Erythromycins clinical efficacy

IMATINIB 1. ANTIBIOTICS - clarithromycin, erythromycin 2. ANTIFUNGALS -fluconazole, itraconazole, ketoconazole voriconazole 3. ANTIVIRALS -efavirenz, ritonavir 4. GRAPEFRUIT JUICE 5. H2 RECEPTOR BLOCKERS - cimetidine t imatinib levels with t risk of toxicity (e.g. abdominal pain, constipation, dyspnoea) and of neurotoxicity (e.g. taste disturbances, dizziness, headache, paraesthesia, peripheral neuropathy) Due to inhibition of CYP3A4-mediated metabolism of imatinib Monitor for clinical efficacy and for the signs of toxicity listed, along with convulsions, confusion and signs of oedema (including pulmonary oedema). Monitor electrolytes and liver function, and for cardiotoxicity... 

Clinical efficacy and safety of dirithromycin in the treatment of acute bronchitis and acute exacerbations of chronic bronchitis are similar to those of erythromycin... 

Yamamoto, M., Kudoh, S., Ina, Y, and Tamura, A. (1990). Clinical efficacy of erythromycin for patients with diffuse panbronchiolitis—A double blind. study. Saishin Igaku 45, 103-108. 

Besides constipation-related IBS, several studies have also suggested abnormalities of colonic bacterial composition in chronic idiopathic constipation [125]. Here again antibiotic treatment with vancomycin [126, 127], rova-mycin (in combination with diphetarsone, an amebicidal agent) [128,129] or erythromycin [130], which, however, displays a prokinetic activity [131, 132], proved to be capable of reversing long-lasting constipation. Furthermore, the efficacy in both clinical conditions of probiotics [133-135] lends further support to the pathogenic role of bowel flora. 

CBZ stimulates the CYP-450 enzyme system, increasing clearance of concomitantly prescribed drugs also metabolized by this system ( 377). Thus, the dose of these medications may need to be increased to maintain efficacy (372). Levels of CBZ may also be influenced by other hepatically metabolized, co-prescribed drugs. VPA, isonicotine, hydrazine, and erythromycin are some of the agents that can increase CBZ levels, while agents such as phenytoin and primidone can lower them. Table 10-25 summarizes the potentially clinically significant interactions between CBZ and other commonly co-prescribed medications ( 379, 380). 

CLARITHROMYCIN, ERYTHROMYCIN IFOSFAMIDE 1 plasma concentrations of 4-hydroxyifosfamide, the active metabolite of ifbsfamide, and risk of inadequate therapeutic response Due to inhibition of the isoenzymatic conversion to active metabolites Monitor clinically the efficacy of ifosfamide and t dose accordingly... 

Double-blind, randomized, multicenter clinical studies showed dirithromycin to be equally effective as erythromycin base in clinical (92-94% vs. 94-95%) and bacteriological (79-84% vs. 86-88%) responses for 10-day treatment of streptococcal pharyngitis and tonsillitis [116, 117]. Dirithromycin also exhibited comparable efficacies as penicillin V and miokamycin in the treatment of such infections [118, 119]. Very few clinical trials were published on the use of this macrolide in treating acute or chronic sinusitis. 

Spiramycin was equally efficacious as doxycycline in the empirical treatment of acute sinusitis [327]. It is also comparable to erythromycin, clarithromycin, and doxycycline in open, randomized, comparative clinical therapeutic studies of LRTIs [328-330]. 

Scaglione, F. (1990). Comparison of the clinical and bacteriological efficacy of clarithromycin and erythromycin in the treatment of streptococcal pharyngitis. Curr. Med. Res. Opin. 12, 25-33. 

The macrolides such as erythromycin might possibly be expected to suppress the bacteria responsible for the enterohepatic recycling of ethinylestradiol, but good evidence that this is clinically important is scant (see Hormonal contraceptives + Antibacterials Penicillins , p.981). Erythromycin, and to a lesser extent the other macrolides discussed here, also inhibit the cytochrome P450 isoenzyme CYP3A4, which is responsible for the metabolism of the contraceptive steroids. Therefore they might be expected to increase rather than reduce contraceptive efficacy. This would be expected to offset any possible reduced enterohepatic recycling. 

Brenn et al. [ 153] compared the efficacy of antibiotics commonly used in dental and oral clinical practice in application to the bacteria most frequently isolated in odontogenic infections (S. viridans, Peptostreptococcus spp, Prevotella intermedia, Porphyromona gingivalis and Fusobacterium nucleatum) based on pharmacokinetic and pharmacodynamic (PK/PD) analyses (effect of the human body upon the drug, reflected by the plasma concentration profile-pharmacokinetics, and the effect of the drug upon the body, as defined by the minimum inhibitory concentration, or MIC-pharmacodynamics). Antibiotics commonly used in dental practice, such as erythromycin, metronidazole or azithromycin, were found to be ineffective in apphcation in over 30% of the strains (39.1%, 50.5% and 33.2%, respectively) [154]. 

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