Abstract

CLINICAL PHARMACOLOGY OF ERYTHROMYCIN IN INFANTS AND CHILDREN

*Gian Maria Pacifici

ABSTRACT

Erythromycin is a macrolide antibiotic binds reversibly to the 50S ribosomal subunits of susceptible organisms. Gram-positive microorganisms accumulate about 100 times more erythromycin than do gram-negative bacteria. Erythromycin is active against streptococci, Corynebacterium diphtheria, Listeria monocytogenes, Haemophilus influenzae, Neisseria gonorrhoea, Borrelia species, Bordetella pertussis, Clostridium jejuni, Moraxella pneumoniae, Legionella pneumophila, and most strains of Chlamydia trachomatis. Chlamydia trachomatis causes urethritis, epididymitis, pelvic inflammatory disease, hepatitis, and endometritis and these diseases are cured by erythromycin. Oral erythromycin base is incompletely absorbed but ester derivatives: stearate, estolate and ethylsuccinate have improved absorption-rates. Erythromycin is actively transported into the cell, where reaches antibacterial activity rapidly, accumulates in the liver, is excreted in the bile, and is metabolized by the superfamily CYP3A into N-demethylation erythromycin and erythromycin sulfoxide. Bacteroides fragilis, Streptococcus epidermis, Streptococcus pneumoniae, Neisseria meningitis, and Haemophilus influenzae cause meningitis and these organisms are inhibited by erythromycin. Prophylaxis with erythromycin has been found useful to prevent infective diseases. Erythromycin interacts with drugs and the interaction may be synergistic or antagonistic. This drug crosses the placenta and the concentration in the newborn infant blood is 3 to 4% of that in the maternal blood at delivery. Erythromycin causes toxicity and adverse-effects in infants and children. Some organisms may become resistant to erythromycin and macrolide consumption induces bacterial-resistance to erythromycin. The aim of this study is to review the published data on erythromycin dosing, pharmacokinetics, efficacy, safety, adverse-effects, drug-interactions, metabolism, meningitis, prophylaxis, placental-transfer, breast-milk migration, bacterial-resistance, infants, and children.

Keywords: erythromycin, dosing, drug-interactions, pharmacokinetics, treatment, bacterial-resistance.