Management of pregnancy

 

Erythromycin

Erythromycin is an antibiotic used for the treatment of several bacterial infections.

• We can say that Erythromycin is not the first choice in treatment for most diseases, and it is not used alone, or it cannot be relied upon alone to treat a moderate or serious disease, but if it is given with other antibiotics, it gives good results.

• Erythromycin belongs to a group of drugs called macrolide antibiotics. Macrolide antibiotics slow the growth of or sometimes killing, sensitive bacteria by reducing the production of important proteins needed by the bacteria to survive.

Medical uses Of Erythromycin

Erythromycin can be used to treat bacteria responsible for causing infections of the skin and upper respiratory tract.

Uses

• Respiratory tract infections.

• Skin infections.
  
  
  

• Chlamydia infections.

• Pelvic inflammatory disease.

• Syphilis.

• It may also be used during pregnancy to prevent Group B streptococcal infection in the newborn.

• As well as to improve delayed stomach emptying, It can be given intravenously and by mouth.

• An eye ointment is routinely recommended after delivery to prevent eye infections in the newborn.

Uses for Erythromycin (Systemic)

Pharyngitis and Tonsillitis

Treatment of pharyngitis and tonsillitis caused by S. pyogenes (group A β-hemolytic streptococci). Generally effective in eradicating S. pyogenes from the nasopharynx.

penicillin is the first choice for the Treatment of pharyngitis and tonsillitis.

Erythromycin is usually the preferred alternative for the treatment of streptococcal pharyngitis in patients hypersensitive to penicillin.

Respiratory Tract Infections

• Treatment of respiratory tract infections caused by susceptible S. pneumonia, Mycoplasma pneumonia, or C. pneumoniae.

• Erythromycin is usually not effective when used alone for the treatment of respiratory tract infections caused by H. influenza.

• We can say that Erythromycin is not the first choice in treatment for most diseases, and it is not used alone, or it cannot be relied upon alone to treat a moderate or serious disease, but if it is given with other antibiotics, it gives good results.

Acute Otitis Media (AOM)

• The drug is recommended as an alternative in patients with type I penicillin hypersensitivity.

• The fixed-combination preparation containing erythromycin ethylsuccinate and sulfisoxazole acetyl is an alternative (not a preferred agent) for the treatment of AOM.

• May not be effective for the treatment of AOM that fails to respond to amoxicillin since a high incidence of S. pneumoniae resistant to the fixed-combination drug has been reported.

Skin and Skin StructureInfections

Treatment of mild to moderate skin and skin structure infections caused by S. pyogenes or Staphylococcus aureus. Consider that erythromycin-resistant Staphylococci may develop during treatment.

Pelvic Inflammatory Disease (PID)

IV erythromycin lactobionate followed by oral erythromycin has been used for the treatment of PID) caused by N. gonorrhoeae, but erythromycins are not included in current CDC recommendations for the treatment of PID.

Bartonella Infections

Has been used in conjunction with IM or IV ceftriaxone for the treatment of bacteremia caused by Bartonella Quintana.

Syphilis

• Has been used as an alternative for the treatment of primary syphilis in penicillin-allergic individuals.

• Penicillin G is the drug of choice for the treatment of all stages of syphilis. Erythromycin is less effective than other possible penicillin alternatives and is not included in CDC recommendations for the treatment of any form of syphilis in adults or adolescents (including primary, secondary, latent, or tertiary syphilis or neurosyphilis).

Prevention of Rheumatic Fever Recurrence

Alternative to IM penicillin G benzathine, oral penicillin V potassium, and oral sulfadiazine for prevention of recurrence of rheumatic fever (secondary prophylaxis) in patients hypersensitive to penicillins and sulfonamides.

Dosage For adults

For adults 400 mg of erythromycin as the ethyl succinate provides erythromycin activity similar to that provided by 250 mg of erythromycin as the base, estolate, or stearate.

Dosage Pediatric Patients

General Pediatric Dosage, Treatment of Infections

Oral

• Erythromycin (base, estolate, ethylsuccinate, or stearate): 30–50 mg/kg daily in 2–4 equally divided doses.

• The dosage may be doubled for severe infections.

IV

Erythromycin (lactobionate): 15–20 mg/kg daily. A dosage of up to 4 g daily may be used for severe infections.

Adverse effects Of Erythromycin

• Gastrointestinal disturbances such as diarrhea, nausea, abdominal pain, and vomiting, are very common because erythromycin is a motilin agonist.

• Because of this, erythromycin tends not to be prescribed as a first-line drug.

• More serious side effects include arrhythmia with prolonged QT intervals, including torsades de pointes, and reversible deafness.

• Allergic reactions range from urticaria to anaphylaxis.

• Cholestasis, Stevens–Johnson syndrome, and toxic epidermal necrolysis are some other rare side effects that may occur.

• Erythromycin estolate has been associated with reversible hepatotoxicity in pregnant women in the form of elevated serum glutamic-oxaloacetic transaminase and is not recommended during pregnancy.

• Some evidence suggests similar hepatotoxicity in other populations.

Erythromycin side effects

signs of an allergic reaction to erythromycin or a severe skin reaction Get emergency medical help immediately.

Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody (even if it occurs months after your last dose);

• headache with chest pain and severe dizziness, fainting, fast or pounding heartbeats;

• a seizure;

• hearing problems (rare);

• pancreatitis - severe pain in your upper stomach spreading to your back, nausea, and vomiting; or

• liver problems - loss of appetite, stomach pain (upper right side), tiredness, easy bruising or bleeding, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Serious side effects may be more likely in older adults, including hearing loss, or a life-threatening fast heart rate.

Interactions Of Erythromycin

• Sudden cardiac death in patients also takes drugs that prolong the metabolism of erythromycin (like verapamil or diltiazem). Hence, erythromycin should not be administered to people using these drugs, or drugs that also prolong the QT interval.

• Other examples include terfenadine (Seldane, Seldane-D), astemizole (Hismanal), cisapride (Propulsid, withdrawn in many countries for prolonging the QT time) and pimozide (Orap). Theophylline, which is used mostly in asthma, is also contraindicated.

• Erythromycin is an inhibitor of the cytochrome P450 system, which means it can have a rapid effect on levels of other drugs metabolized by this system, e.g., warfarin.

Before taking this medicine

• You should not use erythromycin if you are allergic to it.

• Some medicines can cause unwanted or dangerous effects when used with erythromycin, so, Your doctor may change your treatment plan if you also use:

• lovastatin.
• simvastatin.
• pimozide.
• ergotamine, or dihydroergotamine.

Tell your doctor if you have ever had:

• liver or kidney disease.
• myasthenia gravis.
• A heart rhythm disorder (especially if you take medicine to treat it).
• Long QT syndrome (in you or a family member).
• An electrolyte imbalance (such as low levels of potassium or magnesium in your blood).

It is not known whether erythromycin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

Pharmacology Of Erythromycin

Mechanism of action

• Erythromycin displays bacteriostatic activity or inhibits the growth of bacteria, especially at higher concentrations.

• Erythromycin increases gut motility by binding to the Motilin receptor, thus it is a Motillin receptor agonist in addition to its antimicrobial properties.

Pharmacokinetics

• Erythromycin is very rapidly absorbed and diffuses into most tissues and phagocytes. Due to the high concentration in phagocytes, erythromycin is actively transported to the site of infection, where, during active phagocytosis, large concentrations of erythromycin are released.

• Erythromycin is easily inactivated by gastric acid; therefore, all orally administered formulations are given as either enteric-coated or more-stable salts.

Metabolism

• Most of the erythromycin is metabolized by the Liver by the hepatic enzyme CYP3A4.

• Its main elimination route is in the bile with little renal excretion, 2%-15% unchanged drug.

• Erythromycin's elimination half-life ranges between 1.5 and 2.0 hours and is between 5 and 6 hours in patients with end-stage renal disease. Erythromycin levels peak in the serum 4 hours after dosing.

• Erythromycin crosses the placenta and enters breast milk, The American Association of Pediatrics determined erythromycin is safe to take while breastfeeding.

• Absorption in pregnant patients is variable, frequently resulting in levels lower than in nonpregnant patients.

Available forms Of Erythromycin

Erythromycin is available in enteric-coated tablets, slow-release capsules, oral suspensions, ophthalmic solutions, ointments, gels, enteric-coated capsules, non-enteric-coated tablets, non-enteric-coated capsules, and injections.

The following erythromycin combinations are available for oral dosage

• erythromycin bases (capsules, tablets).

• erythromycin estolate (capsules, oral suspension, tablets), contraindicated during pregnancy.

• erythromycin ethyl succinate (oral suspension, tablets).

• erythromycin stearate (oral suspension, tablets).

• For injection, the available combinations are

• erythromycin gluconate

• erythromycin lactobionate

• For ophthalmic use:

• Erythromycin base (ointment).