Erythromycin Treatment Research Articles

Chemical modification of erythromycins. I. 8,9-Anhydro-69-hemiketal of erythromycin A.

By treatment of erythromycin A with compounds containing a mobile halogen atom (tetraacetylglucosyl bromide, t-butyl bromide, triphenylmethyl chloride) in aprotic solvents of high dielectric constant (nitromethane, acetonitrile) and in the presence of pyridine, an anhydrocompound C37H65NO12 was obtained in up to 95% yield. Analytical, spectral, and chemical data indicated that the compound was erythromycin A 8, 9-anhydro-69-hemiketal (2).

Treatment for Early Syphilis and Reactivity of Serologic Tests

The Venereal Disease Branch, Center for Disease Control, in a cooperative study has reevaluated the comparative efficacy of antibiotic schedules for the treatment of early syphilis in 586 patients. All parenteral penicillin, tetracycline, and erythromycin treatment schedules recommended by the Public Health Service were studied. Erythromycin in base form, 20 gm, was given in a divided-dose schedule over a ten-day period. Subsequently, the dose of erythromycin had to be raised to 30 gm because of a high failure rate. All penicillin schedules tested showed a satisfactory cure rate with a cumulative re-treatment rate of only 10% in the 24-month observation period. The 30-gm schedule of erythromycin base proved as effective as tetracycline and penicillin G.

The 1970 Epidemic of Diphtheria in San Antonio

Diphtheria affected 201 persons in San Antonio, Texas, from 1 December 1969 to 31 December 1970. Three unimmunized children died. The predominant signs and symptoms were sore throat, fever, dysphagia, nausea, and headache. A distinctive edema of the neck was commoner in adults than in children. Infection with beta hemolytic streptococci did not affect the course of diphtheria or the response to treatment. Corynebacterium diphtheriae was sensitive to ampicillin, clindamycin, erythromycin, penicillin, tetracycline, and rifampin. Partial or complete resistance to cephalexin, Colistin, lincomycin, and oxacillin was found. Both penicillin by intramuscular injection and erythromycin by intravenous injection eradicated C. diphtheriae from the pharynx of hospitalized patients. Oral erythromycin treatment compared with a single intramuscular injection of benzathine penicillin showed that benzathine penicillin can be used as an alternate to erythromycin for termination of the carrier state.

The effect of low-dose longterm erythromycin on bronchietasis.

Background: Bronchiectasis is characterized by chronic sputum production and complications such as hemoptysis and repeated infections. Even though some patients are cured by surgical resection of bronchiectatic lesions, most bronchiectasis patients can not be treated surgically because of multiple site involvement, and they are treated by medical measures such as postura1 drainage and antibiotics when indicated. Recently there have been some reports that low-dose longterm erythromycin treatment is effective on bronchiectsis, and it is well known that low-dose longterm erythromycin treatment is the treatment of choice in diffuse panbronchiolitis which is characterized by chronic sputum production and dyspnea. To evaluate the efficacy of erythromycin, we tried erythromycin on twenty five stable bronchiectasis patients for more than six months. Methods: We tried erythromycin 250 mg b.i.d. for more than 6 months. We checked respiratory symptoms, chest PA, spirometry, and side effects before treatment and after 3 and 6 months of treatment. Results: 1) 32% of the patients showed marked improvement of symptoms and PFT. 32% showed slight improvement of symptoms with little change of PFT, and 36% showed no change of symptoms and signs. 2) Analysis of the patients showing marked improvement revealed that most of them had diffuse bronchiectasis and paranasal sinus involvement. Conclusion: These results suggest that low-dose longterm erythromycin treatment can be tried on diffuse bronchiectasis patients with sinus involvement. And further studies will be followed on the mechanism of erythromycin in bronchiectasis.

Erythromycin in treatment of early syphilis.

While the treponemicidal properties of erythromycin were first described in 1953 by Keller and Morton,¹it is only recently that adequate clinical information has become available. Keller and Morton, as well as Turner and Schaeffer,²were able to demonstrate Treponema pallidum more susceptible to the action of erythromycin than other antibiotics with the exception of penicillin. Later, Kolmer³reported similar treponemicidal properties to erythromycin but obtained superior results with several other antibiotics. In 1954 Alexander and Schoch⁴treated 4 patients with syphilitic lesions with erythromycin and observed rapid disappearance of Treponema pallidum from the lesions. In 1956 Montero⁵presented 27 patients with early syphilis treated with a total of 9 to 12 gm. of erythromycin with satisfactory results. In 1959 Montgomery and Knox⁶reported on 40 darkfield-positive cases of early syphilis treated with 9 to 10 gm. of erythromycin stearate over a period of

Staphylococcic enterocolitis. Report of six cases with two fatalities after intravenous administration of N-(pyrrolidinomethvl) tetracycline.

The use of N-(pyrrolidinomethyl) tetracycline, a new tetracycline suitable for intravenous injection, has been regarded as largely free from risk, especially with regard to staphylococcic enteritis. However, six patients were observed with staphylococcic enteritis after postoperative intravenous treatment with this drug. In four patients, erythromycin or spiramycin treatment was successful. A fifth patient with severe diarrhea died of staphylococcic gastroenteritis with sepsis 10 days after operation. The sixth patient died of acute necrotizing staphylococcic gastroenteritis three days after operation. The tetracycline concentration in the intestinal lumen after intravenous administration, even if 10 times lower than after oral treatment, is adequate to inhibit normal flora, thus favoring staphylococcic superinfection. Careful supervision of patients thus treated is, therefore, essential.

Treatment of Experimental Infectious Sinusitis of Turkeys with Erythromycin

LEUROPNEUMONIA-like organisms (PPLO) have been implicated as a cause of infectious sinusitis (IS) of turkeys. The literature on this subject has been reviewed by other authors.2'56 Reports on treatment of IS with erythromycin have been made by Hamdy, et al.2' and Holper, et al.5 This paper represents the results of erythromycin treatment of infectious sinusitis induced in young turkeys by the intrasinus injection of avian PPLO.

The role of a chronic carrier in an epidemic of staphylococcal disease in a newborn nursery.

Staphylococcal disease is now recognized as a serious and widespread cause of morbidity and mortality in newborn infants and their mothers. The epidemiological studies made possible by bacteriophage typing of this group of micro-organisms have demonstrated that the agent is usually acquired by the infant in the hospital environment, from nursing personnel, from other infants, or possibly from various fomites 1-7 and that the carrier state may persist long after the infant's discharge from the nursery. 8 Virulance as well as ability to produce a nasal carrier state vary greatly with different bacteriophage types of Staphylococcus pyogenes, 9 the most virulant strain reported to date being lysed by phages 42B/47C/44A/52/80/81. 8 Control of epidemics has not been entirely satisfactory; the usual hygienic measures frequently fail to stop the spread of infection, 10 and hexachlorophene bathing or erythromycin treatment 1, 11,12 has been found necessary to arrest certain outbreaks. This

ERYTHROMYCIN IN THE TREATMENT OF DIPHTHERIA AND DIPHTHERIA CARRIER STATE

The treatment of acute diphtheria has not been drastically changed by the use of antibiotics. Antitoxin remains the primary form of therapy. However, the eradication of virulent diphtheria bacilli from the upper respiratory tract of patients with the active disease and of carriers is of considerable importance in the control of the disease. Streptomycin is effective in vitro and in infections produced experimentally but it has not been clinically evaluated in acute diphtheria or in the carrier state. Chlortetracycline, chloramphenicol, and oxytetracyline, although active against the causative organisms, have not had sufficient clinical trial to permit evaluation in the control of diphtheria and the carrier state. Penicillin eradicates C. diphtheriae from the nasopharynx in 75 per cent of patients within a period of 3 to 4 days. In this study erythromycin eradicated the C. diptheriae from the nose and throat in all of the cases in an average of 2 days in the active cases and in an average of 3 days in the carrier state. In the treatment of diphtheria erythromycin appears on the basis of the present and of previous studies to be the most promising antibiotic developed to date. Erythromycin is advocated as an adjunct to and not as a substitute for antitoxin in the treatment of acute diphtheria.

Erythromycin in treatment of pyoderma in children

Summary Ten cases of pyoderma, in children, were treated successfully with erythromycin (Ilotycin) ointment. There was no evidence of drug sensitization or other untoward reactions.