Oral Erythromycin Ethylsuccinate Research Articles

Alternative Treatments for Syphilis During Pregnancy.

Alternative Treatments for Syphilis During Pregnancy.

Randomized Controlled Trial of a High Dose of Oral Erythromycin for the Treatment of Feeding Intolerance in Preterm Infants

Objectives: To evaluate the effectiveness of high-dose erythromycin to treat feeding intolerance in preterm infants predominantly fed milk formula. Design: This study is a prospective randomized controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin ethylsuccinate at a dose of 50 mg/kg/day for 10 days or until they reached full enteral feeds. Randomization was stratified according to gestational age <32 weeks or ≧32 weeks gestation. The primary end point was the time taken to establish full enteral feeding since enrollment. Potential adverse effects associated with erythromycin were also monitored. Student’s t test was used for comparison of continuous variables and χ²for categorical data. Results: In infants <32 weeks, the use of erythromycin was associated with more daily weight gain (12.8 ± 2.6 g vs. 9.2 ± 5.3 g, p = 0.04) compared to the control group. Time to reach full feed did not differ between the erythromycin (13.8 ± 3.9 days) and the control (17.46 ± 4.9 days) groups (p = 0.07). In infants ≧32 weeks, there were no differences between the erythromycin and the control groups. Conclusion: High-dose erythromycin is associated with greater weight gain in preterm infants <32 weeks gestational age, who are predominantly fed cow’s milk-based protein formulas.

Multiple aphthoid syphilitic chancres of the oral cavity

We describe the case of a 31-year-old man who was affected by three asymptomatic, aphthoid, syphilitic chancres of the oral cavity. These lesions were accompanied by right latero-cervical and chin lymphadenopathy. The infection was previously diagnosed as aphthous stomatitis. The search for Treponema pallidum by means of darkfield microscope examination was positive. The patient was successfully treated with oral erythromycin ethylsuccinate. To our knowledge, this is the first case of multiple aphthoid syphilitic chancres of the oral cavity reported in the literature. We suggest that all patients with a recent history of painless ulcers in the oral cavity, accompanied by regional lymphadenopathy in which the clinical diagnosis has not been confirmed, should undergo a darkfield microscope examination.

Does carboxymethylcellulose have a role in reducing time to full enteral feeds in preterm neonates?

The efficacy of prophylactic carboxymethylcellulose (CMC) in reducing the time to reach full enteral feeds (FEFs) in neonates <32 weeks' gestation was studied in a clinical trial. When ready for feeds, enrolled neonates were allocated to either CMC (dose: CMC content of 12 mg oral erythromycin ethyl succinate syrup, 6 hourly) or placebo till either maximum 10 days treatment or FEF (150 ml/kg/day) was reached. A standardised regimen guided enteral feeding. Demographic characteristics of enrolled neonates (CMC, placebo: n = 35) were comparable. Median (interquartile range) gestational age and birth weight were 29 (28, 30) vs. 29 (27, 31) weeks and 1090 (905, 1390) vs. 1236 g (928, 1565) for the CMC and placebo groups, respectively. Median (interquartile range) time to reach FEF was 5 (4, 6) vs. 5 (3, 8) days for CMC and placebo group, respectively (p = 0.5). No CMC-related adverse effects occurred. Prophylactic CMC did not have a significant role in reducing time to reach FEF.

A placebo‐controlled trial of low‐dose erythromycin to promote feed tolerance in preterm infants

The aim of this study was to assess the efficacy of erythromycin, a motilin agonist, in promoting enteral feed tolerance in preterm infants of < or = 32 wk gestation. Eligible infants were randomized to receive either low-dose (2.5 mg kg(-1) per dose 6 hourly) oral erythromycin ethylsuccinate or placebo for 10 d from the time of the first oral feed. The data from 22 erythromycin and 21 placebo infants were analysed. Birthweights (erythromycin 1,216 +/- 380 g, placebo 1,355 +/- 228 g, p = 0.25), gestation (erythromycin 28.6 +/- 2.2 wk, placebo 29.3 +/- 1.7 wk, p = 0.24) and other clinical variables were not different between the groups. Almost all infants were fed expressed breast milk. Erythromycin infants had significantly fewer episodes of large residual gastric aspirates (>30% of the previous 6 h worth of feeds) over 10 d (erythromycin 1.1 +/- 1.9, placebo 3.6 +/- 2.2 episodes, p = 0.0007). Infants in the erythromycin group achieved full oral feeds more quickly (6.0 +/- 2.3 vs 7.9 +/- 3.5 d, p = 0.04). There were no significant differences between the groups with regard to the number of days on total parenteral nutrition or to the time needed to regain birthweight. One enrolled infant from each group died of necrotizing enterocolitis. Low-dose erythromycin promoted gastric emptying and feed tolerance in premature infants at a lower gestational age than previously reported. Increased exposure to broad-spectrum antibiotics may not be free of risk. Further studies are recommended to assess its efficacy in premature infants with established feed intolerance.

CAN PROPHYLACTIC ORAL ERYTHROMYCIN REDUCE TIME TO FULL ENTERAL FEEDS IN PRETERM NEONATES?

SUMMARYEfficacy of oral, prophylactic erythromycin in reducing the time to establish full enteral feeds (150 ml/kg/day) was assessed in neonates &lt;32 weeks, ready for enteral feeds. Seventy‐three consecutive neonates were randomised to receive oral erythromycin ethyl succinate (n=36) or placebo (n=37) in a double‐blind trial until full enteral feeds or 14 days of therapy were reached. A prospectively designed feeding regimen, including plan of action for signs of feed intolerance, was common for all enrolled neonates. The median gestational age, birth weight and postnatal age at start of feeds were 29 versus 30 weeks (p=0.40), 1232 versus 1280 g (p=0.96) and 5 versus 5 days (p=0.84) for erythromycin and placebo group, respectively. Time to achieve full feeds was not significantly different in the two groups. (median times: erythromycin 93.5 versus placebo 104 hours, p=0.60). Erythromycin‐related side‐effects did not occur.

Treatment of Cyclic Vomiting in Childhood with Erythromycin

Cyclic vomiting syndrome (CVS) is an unusual cause of episodic emesis in children. It manifests as intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. Dehydration necessitating intravenous fluid therapy may occur. Most therapeutic maneuvers have proven unsuccessful. We report the use of erythromycin as a prokinetic agent in the treatment of cyclic vomiting in 24 children (10 boys, 14 girls). Many patients had mild associated abdominal pain with their vomiting. Fourteen patients had previously been given metoclopramide but none responded. Two patients were mildly developmentally delayed. Twenty-four patients were given oral erythromycin ethylsuccinate, approximately 20 mg/kg/day, in two to four divided doses for 7 days. This dose was repeated as needed when symptoms reappeared. Eighteen of 24 patients reported total resolution of symptoms when re-evaluated at 2 and 6 months. All males responded, eight of 18 responders were female, and all six with partial or no response to therapy were female. This uncontrolled trial suggests that erythromycin may be a useful prokinetic agent in the treatment of CVS in childhood. Because the study was uncontrolled, placebo effect cannot be excluded. Case-controlled, double-blinded prospective trials should be considered to evaluate the effectiveness of erythromycin in CVS.

Treatment of Cyclic Vomiting in Childhood with Erythromycin

Summary:Cyclic vomiting syndrome (CVS) is an unusual cause of episodic emesis in children. It manifests as intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. Dehydration necessitating intravenous fluid therapy may occur. Most therapeutic maneuvers have proven unsuccessful. We report the use of erythromycin as a prokinetic agent in the treatment of cyclic vomiting in 24 children (10 boys, 14 girls). Many patients had mild associated abdominal pain with their vomiting. Fourteen patients had previously been given metoclopramide but none responded. Two patients were mildly developmentally delayed. Twenty‐four patients were given oral erythromycin ethylsuccinate, approximately 20 mg/kg/ day, in two to four divided doses for 7 days. This dose was repeated as needed when symptoms reappeared. Eighteen of 24 patients reported total resolution of symptoms when re‐evaluated at 2 and 6 months. All males responded, eight of 18 responders were female, and all six with partial or no response to therapy were female. This uncontrolled trial suggests that erythromycin may be a useful prokinetic agent in the treatment of CVS in childhood. Because the study was uncontrolled, placebo effect cannot be excluded. Case‐controlled, double‐blinded prospective trials should be considered to evaluate the effectiveness of erythromycin in CVS.

Effects of motion sickness and antimotion sickness drugs on gastric function.

This study examined the effects of motion sickness and antimotion sickness drugs on gastric emptying (GE). Drugs were tested in normal and motion sick subjects. To induce motion sickness, subjects performed head movements while seated in a rotating chair. Gastric emptying of liquid (300 mL) was determined by nuclear medicine techniques, whereas gastric electrical activity, the electrogastrogram (EGG), was monitored from surface (cutaneous) electrodes positioned over the abdominal area. Gastric emptying was severely inhibited at the peak of motion sickness symptoms, but returned to normal 15 minutes later when symptoms abated. In normal (non-motion sick) subjects intramuscular (IM) scopolamine (0.1 mg) and IM promethazine (25 mg) inhibited GE, whereas erythromycin ethylsuccinate (EES) suspension (200 mg) given orally increased GE. When administered to motion sick subjects, IM scopolamine and IM promethazine added slightly, but not significantly, to the inhibition of GE already present. Oral EES did not significantly alter GE in motion sick subjects. Although EGG frequency remained within normal limits (approximately 2.5-3.5 cpm) after liquid ingestion in both normal and motion sick subjects, EGG amplitude was differentially affected in the two groups. Electrogastrogram amplitude increased twofold to fourfold after liquid ingestion in normal, but not in motion sick subjects. The results suggest that (1) maximal inhibition of GE is coincident with peak motion sickness symptoms, (2) both IM scopolamine and IM promethazine inhibit GE in normal subjects, but do not add significantly to the inhibition of GE already established during motion sickness, (3) orally administered erythromycin enhances GE in normal, but not in motion sickness subjects, and (4) the normal stimulatory effect of liquid ingestion on gastric motility does not occur in motion sick subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of Cyclic Vomiting in Childhood with Erythromycin

SummaryCyclic vomiting syndrome is an unusual cause of episodic emesis in children. It manifests as intermittent episodes of severe vomiting, similar in time of onset and duration, with no symptoms during the intervening period. Dehydration necessitating intravenous fluid therapy may occur. Most therapeutic maneuvers have proven unsuccessful. We report the use of erythromycin as a prokinetic agent in the treatment of cyclic vomiting in 20 children (9 boys, 11 girls). Many patients had mild associated abdominal pain with their vomiting. Thirteen patients had previously been given metoclopramide, but none responded. Two patients were mildly developmentally delayed. Twenty patients were given oral erythromycin ethylsuccinate, approximately 20 mg/kg/day, in 2–4 divided doses for 7 days. This dosage was repeated as needed when symptoms reappeared. Thirteen of 20 patients reported total resolution of symptoms when reevaluated at 2 and 6 months. All males responded, 4 of 13 responders were female, and all seven with partial or no response to therapy were female. This uncontrolled trial suggests that erythromycin may be a useful prokinetic agent in the treatment of cyclic vomiting syndrome in childhood. As the study was uncontrolled, placebo effect cannot be excluded. Case‐controlled, double‐blinded prospective trials should be considered to evaluate the effectiveness of erythromycin in cyclic vomiting syndrome.

Comparison of oral erythromycin ethylsuccinate and ciprofloxacin in the treatment of acute respiratory tract infections

AbstractA total of 619 patients with acute upper or lower respiratory tract infection were randomised to receive either erythromycin ethylsuccinate tablets at a dose of 1 g twice daily, or ciprofloxacin tablets 500 mg twice daily in a singleblind, multicentre study. The efficacy of each antibacterial was similar, with close to 90% of patients on each treatment being reported as either cured or improved. Gastrointestinal symptoms were the most commonly reported side‐effects, being similar in overall incidence for both agents. Nausea, vomiting, dizziness and headache occurred more frequently in the ciprofloxacin group, while abdominal pain and diarrhoea occurred more frequently in the erythromycin ethylsuccinate group. In each group, the number of patients failing to complete treatment was similar and the main reasons cited for discontinuation were gastrointestinal symptoms. This study indicates that both erythromycin ethylsuccinate and ciprofloxacin are well tolerated and are equally effective for routine empirical treatment of acute respiratory tract infections.

A bacteriologically controlled, randomized study comparing the efficacy of 2% mupirocin ointment (Bactroban) with oral erythromycin in the treatment of patients with impetigo

Sixty patients participated in a bacteriologically controlled, randomized, parallel group comparison of 2% mupirocin ointment (Bactroban) and oral erythromycin ethylsuccinate for the treatment of impetigo. The trial included clinical and bacteriologic evidence and safety assessments. The Investigator's Global Evaluation, which compared the overall efficacy and safety of the trial drugs, demonstrated a more favorable performance for the mupirocin regimen. This difference was statistically and clinically significant. There were no significant differences between the trial regimens for any of the other efficacy variables examined. The bacteriologic success rate was 100% for both treatment groups. There was a clinically significant difference in adverse experience rates between treatment groups, with four (13%) of the erythromycin-treated patients reporting six adverse experiences versus none of the mupirocin-treated patients. The results of the trial indicate that 2% mupirocin ointment is as safe and effective as oral erythromycin ethylsuccinate in the treatment of patients with impetigo.

Topical Mupirocin Treatment of Impetigo Is Equal to Oral Erythromycin Therapy

Topical antimicrobial therapy has not been effective in the past against cutaneous bacterial infections. In this study, a new topical antibiotic ointment, mupirocin, was compared with oral erythromycin ethylsuccinate in the treatment of impetigo. Seventy-five patients clinically diagnosed as having impetigo and with positive cultures of Staphylococcus aureus, Streptococcus pyogenes, or both were examined in an investigator-blinded study. Patients used topical mupirocin applied three times daily or the usual oral dose of erythromycin ethylsuccinate (30 to 50 mg/kg per day). Patients' lesions were examined clinically and cultured bacteriologically on days 0, 3, and 8, and 1 week after treatment. Susceptibility testing was performed on pathogens isolated to determine antibiotic resistance. Mupirocin treatment produced similar clinical results to oral erythromycin and was superior in the eradication of S aureus, including antibiotic-resistant S aureus. These results show topical mupirocin to be a safe and effective alternative to oral antibiotic therapy in the treatment of impetigo.

Neonatal Chlamydial Conjunctivitis

Chlamydia trachomatis (Ct) was isolated from eyes of 33 out of 160 infants with neonatal conjunctivitis. In nineteen (58%) of the infants with chlamydial conjunctivitis Ct could also be isolated from the nasopharynx. All infants were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 hours for 14 days combined with lid hygiene. All were clinically cured, and none had a relapse of clinical Ct conjunctivitis during an observation period of one year. However, one infant had persistent asymptomatic chlamydial eye infection, two displayed a persistent infection of the nasopharynx, and one infant's vagina was infected despite therapy. Serum IgG antibodies to Ct were significantly more often detected in clinical cases (90%) than in controls (33%) (p less than 0.01). Infants with conjunctivitis developed detectable IgM antibodies to Ct in 43% as compared to 7% in controls (p less than 0.01).

Levels of erythromycin in tear fluid and serum in infants with conjunctivitis.

38 newborns with purulent conjunctivitis were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 h for 14 days. 3-4 days after initiation of therapy, erythromycin levels in serum and tear fluid were measured 1 and 12 h after the administration of erythromycin. The level of erythromycin in tear fluid was significantly higher than that in serum 1 and 12 h after administration of the antibiotic. On both occasions the concentrations of erythromycin in tear fluid and in serum exceeded the minimum inhibitory concentration (MIC) in vitro for Chlamydia trachomatis.

Treatment of Neonatal Conjunctivitis

The effect of different treatment regimens on clinical and microbiologic cures of neonatal conjunctivitis was evaluated during a 32-day observation period. In 84 infants with mild to moderate conjunctivitis and no signs of dacryocystitis, clinical cures were achieved in more than 50% of the cases with lid hygiene only. Staphylococcus aureus was the most common organism (48%) isolated from these infants. Chlamydia trachomatis could not be isolated from eyes with mild to moderate conjunctivitis. Forty-four infants with severe conjunctivitis, with or without dacryocystitis, were randomly assigned to treatment with either topical chloramphenicol or oral erythromycin for 14 days. Chlamydia trachomatis was isolated from 19 (43%) of these infants. All infants with chlamydial conjunctivitis who were treated with 25 mg/kg of oral erythromycin ethylsuccinate twice daily for 14 days were clinically and microbiologically cured. In contrast, all treatment of chlamydial conjunctivitis with topical chloramphenicol failed clinically as well as microbiologically. Dacryocystitis was a common complication in neonatal conjunctivitis (17%). The clinical failures in neonatal nonchlamydial conjunctivitis were associated with persistent obstruction of the nasolacrimal duct.

Penetration of erythromycin into tonsillar tissue

A study was carried out to investigate serum levels and tonsillar tissue penetration of erythromycin in 80 children suffering from chronic tonsillitis who had to undergo tonsillectomy. Oral erythromycin ethyl succinate (1 g twice daily) was given for the 2 days preceding surgery, the last dose scheduled for 2, 3, 4 or 6 hours before the start of the operation and the withdrawal of blood and tissue samples. The results showed that erythromycin penetrated quickly into tonsillar tissue and the levels were higher in tissue than in serum at all time points. Mean levels of erythromycin were consistently greater than the minimum inhibitory concentrations for most common Gram-positive oro-pharyngeal pathogens and H. influenzae.

Campylobacter Septicemia After Peritonitis Complicating Peritoneal Dialysis

To the Editor. —A 62-year-old patient treated by continuous ambulatory peritoneal dialysis (CAPD) had peritonitis caused by Campylobacter fetus subspecies intestinalis , a bacterium seldom isolated in this setting. Tobramycin sulfate and cefazolin sodium were added to the dialysate for three weeks, with rapid resolution. Twenty-five days later, our patient had a clinical picture of septicemia and local inflammation at a still-functioning arteriovenous fistula. Two blood cultures drawn a week apart yielded the same Campylobacter subspecies as previously isolated. Parenteral tobramycin administration followed by a course of oral erythromycin ethylsuccinate effected a cure. Continuous ambulatory peritoneal dialysis is still often complicated by peritonitis, which is sometimes caused by unusual organisms. 1 In contrast to C jejuni, which usually causes acute gastroenteritis in children, C fetus intestinalis is an opportunistic organism that infects adults, often elderly, debilitated persons, with symptoms of systemic illness, including bacteremia. 2 The two previously described patients with