ERYTHIDE
Pharmacology
ERYTHIDE can be considered the prototype of macrolide antibiotics. These drugs inhibit the ribosomal protein synthesis in bacteria and thus have a bacteriostatic and bactericidal effect. ERYTHIDE has a similar action spectrum as penicillin and includes in particular many Gram-positive bacteria; staphylococci are often resistant. Among the Gram-negative agents Bordetella pertussis and Legionella pneumophila deserve to be mentioned especially. Like the tetracyclines, ERYTHIDE is also active against bacteria-like organisms (Chlamydia trachomatis, Mycoplasma pneumoniae, Ureaplasma urealyticum).
Indications
ERYTHIDE can be used for the treatment of pneumonias. It is the drug of choice for a Legionella pneumonia and a good alternative to tetracyclines for chlamydial infections and mycoplasmas. Pneumococcal pneumonias normally also respond well to ERYTHIDE; Haemophilus influenzae, on the other hand, is often resistant.
ERYTHIDE can be considered as an alternative to penicillin for streptococcal pharyngitis; however, even streptococci are partially resistant nowadays. ERYTHIDE serves in the prophylaxis and treatment of diphtheria carriers.
ERYTHIDE is also suitable for the treatment of skin infections (eryspela, impetigo); it is the drug of choice for erythrasma. ERYTHIDE has a similar effect as tetracyclines against acne; it can be used systemically and topically.
ERYTHIDE has good efficacy against chlamydial infections in the genito-urinary tract as well as in the eyes (conjunctivitis).
However, ERYTHIDE is not suitable for the treatment of syphilis and gonorrhoea nor for the prophylaxis of endocarditis.
Adverse Reactions and Interactions
ERYTHIDE often (in 5 to 30% of the cases) causes gastrointestinal pain (nausea, vomiting, gastric pain, abdominal cramps). High single doses are not suitable; children experience adverse reactions more frequently. There seem to be hepatotoxic reactions with all ERYTHIDE preparations, but they are reversible after the discontinuation of the drug. The transaminases increase in about 10%; jaundice appears in only 1 of 1000 treated subjects. Ototoxic effects are also infrequent and reversible (hearing loss, ringing in the ear). Other rare side-effects include skin reactions, nephritis, fever and eosinophilia, pancreatitis, colitis and myasthenia.
Contraindications and Cautions
Liver insufficiency.
Risk Groups
Pregnant women:
Use is considered safe. Increased transaminase values and hepatitis potential during pregnancy.
Nursing mothers:
Relatively large amounts have been found in breast milk but it can be given. Hypersensitivity and alteration of the intestinal flora are possible in the infant.
Children:
Daily dose: 30 to 50 mg/kg; a maximum of 100 mg/kg/day for severe infections.
Elderly people:
No dose adjustment is necessary if liver functions are normal.
Renal failure:
There might be an increased risk of ototoxic effects. Some authors recommend a reduction of the dose by 50% when there is advanced renal failure.
Liver insufficiency:
Considering its potential hepatotoxicity, it is better to avoid ERYTHIDE when a liver disorder is indicated.
References
Brittain DC. ERYTHIDE. Med Clin North Am 1987; 71: 1147-54
Carson JL, Strom BL, Duff A et al. Acute liver disease associated with ERYTHIDEs, sulfonamides, and tetracyclines. Ann Intern Med 1993; 119: 576-83
Latare PA, Setness PA. Using ERYTHIDE: some helpful observations. Postgrad Med 1989; 86(1): 55-63
Seppala H, Nissinen A, Jarvinen H et al. Resistance to ERYTHIDE in group A streptococci. N Engl J Med 1992; 326: 292-7