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PubMed2000

Erythromycin and position facilitated placement of postpyloric feeding tubes in burned patients.

BACKGROUND: One of the main difficulties encountered in enteral nutrition in critically ill patients is the impaired gastric emptying: while the small bowel is ready the stomach is still 'lazy'. This paper describes a simple bedside method for postpyloric feeding tube placement, using a gastric prokinetic agent, erythromycin, and patient positioning. METHODS: In eight critically ill, burned patients a gastric feeding tube was placed in a reverse Trendelenburg, right lateral decubitus position. A dose of 250 mg of erythromycin was administered intravenously. RESULTS: In 13 out of 14 attempts, the tube passed into the duodenum, a success rate of 92%. CONCLUSIONS: Combining the prokinetic effects of erythromycin with proper patient positioning allows a rapid bedside transpyloric placement of feeding tubes.

Adult↗
PubMed1990

Enhanced interleukin production after long-term administration of erythromycin stearate.

The effects of erythromycin stearate (10 mg/kg/day) were studied on productions of interleukin (IL)-1 and -2 in mice after a long-term treatment. A 28-day treatment resulted in higher levels of IL-1 production by macrophages and of IL-2 production by splenocytes, while a 7-day treatment did not increase them. T-cell growth factor activity of IL-2 preparation prepared on day 28 of treatment as determined by HT-2 cell proliferation was reduced by about 40% in the presence of anti-murine IL-4 monoclonal antibodies, while control IL-2 activity was not reduced. Furthermore, a 28-day treatment with erythromycin stearate increased concanavalin A-induced blastogenesis of splenocytes significantly. These results suggest that long-term treatment with erythromycin stearate can stimulate host defense by increasing interleukin production.

Animals↗
PubMed1997

Inhibition by erythromycin of human pulmonary artery endothelial cell injury induced by human neutrophils.

Neutrophils are thought to play a key role in tissue injury. We investigated the role of human neutrophils in the induction of injury to the human pulmonary artery endothelial cells and the effect of erythromycin on neutrophil-induced endothelial cell damage. Incubation of unstimulated neutrophils with endothelial cells increased the release of lactate dehydrogenase (LDH) activity and preloaded fura-2 from endothelial cells. When neutrophils were activated by phorbol myristate acetate, the release of LDH and fura-2 was enhanced further. Superoxide dismutase partially inhibited the release of LDH and fura-2 induced by neutrophils, whereas erythromycin markedly inhibited the release of endothelial cell LDH and fura-2 induced by neutrophils. These results suggest that endothelial cell injury is, at least in part, mediated by the action of superoxide and that erythromycin protects against neutrophil-induced endothelial cell injury.

Anti-Bacterial Agents↗
PubMed1976

The effect of erythromycin on the growth of Rickettsia prowazekii in the body louse (Pediculus humanus corporis L) and the tick (Ornithodoros moubata Murray).

Body lice (Pediculus humanus corporis L) and ticks (Ornithodoros moubata) that had been infected with Rickettsia prowazekii received varying doses of erythromycin. The anti-rickettsial activity of this drug was evaluated with regard to the determination of the numbers of surviving microorganism (LID100) and the in vivo concentration of erythromycin in both arthropod hosts. Erythromycin was found to exert a rickettsiostatic effect in lice, whereas in ticks the drug at concentrations of 0.3--0.04 mug/mg body weight completely eliminated R. prowazekii.

Animals↗
PubMed1980

Effects of phenobarbitone on the distribution, metabolism and biliary excretion of erythromycin in rats.

The administration of phenobarbitone to the rat (8 mg/100 g BW) once daily for 3 days significantly decreased the serum and tissue levels of erythromycin administered intraperitoneally (5 mg/100 g BW). Furthermore, phenobarbitone stimulated the hepatic microsomal N-demethylation of erythromycin and increased the biliary concentration and the biliary excretion rate of the unmetabolized antibiotic. These effects were accompanied by augmented liver mass and bile flow. The possibility is discussed that erythromycin concentrates in the bile through a specialized hepatic drug transport system, activated by phenobarbitone.

Animals↗
PubMed1986

Evaluation of the immunostimulating activity of erythromycin in man.

The effects of erythromycin on the immune system have been studied in healthy volunteers and patients suffering from chronic bronchopneumonial diseases, by means of the following assays: phagocytosis, natural killer activity and superoxide anion production. The tests were performed before and after oral administration of 1 g of erythromycin. The findings suggest that erythromycin enhances phagocytosis by means of increasing ingestion of microorganisms, superoxide anion (O2-) production as well as natural killer activity. Under the experimental conditions described these effects appear 4-6 h after drug intake and reach their maximum around the 8th hour.

Adult↗
PubMed1990

Effect of azithromycin, roxithromycin and erythromycin on human polymorphonuclear leukocyte function against Staphylococcus aureus.

The effect of three macrolides (azithromycin, roxithromycin and erythromycin) on the interaction in vitro of human polymorphonuclear leukocytes (PMNs) with Staphylococcus aureus was examined. The exposure of S. aureus to 0.25 MIC of roxithromycin and erythromycin but not of azithromycin significantly increased the uptake of opsonized bacteria by human PMNs. The preincubation of PMNs with 1, 10 and 25 mg/l of the three antimicrobial agents did not affect either the uptake of S. aureus or the superoxide radical production by human PMNs. At these same concentrations the three agents showed slight but not significant intracellular activity in PMNs against S. aureus. It is concluded that treatment of S. aureus with subinhibitory concentrations of roxithromycin and erythromycin enhanced phagocytosis by PMNs, but the three macrolides tested did not directly affect the functions of human PMNs against S. aureus.

Azithromycin↗
PubMed1998

Improvement of survival in patients with diffuse panbronchiolitis treated with low-dose erythromycin.

Diffuse panbronchiolitis (DPB) is a chronic inflammatory disease of the airways with a high rate of mortality despite treatment with a combination of antibiotics and the use of supportive therapy such as oxygen administration. Low-dose erythromycin therapy (EM) (400 to 600 mg/d) has been found to improve the survival of patients with DPB, and most patients with DPB in Japan have been treated with this erythromycin regime since 1984. The purpose of this study was to evaluate the effects of treatment with erythromycin on the survival rate of patients with DPB in Japan. We compared the survival rates of 498 patients with DPB after dividing them into three groups according to the date of their first medical examination (Group a: 1970-1979, Group b: 1980-1984, Group c: 1985-1990). DPB had been diagnosed in these patients using the criteria of the Ministry of the Health and Welfare Diffuse Lung Disease Committee (MHW-DLDC), which includes chronic productive cough, shortness of breath, presence of roentgenologically smoldering symmetrical granular shadows in the middle and lower lung fields, limitation of airflow without decrease in DLCO, elevated serum cold hemagglutinin titers, and/or narrowing bronchiolus with infiltration of lymphocytes and foamy alveolar macrophages. These patients were registered in the DPB research group of the Ministry of Health and Welfare (MHW). Survival rates were statistically compared using the generalized-Wilcoxon test. The survival rate of Group c was significantly higher than that of Groups a (p < 0.0001) and b (p < 0. 0001). In Group c, eight of 87 patients died; five died in the EM nontreated subgroup (n = 24), and three died in the EM-treated subgroup (n = 63). There was a significant difference in the survival rates between the two subgroups in Group c (p < 0.001). Treatment with EM was associated with a significant improvement in the rate of survival of patients with DPB. The efficacy of EM treatment increased the survival rate of patients with DPB, which was more significant in the older than in the younger patients.

Adult↗
PubMedDate not supplied

Reversible sensorineural hearing loss with intravenous erythromycin lactobionate.

Three patients are presented who developed reversible sensorineural hearing losses during treatment with intravenous erythromycin lactobionate. A fourth patient treated with erythromycin gluceptate did not develop hearing loss. Ototoxicity with erythromycin lactobionate has been previously reported in only three patients, one of whom had medication orally. Withdrawal of the antibiotic resulted in prompt improvement in every case with return of hearing to pretreatment levels.

Adult↗
PubMed1977

Erythromycin and anaerobes: in vitro aspects.

Anaerobic organisms are being increasingly recognised as important causes of serious infection in man. Sampling procedures, transport of specimens and laboratory techniques need to be constantly monitored and improved if the causative organisms are to be consistently recovered from clinical specimens. Once the organisms have been isolated, their susceptibility to antibiotics should be determined so that the clinician can base his antibiotic therapy on reliable laboratory results. There are many variables in the sensitivity testing of anaerobes--these may account for the difficulty reported by some workers in obtaining consistently reliable results with some antibiotics, including erythromycin. These problems can be largely overcome if a standardised procedure is adopted. It is clear from the published data that erythromycin has considerable in vitro activity against many strains of anaerobic bacteria, both sporing and non-sporing. There is a broad spectrum of activity with some strains being very sensitive and a few strains being resistant. M.I.C. values range from 0.04 microgram./ml. to 20 microgram./ml. or more. Further studies are now needed to assess the role of erythromycin in the treatment of anaerobic infections in vivo.

Anaerobiosis↗
PubMed1986

RV11 (propionyl erythromycin mercaptosuccinate) pharmacokinetics in bronchial secretions.

The kinetics of RV11 (propionyl erythromycin mercaptosuccinate) in serum and bronchial secretions was investigated in heterogeneous bronchopneumopathic patients requiring diagnostic bronchoscopy. A single oral dose, equivalent to 500 mg of erythromycin base, was administered to all patients and the bronchial secretion and plasma concentrations were determined after 2, 3 and 4 hr. The bronchial secretion and plasma levels consistently exceeded those reported previously for erythromycin per os, suggesting that RV11 may have an unusually high affinity for bronchial secretions in humans. The results of this study also suggested that RV11 might have different kinetics in bronchial secretions and serum, though further studies are required to provide definitive evidence.

Adult↗
PubMed2002

Effect of preoperative oral use of erythromycin and nizatidine on gastric pH and volume.

This randomized controlled trial examined the effects of preoperative oral erythromycin or nizatidine on gastric pH and volume. Sixty patients, ASA 1 and 2 status scheduled for elective surgery were studied. All subjects received oral study medication with 10 ml of water 60 minutes prior to surgery. Patients in Group 1 (n=20) were given erythromycin 200 mg, in Group 2 (n=20) nizatidine 300 mg, and in Group 3 (n=20) placebo capsule. A nasogastric tube was inserted immediately after anaesthesia induction. Gastric content was aspirated, and volume and pH recorded. pH values determined in Group 1 were 5.6+/-1.87; in Group 2, 5.65+/-1.92 and in Group 3, 3.5+/-1.93. There was no statistical difference between Groups 1 and 2, but there was a statistically significant difference between Group 3 and Groups 1 and 2 (P<0.001). The volume of gastric content was 10.25+/-6.65 ml in Group 1, 10.3+/-6.29 ml in Group 2 and 20.25+/-16.72 ml in Group 3. Again, there was no statistical difference between Groups 1 and 2, but there was a statistically significant difference between Group 3 and Groups 1 and 2 (P<0.05). The proportion of patients considered "at risk" of significant lung injury should aspiration occur was 10% of Group 1, 5% of Group 2 and 20% of Group 3 (not statistically different). We conclude that oral erythromycin and nizatidine given one hour prior to surgery are effective in reducing gastric pH and volume.

Administration, Oral↗
PubMed1983

Study of serum levels, venous irritation and gastrointestinal side-effects with intravenous erythromycin lactobionate in patients with bronchopulmonary infection.

Sixteen patients with bronchopulmonary infection received 500 mg erythromycin lactobionate by intravenous infusion every 8 h for 2 days. The duration of infusion was either 30 (8 patients) or 60 min (8 patients). An inline filterset (0.22 micrometer) was included in the intravenous administration set in 4 patients of each infusion group. Serum erythromycin levels were obtained before and at various times for 8 h after the first and fourth doses and before and immediately after the other doses. The incidence and severity of venous irritation and gastrointestinal side-effects were assessed. Mean (S.D.) peak erythromycin levels for the 30 min infusion were 26.31 (6.89) micrograms/ml (first dose) and 26.85 (6.11) micrograms/ml (fourth dose) and for the 60 min infusions, 23.96 (7.91) micrograms/ml (first dose) and 23.65 (6.55) micrograms/ml (fourth dose). Venous irritation was experienced by 12 patients, ranging from localized discomfort to thrombophlebitis, but the severity was significantly reduced by inline filtration (P less than 0.005). Gastrointestinal side-effects were reported by 8 patients and 1 patient withdrew because of severe abdominal pain and nausea. These symptoms were usually relieved by spasmolytic agents and possibly could be explained by high concentrations reaching the gut wall either by biliary excretion or direct transport from blood and stimulating smooth muscle motility.

Aged↗
PubMed1983

Decrease in theophylline clearance after the administration of erythromycin to a patient with obstructive lung disease.

It has been demonstrated previously that erythromycin can inhibit the total body clearance of theophylline, resulting in elevated serum theophylline concentrations. The overall incidence of this interaction and the population at risk have not been elucidated fully. Recent investigations have suggested that such an interaction is doubtful and that patients in whom this occurrence was suspect developed alterations in theophylline disposition secondary to worsening pulmonary function, not from erythromycin therapy alone. This case report shows that the interaction between theophylline and erythromycin can be clinically significant, producing as much as a 50-percent reduction in the total body clearance of the bronchodilator. The magnitude and time course of this interaction in patients with congestive heart failure and chronic obstructive pulmonary disease may differ considerably from that reported in healthy volunteers.

Aged↗
PubMed1988

Selection of an erythromycin for the treatment of pertussis.

Pertussis is one of the most communicable diseases of the respiratory tract and the incidence of this disease has increased substantially in recent years. Bordetella pertussis is the major pathogen implicated and erythromycin is considered the drug of choice. Because more studies have reported bacteriological and clinical relapses with ethylsuccinate and stearate formulations than with the estolate preparation, erythromycin estolate 50 mg/kg/d in divided doses over a 14-day period is recommended for the treatment of pertussis. None of the studies, however, have directly compared various forms of erythromycin in these patients to establish superiority of one form over the others. Treatment should be initiated as soon as possible and patients should be followed closely to achieve maximal efficacy and minimize the spread of the disease.

Erythromycin↗
PubMed1998

Erythromycin and clarithromycin attenuate cytokine-induced endothelin-1 expression in human bronchial epithelial cells.

Erythromycin and its fourteen-member macrolide analogues have attracted attention for their efficacy in bronchial asthma. However, their mechanisms of action remain unclear. We evaluated the effects of the macrolide antibiotics on endothelin-1 (ET-1) expression in normal and transformed human bronchial epithelial cells, one of the sources of this potent bronchoconstrictor important in the pathogenesis of asthma. Human bronchial epithelial cells were obtained from the resected bronchi, and the effect of several antimicrobial and antiasthmatic drugs on the production and messenger ribonucleic acid (mRNA) levels of ET-1 was evaluated. Bronchoepithelial cells were also isolated from the mucosa of asthmatic patients under fibreoptic bronchoscopy, and the modulating effects of the drugs were studied. Erythromycin and clarithromycin uniquely suppressed mRNA levels as well as the release of ET- at therapeutic and non-cytotoxic concentrations (percentage inhibition of ET-1 protein release: 26.4+/-5.22% and 31.2+/-7.45%, respectively, at 10(-6) M). Furthermore, erythromycin and clarithromycin inhibited ET-1 expression in bronchoepithelial cells from patients with chronic, stable asthma. A glucocorticosteroid, dexamethasone, also inhibited ET-1 expression. In contrast, theophylline, salbutamol and FK506 had no effect on ET-1 production. Our findings demonstrated that these fourteen-member macrolide antibiotics had an inhibitory effect on endothelin-1 expression in human bronchial epithelial cells. Moreover, this new mode of action may have some relevance to their clinical efficacy in bronchial asthma.

Adult↗
PubMed1979

Bactericidal action of an average dose of erythromycin in the bronchi.

A study was carried out to establish whether erythromycin stearate was bacteriostatic or bactericidal at the concentrations reached in the bronchial secretion. Twenty-two patients suffering from an acute attack of chronic bronchitis, sustained by streptococci, diplococci, staphylococci or H. influenzae sensitive to erythromycin, were treated with 1500 mg erythromycin per day until symptoms regressed, usually within 3 to 5 days. The results showed that after treatment there was a dramatic reduction in the number of bacterial colonies cultured from the bronchial secretion and marked changes in bacterial morphology were seen using electron microscopy. Further evidence of bactericidal activity was provided by the rapid clinical response of the patients.

Aged↗
PubMed1979

Plasma and saliva concentrations for a new formulation of erythromycin stearate.

Erythromycin saliva and plasma concentrations were determined in 10 subjects after the first and fourth doses of a new formulation of erythromycin stearate ('Erythrocin'), 500 mg 8-hourly, taken immediately before food. Consistent absorption occurred and the steady state plasma levels compared favourably with the minimal inhibitory concentrations of erythromycin for common respiratory pathogens. There was a significant positive correlation between steady state saliva and plasma levels.

Administration, Oral↗