Erythromycin versus Azithromycin: which is the fittest substitute for Penicillin in allergic patients?

Abstract

Objective: Since the usage of Penicillin in the early 20th century, limitations to its use such as allergy, began to demand alternatives, cause of life-threatening adverse reactions of Penicillin. Plus, the difficulty and cost to establish patient’s allergic profile and the discrepancy between test results and medical history add to this problem. In order to find a perfect substitute for Penicillin, many articles have reported the successful use of drugs of the macrolide class in treating infections for which Penicillin would normally be indicated as the first line but cannot be used due to allergy. Compiling recent publications, we compared Erythromycin and Azithromycin, as the most prominent macrolide agents which considering efficient against for broad range microbial spectrum beside determine which is the fittest to substitute Penicillin in allergic patients. We were compelled to conclude that although the drugs are fundamentally similar, Azithromycin not only presents better adverse reaction profile, but has proven to be superior in efficacy to Erythromycin in many infections where the substitute is needed, and also widens its appliance against to atypical infections, which are subject of promising for the further investigations.