 6 h. Quinolone kill kinetics were similar for the 10 macrolide-resistant strains. For macrolide-resistant strains, at 64 to 128.0 micrograms/ml, virtually no decrease in count was seen, with no bactericidal effect.

Anti-Bacterial Agents↗
PubMed1998

Comparative activity of ciprofloxacin, ofloxacin, levofloxacin, and erythromycin against Legionella species by broth microdilution and intracellular susceptibility testing in HL-60 cells.

Animal lung macrophages or human peripheral blood mononuclear cells have been used for testing intracellular activity of anti-Legionella antibiotics; such studies are labor intensive such that comparative antibiotic studies for the many Legionella species are few. We evaluated a human monocyte cell line (HL-60) as an alternative model. HL-60 (1.5 x 10(6) cells/well) was differentiated into adherent cell and infected with 1.5 x 10(7) CFU of Legionella pneumophilia (L. pneumophilia). Erythromycin and quinolones, ciprofloxacin, ofloxacin, and levofloxacin were added to cells at 1 and 8 x MIC. Percent (%) inhibition ratios equal to total L. pneumophila with agent divided by L. pneumophila without agent x 100 were determined at 48 h; lower ratios implied greater potency. By broth dilution in buffered yeast extract broth, the most potent agents against L. pneumophila were (MIC): ciprofloxacin (0.015-0.03), ofloxacin (0.015-0.03), levofloxacin (0.015-0.03), erythromycin (0.125-1.0 microgram/mL). In the intracellular model, the most potent inhibitors of L. pneumophila multiplication at 8 x MIC were (in order of potency) levofloxacin (24.2%), ciprofloxacin (30.6%), ofloxacin (37.1%), and erythromycin (55.0%). All the quinolones were highly active and significantly more potent against L. micdadei and L. bozemanii when compared to L. pneumophila.

Anti-Bacterial Agents↗