Comparative tolerability of erythromycin and newer macrolide antibacterials in paediatric patients

Nicola Principi, Susanna Esposito

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

The macrolides are a well established group of antibacterials frequently used in general practice. The most frequently used macrolides in paediatric patients are erythromycin, a naturally occurring compound, and clarithromycin and azithromycin, recently developed macrolides. Overall adverse effect rates of 7 to 26% for erythromycin, 14 to 26% for clarithromycin, and 6 to 27% for azithromycin have been described in children. Adverse gastrointestinal effects, including nausea, vomiting, diarrhoea and abdominal cramps, are the most common problems in children. Allergic reactions, hepatotoxicity, ototoxicity and adverse effects involving the central and peripheral nervous systems have also been observed in children. Stevens-Johnson, Schonlein-Henoch and Churg-Strauss syndromes have been rarely described in children. Treatment-related laboratory abnormalities have been recorded in 2 to 4% of erythromycin- and in 0 to 1% of both clarithromycin- and azithromycin-treated children. Elevation in liver function tests was the most common abnormality cited. Increased macrolide use in children in recent years has resulted in a growing potential for drug interactions between them and other pharmacologically active agents via the inhibition of cytochrome P450 (CYP) microsomal enzymes. Drug interactions with theophylline, cyclosporin, carbamazepine, terfenadine and warfarin limit erythromycin use. Clarithromycin is a weak inducer of CYP and exhibits fewer drug-drug interactions than erythromycin. However, its use with theophylline, carbamazepine and terfenadine is contraindicated. In contrast, no significant interactions have been reported with azithromycin to date. Macrolides have been proven to be well tolerated in the treatment of upper and lower respiratory tract infections, skin and soft tissue infections, and also in less frequent infections occurring in paediatric patients. In addition, clarithromycin and azithromycin have shown good tolerability profiles in immunocompromised paediatric patients. In conclusion, macrolides antibacterials have proven to be well tolerated in paediatric patients. Although the incidence of adverse effects is similar with the use of erythromycin and the newer macrolides, drug interactions occur significantly less when clarithromycin or azithromycin are administered.

Original languageEnglish
Pages (from-to)25-41
Number of pages17
JournalDrug Safety
Volume20
Issue number1
DOIs
Publication statusPublished - 1999

Fingerprint

Pediatrics
Macrolides
Erythromycin
Azithromycin
Clarithromycin
Drug interactions
Drug Interactions
Terfenadine
Cytochrome P-450 Enzyme System
Carbamazepine
Theophylline
Churg-Strauss Syndrome
Soft Tissue Infections
Colic
Liver Function Tests
Peripheral Nervous System
Immunocompromised Host
Neurology
Warfarin
Respiratory Tract Infections

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Pharmacology
  • Toxicology
  • Health, Toxicology and Mutagenesis

Cite this

Comparative tolerability of erythromycin and newer macrolide antibacterials in paediatric patients. / Principi, Nicola; Esposito, Susanna.

In: Drug Safety, Vol. 20, No. 1, 1999, p. 25-41.

Research output: Contribution to journalArticle

Principi, Nicola ; Esposito, Susanna. / Comparative tolerability of erythromycin and newer macrolide antibacterials in paediatric patients. In: Drug Safety. 1999 ; Vol. 20, No. 1. pp. 25-41.
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