Erythromycin adverse reactions

Erythromycin Adverse reactions occurring in at least 3% of patients include abdominal pain/discomfort, diarrhea/loose stools, headache, increased platelet count, and nausea. 

Erythromycin is bacteriostatic for many gram-positive organisms, such as S. aureus and S. pneumoniae. Erythromycin may have some bacteriostatic activity against Haemophilus and Neisseria, but it is not a drug of choice for these organisms. Resistant strains of S. aureus may be encountered. Because of its low incidence of adverse reactions, erythromycin is extremely well tolerated, particularly by children. It is used primarily as adjimctive therapy at bedtime. 

Adverse reactions. Erythromycin is remarkably nontoxic, but the estolate can cause cholestatic hepatitis with abdominal pain and fever which may be confused with viral hepatitis, acute cholecystitis or acute pancreatitis. This is probably an allergy, and recovery is usual but the estolate should not be given to a patient with liver disease. Other allergies are rare. Gastrointestinal disturbances occur frequently (up to 28%), particularly diarrhoea and nausea, but, with the antibacterial spectrum being narrower than with tetracycline, opportunistic infection is less troublesome. 

Cholestatic hepatitis, which is associated primarily with erjdhromycin estolate, can be caused by all forms of erythromycin, including the base, estolate, ethylsuccinate, propionate, and stearate (39,41). Although it was originally speculated that a hypersensitivity reaction to the estolate ester rather than to the erjdhromycin itself was responsible for this adverse reaction (42), erythromycin does inhibit bile flow (43). Most probably the differences in hepatotoxicity between the various erythromycin derivatives are of a quantitative rather than a qualitative nature (44,45), perhaps because of better intestinal absorption of the estolate. Potentially severe but rare cholestatic liver injury occurs in perhaps up to 2-4% of... 

Eichenwald HF. Adverse reactions to erythromycin. Pediatr Infect Dis 1986 5(l) 147-50. 

Adverse reactions Erythromycin can cause nausea, vomiting, diarrhea, and abdominal cramping. Gl intolerance due to erythromycin is due to direct stimulation of the motilin receptor, leading to increased Gl motility. This occurs with both the IV and PO formulation. Although rare, all macrolides can cause hepatotoxicity. The estolate formulation of erythromycin has been associated with cholestatic hepatitis in pregnant women. In high doses, all macrolides can cause tinnitus. All macrolides can cause QT prolongation and torsade de points... 

Adverse reactions to clarithromycin are rare. The most common complaints relate to gastrointestinal symptoms, but these seldom require discontinuance of therapy. Clarithromycin, like erythromycin, inhibits cytochrome P-4S0 oxidases and, thus, can potentiate the actions of drugs metabolized by these enzymes. 

The AUC of erlotinib has been found to be increased by 66% when given with ketoconazole 200 mg twice daily for 5 days. The manufacturers advise caution with concurrent use, and recommend that the dose of erlotinib should be reduced if severe adverse reactions occur when given with strong CYP3A4 inhibitors. They specifically name atazanavir, clarithromycin, erythromycin, grapefruit and grapefruit juice, indinavir, itraconazole, ketoconazole, nefazodone, neltinavir, ritonavir, saquinavir, telithromycin, troleandomycin and voriconazole. ... 

Isolated cases of contraceptive failure have been attributed to erythromycin, and two pregnancies were attributed to the use of erythromycin and an oral contraceptive (unspecified) in the adverse reactions register of the... 

Fisher AA (1983) Adverse reactions to topical clindamycin, erythromycin and tetracycline. Cutis 32 415, 419, 424, 428... 

In patients allergic to penicillin, a macrolide such as erythromycin or a first-generation cephalosporin such as cephalexin (if the reaction is nonimmunoglobulin E-mediated hypersensitivity) can be used. Newer mac-rolides such as azithromycin and clarithromycin are as effective as erythromycin and cause fewer GI adverse effects. 

In topical preparations, the base of erythromycin rather than a salt is used to facilitate penetration. Although the mechanism of action of topical erythromycin in inflammatory acne vulgaris is unknown, it is presumed to be due to its inhibitory effects on P acnes. One of the possible complications of topical therapy is the development of antibiotic-resistant strains of organisms, including staphylococci. If this occurs in association with a clinical infection, topical erythromycin should be discontinued and appropriate systemic antibiotic therapy started. Adverse local reactions... 

Erythromycin is regularly used in veterinary practice and seems to be tolerated well by many animal species. Like humans, animals can develop hypersensitive reactions to erythromycin. Also like humans, acute gastrointestinal effects are the most commonly seen adverse effects. 

Spiramycin is a macrohde antibiotic. However, in contrast to other macrohde derivatives such as erythromycin salts, ototoxicity, neurosensorial disorders, and cardiac rhythm disorders do not appear to have been described after spiramycin. Reported adverse effects of spiramycin include G1 disorders, immune-allergic reactions, and liver injury (see also Figure 88). 

Erythromycin caused a minor inhibition of warfarin metabolism in three pharmacokinetic studies, and there are at least 11 published cases of interactions with coumarins, and 19 cases mentioned in a report from the Adverse Drug Reactions Advisory Committee of Australia. These are discussed below. 

The adverse effect profile of roflmnilast has been described previously. However, new data became available recently. A systematic review smnmarised the available data on adverse effects and drug reactions of roflmnilast. This systematic review was based on six clinical trials with a total population of 9102 COPD patients, with the study duration ranging between 24 and 52 weeks [89 ]. Roflmnilast is metabolised by CYP 3A4, CYP 2C19 and CYP 1A2. Inhibitors of these enzymes such as erythromycin or ketoconazole were shown to increase the activity and half-life of roflumilast. In contrast, drugs that induced these enzymes, like rifampicin, had the opposite effect, reducing the activity and half-life of roflumilast. Roflumilast did not significantly interact with montelukast, budesonide, or antacids. 

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