Uses of Erythromycin
Erythromycin is a macrolide antibiotic that is used for treating various bacterial infections. Some of the common uses of erythromycin include:
- Streptococcal Pharyngitis (Strep Throat): Erythromycin is indicated for treating streptococcal pharyngitis, which is a throat infection caused by group A streptococcus bacteria. It helps alleviate sore throat symptoms and reduces the risk of complications.
- Pneumonia: Both atypical and typical pneumonia can be treated with erythromycin. It effectively treats pneumonia caused by Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae bacteria.
- Skin and Soft Tissue Infections: Boils, cuts or wounds that have become infected due to bacteria like staphylococci or streptococci can be treated with topical or oral erythromycin. It helps clear the infection and promotes wound healing.
- Sexually Transmitted Infections: Erythromycin is used to treat certain sexually transmitted diseases like chlamydia and early syphilis. It kills the causative bacteria and cures the infection.
- Gastrointestinal Infections: Erythromycin is effective against bacteria that cause GI infections like Helicobacter pylori which causes ulcers, Campylobacter that causes food poisoning, and pathogenic Escherichia coli.
- Periodontitis: As an antibiotic gel or mouthwash, erythromycin can be used to treat gum infections and periodontitis by eliminating pathogenic bacteria in the gums and oral cavity.
Mechanism of Action of Erythromycin
Erythromycin works by interfering with bacterial protein synthesis. It specifically inhibits bacterial growth and reproduction in the following way:
- Erythromycin binds to the 50S subunit of the bacterial ribosome and inhibits transpeptidation and translocation steps of protein synthesis.
- Transpeptidation refers to the formation of peptide bonds between amino acids whereas translocation involves the movement of transfer RNA from the aminoacyl-tRNA site to the peptidyl-tRNA site on the ribosome.
- By binding to the 50S subunit, erythromycin prevents these key steps and prevents the growth and spread of bacteria. The bacterial cell is unable to synthesize new proteins and dies eventually.
- Erythromycin does not affect the ribosomes of human cells as their ribosomes have a different structural composition compared to bacterial ribosomes. This specificity is what makes it selectively toxic to bacteria over human cells.
Spectrum of Activity
Erythromycin has broad-spectrum activity against both gram-positive and certain gram-negative bacteria:
Gram-Positive Bacteria
- Streptococci: Streptococcus pyogenes, Streptococcus pneumoniae
- Staphylococci: Staphylococcus aureus
- Corynebacterium diphtheriae
- Listeria monocytogenes
- Clostridium spp.
- Mycoplasma pneumoniae
- Legionella pneumophila
Gram-Negative Bacteria
- Haemophilus influenzae
- Bordetella pertussis
- Campylobacter jejuni
- Helicobacter pylori
- Neisseria gonorrhoeae
Erythromycin is generally ineffective against gram-negative aerobic bacteria like Pseudomonas, Proteus, Serratia due to the presence of outer membrane in their cell wall. However, it can treat certain intracellular gram-negative bacteria.
Drug Interactions
Some drugs may interact with erythromycin and either decrease its efficacy or increase the risk of side effects. Key drug interactions include:
- Proton pump inhibitors like omeprazole: Can decrease erythromycin levels by promoting its breakdown in the liver.
- HMG-CoA reductase inhibitors or statins: Combining with erythromycin can significantly raise statin levels and risk of toxicity like rhabdomyolysis
- Calcium channel blockers: Erythromycin increases levels of verapamil, diltiazem, nifedipine and risk of cardiovascular side effects.
- Antiplatelet drugs: Increases risk of bleeding by enhancing effects of warfarin, clopidogrel, ticagrelor
- Antiarrhythmics: Combining with drugs like amiodarone, quinidine raises their levels and can cause dangerous arrhythmias.
Therefore, patients should always inform their doctor about all medication they consume to avoid any adverse interactions with erythromycin. Therapeutic drug monitoring may be required in a few cases.
Adverse Effects
Although generally well-tolerated, some common side effects of erythromycin include:
- Gastrointestinal issues: Nausea, vomiting, diarrhea, abdominal pain
- Allergic reactions: Rash, itching, fever, difficulty breathing
- Liver toxicity: Jaundice, abnormal liver function tests in severe cases
- Vertigo, tinnitus, hearing impairment (especially with intravenous administration)
- Pseudomembranous colitis due to C. difficile infection
- Cardiovascular effects: QT prolongation, arrhythmias (rare)
- Potential teratogenicity if taken during pregnancy
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