Oral Erythromycin Research Articles

Analysis of the Efficacy of Erythromycin Cyclic 11,12-Carbonate Combined with Azithromycin in the Treatment of Severe Mycoplasma Pneumoniae Pneumonia in Children and its Effect on Cytokines

Introduction: Mycoplasma Pneumoniae Pneumonia (MPP) is an inflammation of the lungs caused by Mycoplasma pneumoniae infection. Macrolide antibiotics are the therapeutic agents of choice for MPP. This study aimed to explore the efficacy of erythromycin cyclic 11,12-carbonate combined with azithromycin in treating children with severe Mycoplasma pneumoniae pneumonia (SMPP). Methods: 84 children with SMPP treated at Hubei Maternal and Child Health Hospital between February 2021 and December 2021 were randomly divided into two groups. The control group was treated with intravenous azithromycin and then changed to oral azithromycin. The experimental group was treated with intravenous azithromycin and then switched to oral erythromycin cyclic 11,12-carbonate. The clinical efficacy, symptom improvement, inflammatory levels, and cytokine levels before and after treatment were compared, and the occurrence of adverse reactions was recorded. Results: The overall effective rate of treatment in the experimental group was significantly higher than that in the control group (P<0.05). The time to the disappearance of clinical symptoms and length of hospitalization of the experimental group was significantly shorter than that of the control group (P<0.05). After treatment, inflammatory levels and cytokine levels of the experimental group were significantly lower than those of the control group (P<0.05). There was no difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion: Erythromycin cyclic 11,12-carbonate combined with azithromycin in the treatment of children with SMPP had significant efficacy, superior to azithromycin monotherapy, which could effectively improve immune function and clinical symptoms.

Bilateral renal artery stenosis in pediatric patient with Post-Streptococcal Glomerulonephritis in children: A case report

The immune-complex mediated inflammation known as post-streptococcal glomerulonephritis (PSGN) was once thought to be one of the most common causes of acute nephritis in children. In this case, we present a 12-year-old girl experiencing symptoms of cough phlegm, congested breath, change of urine color, decreased urine production, as well swelling in the area face and legs after experiencing fever, pain swallowing, cough, and runny nose 3 weeks before admission. On physical examination, the pressure blood was 130/80 mmHg. In addition, the palpebral and extremity were edema bilateral, hyperemia of the tonsil and pharynx, enlarged tonsils T2/T3, and detritus were found. Laboratory and Imaging Tests: hematology; leukocytes 12,930, albumin 2.4 g/dl, on urinalysis, obtained urine cloudy, brownish, leukocyturia, hematuria, and proteinuria, there was also an increase in ASTO titers, abdominal ultrasound found bilateral renal artery stenosis and nephritis bilateral acute. The patient in this case presented with bilateral renal artery stenosis, which is a rare finding in PSGN cases. Management of PSGN include bed rest, low salt diet, fluid balance, as well supportive treatment with IVFD D5 ½ NS 15 drops/min (micro), Antibiotics injection of Ceftriaxone 1 gram/12 hours on the first day and continued with oral Erythromycin 4x500mg, injection prednisolone 3x1, injection Furosemide 1x1 amp, oral spironolactone and sublingual nifedipine, and hypoalbuminemia correction. Prognosis in patients with the given GNAPS governance optimally will give good results.

Mycoplasma pneumoniae-Associated Encephalitis: Favorable Aggressive Immunosuppression in a Patient

AbstractMeningoencephalitis is the most important extrapulmonary manifestation of Mycoplasma pneumoniae infection. It is complicated by seizures in at least 40% of cases, and in half of them, status epilepticus can occur during the acute phase, often leading to severe neurological sequelae. Brain imaging ranges from normal to diffuse edema, focal changes, and abnormal signals in the white matter, basal ganglia, and hippocampi. Here, we describe a boy who presented with an acute onset of transient alteration of behavior, meningeal irritation, fever, vomiting, and leg pain. Meningoencephalitis due to M. pneumoniae infection was confirmed by focal pneumonia, positive immunological tests, and increased protein content in cerebrospinal fluid. Magnetic resonance imaging of the brain showed bilateral focal abnormalities in the temporoinsular cortex, and electroencephalographic recordings showed slow waves in the same regions. After early infusion of acyclovir on the first day, aggressive combination therapy with oral erythromycin, and intravenous methylprednisolone and immunoglobulin was promptly initiated once a complete diagnosis was obtained on the second day, and the boy recovered within a few days. Two weeks later, brain imaging findings had resolved completely. The rapid clinical and neuroradiological recovery after immunosuppressive therapy suggests an immune-mediated pathogenetic mechanism. He developed immune-mediated myositis 2 years later demonstrating the instability of his immunological status.

Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus.

Pulsatile tinnitus (PT) is increasingly recognized as a cardinal symptom of idiopathic intracranial hypertension (IIH). However, clinicians should remain aware of other causes of nonidiopathic or secondary intracranial hypertension manifesting as PT. We present 2 patients with isolated PT (without accompanying headache, blurred vision, and papilledema) thought to be secondary to tetracycline-induced intracranial hypertension. To our knowledge, these are the first cases of PT as the presenting symptom of this condition. A 41-year-old female (body mass index [BMI] 29 kg/m2) with ocular rosacea was initially treated with minocycline. Shortly after transitioning to oral doxycycline and erythromycin eye ointment, she noted left-sided PT. Her PT resolved after discontinuing doxycycline. In a second case, a 39-year-old female (BMI 19 kg/m2) with acne presented with a three-year history of left-sided PT while on long-term oral doxycycline for many years. She denied visual or auditory changes and atypical headaches. MRI findings were concerning for intracranial hypertension. Three months later, the patient was seen by neuro-ophthalmology, with findings suggesting prior papilledema. The patient reported PT improvement after discontinuing doxycycline. This case series highlights 2 cases of isolated PT as the sole symptom of intracranial hypertension that resolved with tetracycline cessation. The presentation and unexpected improvement following tetracycline discontinuation are atypical compared with previous reports of tetracycline-induced intracranial hypertension. Clinicians should maintain a high index of suspicion for all types of intracranial hypertension (idiopathic and secondary), even in patients with a lower BMI. Current and prior medications should be reviewed when considering the etiology of intracranial hypertension.

Seven year follow up of subclinical rheumatic disease using WHF criteria

Abstract Background The prevalence of rheumatic heart disease (RHD) is higher using echocardiographic screening compared with clinical examination. It is proven that clinical screening underestimates the prevalence, but it still remains the cornerstone for the purpose of intervention. Echocardiography can identify subclinical RHD and can be used for subclinical cases and to see progression /regression on follow up. Follow-up data of children with subclinical lesions are very much needed before implementing large scale screening programs in endemic regions. We are submitting the 7 year follow up data for subclinical RHD who were on RF prophylaxis. Method A total of 3000 school going children were screened echocardiographically during November 2015 to December 2018 for subclinical rheumatic heart disease using WHF criteria. Subjects with subclinical rheumatic heart disease were given prophylaxis for rheumatic fever in form of injection Benzathine penicillin or oral penicillin or tablet erythromycin depending upon tolerance and acceptance. These cases were followed up at 2-year and 7-year for echocardiographic evaluation and compliance to the prophylaxis. Results Out of 3000 cases screened, 114 were found to be having subclinical rheumatic heart disease. 39 subjects turned up for 2-year follow up and 13 subjects turned up for 7-year follow up(Table 1). All 13 were on rheumatic fever prophylaxis. 23% ( 3 out of 13) turned to be with normal echocardiography findings using WHF 2012 criteria. Limitation: Children who were not taking prophylaxis were not evaluated echocardiographically, therefore comparison could not be done. Conclusion Our study shows screening of school going children by echocardiography can detect subclinical rheumatic heart disease and rheumatic fever prophylaxis in such cases can results in reversion of the lesion and prevention of progression of RHD.

Diphtheritic tonsillitis in an immunized adult: A case report

Corynebacterium diphtheriae is a Gram-positive bacillus which can be either toxigenic or non-toxigenic depending on the production of the diphtheria exotoxin. Diphtheria is a potentially fatal infectious disease caused by toxigenic strains of C. diphtheriae. Despite the national immunization program, India accounts for approximately 20% of the total cases according to the recent World Health Organization reports. Even though it is a vaccine preventable disease, cases are being reported, which may be due to lack of booster doses or waning of immunity with increasing age. Here, we report a case of diphtheritic tonsillitis in a 30-year-old immunized adult who came to the otorhinolaryngology outpatient department with acute onset of throat pain and difficulty in swallowing. C. diphtheriae was isolated from bacteriological culture of throat swab. The patient was symptomatically better with 2 weeks of treatment with oral erythromycin 500 mg twice a day.

Comparison of mean time of achieving full enteral feed with oral erythromycin as compared to placebo for the treatment of gastrointestinal dysmotility in low birth weight preterm neonates.

INTRODUCTION: Erythromycin, a commonly used macrolide antibiotic, has been found to possess potent prokinetic properties and therefore enhances gastrointestinal motor activity. Its motilin agonist action has been clinically exploited for the treatment of patients with chronic functional pseudo-obstruction, gastro-oesophageal reflux, postoperative intestinal dysmotility, gastroparesis secondary to diabetes, and scleroderma, and after surgical vagotomy.
 OBJECTIVE: The objective of my study is to compare mean time of achieving full enteral feed with oral erythromycin as compared to placebo for treatment of gastrointestinal dysmotility in low birth weight preterm neonates.
 
 MATERIALS AND METHODS:
 Study design: Randomized controlled trial.
 Setting: Department of paediatrics, Lahore general hospital, Lahore.
 Duration of study: This study was conducted for 6 months [December 19, 2017 till June 19, 2018]
 
 DATA COLLECTION PROCEDURE: After approval from hospital ethical committee 100 preterm neonates who presented in the paediatrics neonatal unit and emergency department of LGH fulfilling the inclusion criteria were selected. After an informed consent from the parents, the preterm neonates were randomly allocated to two groups using lottery method into Group A and group-B. Preterm neonates assigned to group A received erythromycin (12.5mg/kg/dose every 6 hour through oral route or nasogastric tube). Those allocated to group B received placebo solution (equivalent volume of normal saline orally 6 hourly). Preterm was given oral feed according to protocol (via nasogastric tube, orogastric tube or oral route). Both groups received erythromycin and placebo for 14 days. If patient developed necrotizing enterocolitis or deteriorated after start of study, erythromycin and placebo solution was discontinued. The duration of achieving full enteral feeding, type of milk used was noted in questionnaire along with demographic details of neonate.
 
 RESULTS: The mean age of all cases was 6.74 ± 2.29 days while mean age in Erythromycin group was 6.66 ± 2.48 days and in placebo group was 6.82 ± 2.10 days. In erythromycin group there were 35(70%) male and 15(30%) female cases while in placebo group there 21(42%) male and 29(58%) female cases. In erythromycin group 19(38%) cases were on mother feeding and 31(62%) cases were formula feeding and in placebo group 23(46%) cases were on mother feeding while 27(54%) cases were on formula feeding. The mean time to achieve enteral feeding in erythromycin group was 23.04 ± 4.42 days and in placebo was 26.46 ± 4.95 days. The mean time to achieve enteral feeding was statistically less in erythromycin group was statistically less as compared to placebo group, p-value < 0.001.
 CONCLUSION: The study concludes that the mean time of achieving full enteral feed with oral erythromycin was significantly less as compared to placebo for treatment of gastrointestinal dysmotility in low birth weight preterm neonates. So, therapeutic effects of erythromycin can be utilized to achieve early feeding. This can also help to minimize the related morbidity and hospital stay.
 Keywords: 
 Gastrointestinal dysmotility, preterm birth, prematurity, low birth weight, enteral feeding, oral erythromycin

Effects of the Moderate CYP3A4 Inhibitor Erythromycin on the Pharmacokinetics of Palbociclib: A Randomized Crossover Trial in Patients With Breast Cancer.

Palbociclib is an oral inhibitor of cyclin-dependent kinases 4 and 6 used in the treatment of locally advanced and metastatic breast cancer, and is extensively metabolized by cytochrome P450 enzyme 3A4 (CYP3A4). A pharmacokinetic/pharmacodynamic relationship between palbociclib exposure and neutropenia is well known. This study aimed to investigate the effects of the moderate CYP3A4 inhibitor erythromycin on the pharmacokinetics of palbociclib. We performed a randomized crossover trial comparing the pharmacokinetics of palbociclib monotherapy 125mg once daily (q.d.) with palbociclib 125mg q.d. plus oral erythromycin 500mg three times daily for seven days. Pharmacokinetic sampling was performed at steady-state for both dosing schedules. Eleven evaluable patients have been enrolled. For palbociclib monotherapy, geometric mean area under the plasma concentration-time curve from zero to infinity (AUC0-24h ), maximum plasma concentration (Cmax ), and minimum plasma concentration (Cmin ) were 1.46 × 103 ng•h/mL (coefficient of variation (CV) 45.0%), 80.5ng/mL (CV 48.5%), and 48.4ng/mL (CV 38.8%), respectively, compared with 2.09 × 103 ng•h/mL (CV 49.3%, P=0.000977), 115ng/mL (CV 53.7%, P=0.00562), and 70.7ng/mL (CV 47.5%, P=0.000488) when palbociclib was administered concomitantly with erythromycin. Geometric mean ratios (90% confidence intervals) of AUC0-24h , Cmax , and Cmin for palbociclib plus erythromycin vs. palbociclib monotherapy were 1.43 (1.24-1.66), 1.43 (1.20-1.69), and 1.46 (1.30-1.63). Minor differences in adverse events were observed, and only one grade ≥ 3 toxicity was observed in this short period of time. To conclude, concomitant intake of palbociclib with the moderate CYP3A4 inhibitor erythromycin resulted in an increase in palbociclib AUC0-24h and Cmax of both 43%. Therefore, a dose reduction of palbociclib to 75mg q.d. is rational, when palbociclib and moderate CYP3A4 inhibitors are used concomitantly.

Periocular tinea caused by zoonotic Trichophyton benhamiae

A 52-year-old immunocompetent woman was referred to the outpatient dermatology department of the Erasmus University Medical Center (Rotterdam, Netherlands) with a large, sharply demarcated erythematous plaque with yellow crustae around the right eye and on the upper right eyelid, without systemic symptoms and despite previous treatment (figure). Up until the appointment at our department, she was treated with oral valacyclovir (1000 mg three times a day) for 15 days, oral erythromycin (500 mg four times a day) for 6 days, and both fusidic acid cream and acyclovir cream two times a day.

Rheumatic heart disease: a school-based experience in guinea bissau

Abstract Introduction Rheumatic heart disease (RHD) remains a major cardiovascular issue in developing countries. Currently, large population-based data regarding RHD in Guinea Bissau are lacking and most of the patients are diagnosed with advanced stages. Our school-based echocardiography screening aimed at determining the prevalence of RHD and its socioeconomic distribution in Guinea Bissau. Methods Children (5–15 years old) from the Bissau region were enrolled from March 2017 to April 2020 in selected primary and secondary schools. Every child underwent echocardiography and group A streptococcus swab test. Presence of RHD was defined according to the World Heart Federation criteria for individuals ≤20 years. Results A total of 6784 children were screened: 585 (8.6%) participants had a positive swab test and received single dose of benzathine-penicillin-G, with the majority, 417 (71.3%) living in rural areas. A total of 6784 out-clinic echocardiography exams were performed; 1121 (16.5%) were positive for RHD (possible or definite), of which 606 (54.1%) were from rural areas. Every child with RHD (definite or probable) was invited for an outpatient visit in a clinic in Bissau, 863 (77%) attended the visit and echocardiography was repeated. RHD was confirmed in 659 cases (58.8%). Every child with confirmed RHD started secondary prophylaxis with BPG (or oral erythromycin in case of known penicillin allergy) every 21–28 days. At a median follow-up of 3 years only 391 (59.4%) continued regular administration. Estimating a population of 798370 subjects aged 5–15 years, we calculated a national prevalence of silent RHD of 77522 subjects, almost 1 every 10 children. Conclusions A school-based echocardiographic screening has an important role in the detection of subclinical RHD. In our population the prevalence of RHD is 9.7% with a significant difference between rural and urban areas, which is an additional challenge for health care providers. Additionally, regular administration of secondary prophylaxis is jeopardised by high attrition rate and lost-to-follow-ups. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Public fundraising on social media and at local events

Comparison of Low-Dose Treatment of Isotretinoin and Flutamide Combined with Oral Erythromycin for Female Patients with Severe Acne

Comparison of Low-Dose Treatment of Isotretinoin and Flutamide Combined with Oral Erythromycin for Female Patients with Severe Acne

Efficacy comparison between oral erythromycin versus domperidone for the treatment of feeding intolerance in preterm neonates

Domperidone and erythromycin are commonly used as prokinetic agents for feeding intolerance in preterm neonates; however, no data from a previous study have compared their efficacy. This study aimed to compare the efficacy of orally administered domperidone and erythromycin for the treatment of feeding intolerance in preterm infants. This retrospective cohort study included preterm neonates with a birthweight of <1800g and gestational age <37 weeks. Data were collected from medical records at Queen Sirikit National Institute of Child Health (QSNICH) from 2006 to 2014. The primary outcome was the time to establish full enteral feeding (150ml/kg/day) after starting oral domperidone or erythromycin for the treatment of feeding intolerance in preterm neonates. The secondary outcome was adverse effects associated with domperidone and erythromycin therapy. Among the 150 preterm neonates enrolled in this study, 66 received domperidone, and 84 received erythromycin. The baseline characteristics and comorbidities were not significantly different between the two groups; however, the gestational age at birth of neonates in the domperidone group was significantly lower than that of those in the erythromycin group. The time to establish full enteral feeding did not differ between the domperidone (11 days, "IQR," [6, 17]) and erythromycin (10 days, IQR [7, 14]) groups (p=0.622). No major adverse effects were noted. There were only three preterm infants who had elevated liver enzymes in each group, but the difference between groups was not significant. From this study, the efficacy of oral domperidone was promising equivalent to oral erythromycin and seems to be one of the treatment options for feeding intolerance in preterm neonates. However, large randomized, controlled trials are needed to confirm the efficacy and safety of domperidone in this population.

A Case of Pseudochromohidrosis Cured with Oral Erythromycin and Topical Clindamycin

A Case of Pseudochromohidrosis Cured with Oral Erythromycin and Topical Clindamycin

Impact of oral antibiotic prophylaxis on surgical site infection after rectal surgery: results of randomized trial.

To evaluate the impact of oral antibiotic prophylaxis on surgical site infection (SSI) rate after rectal surgery. It was a single-center 1:1 randomized controlled open parallel trial (registration number NCT03436719). The patients undergoing rectal resection for benign and malignant tumors were assigned randomly to two groups: the oral plus intravenous (IV) antibiotic prophylaxis (AP) and the IV antibiotic prophylaxis only. The primary endpoint was the overall rate of SSI. Between November 2017 and December 2018, 116 (male-55, the mean age-64 years) patients were enrolled into the trial. Of them, 57 had oral erythromycin 500 mg + metronidazole 500 mg a day before surgery and 1,000 mg of cephalosporin IV 30-90 min before operation. In the other group, 59 patients had the same IV antibiotics only. The incidence of SSIs was 22% (13/59) and 3.5% (2/57) correspondingly (р = 0.002). The statistically significant difference was detected for superficial SSI 0 (0%) vs. 5 (8.5%) (p = 0.03) and organ/space SSI 2 (3.5%) vs. 9 (15.3%) (p = 0.03), respectively. A multivariate analysis of risk factors of SSI identified two independent ones: bacterial contamination of the pelvic cavity ≥ 105 CFU at the end of surgery OR 17.9, 95% CI 2.1-150.0 (p = 0.008) and oral antimicrobial prophylaxis OR 0.2, 95% CI 0.03-0.8 (p = 0.02). Oral-parenteral AP significantly reduced the risk of SSI following elective rectal surgery. Bacterial contamination of the pelvic cavity ≥ 105 CFU at the end of surgery and oral antimicrobial prophylaxis were independent risk factors of SSI.

A Case Report of COVID-19 in a Pregnant Woman with Clinical Manifestations of Chorioamnionitis in Ilam, Iran

Introduction: Confrontation with COVID-19 has threatened all people of the world, including pregnant women, as a high-risk group. Case Presentation: The present study presents a 29-year-old female G1P0 at 33 weeks’ gestation. The patient’s initial complaint was the premature rupture of membranes. The patient’s vital signs showed an abnormal pulse rate and temperature. Initial assessments were carried out, including regular monitoring and recording of vital signs, mother’s blood ABG, uterine contractions, laboratory tests, and fetal heart rate. Treatment for chorioamnionitis began with intravenous ampicillin, gentamicin, and oral erythromycin. Because of the epidemic of COVID-19 in Iran and Ilam, a throat swab specimen was obtained from the upper respiratory tract of the patient. The RT-PCR assay confirmed that the throat swab sample of the patient was positive for COVID-19. A throat swab specimen was taken from the newborn for RT-PCR. Also, the mother’s chest CT scan was done that showed abnormality; however, the RT-PCR throat swab specimen was negative for the newborn. The patient was transferred to the COVID-19 care unit. She was healthily discharged from the hospital with two negative RT-PCR tests. Her newborn was followed for two weeks, and no symptoms of COVID-19 were reported. Conclusions: Some major prenatal complications, including fetal distress, preterm labor, premature rupture of membranes, and amniotic fluid abnormalities, have been reported among some pregnant women infected with COVID-19 (7); however, the clinical manifestations of COVID-19 are deceptive. Therefore, low attention to all aspects of COVID-19 and late examination would increase the risk of spreading the disease among therapists providing services and other hospitalized mothers. These concerns make pregnant mothers afraid of even the most necessary referrals for appropriate and necessary midwifery interventions. Therefore, it is necessary to pay attention to two important issues: first, the concerns and anxieties of pregnant mothers and second, making the diagnosis in suspected cases as soon as possible.

Oral Erythromycin Improves the Quality of Endoscopy in Upper Gastrointestinal Bleeding Patients.

BackgroundUpper gastrointestinal bleeding is a life-threatening emergency. Endoscopy is the therapeutic and diagnostic procedure of choice after initial stabilization of the patient. But the presence of retained blood, blood products, and other residual material in the stomach is a big challenge for endoscopists during urgent endoscopy after acute upper gastrointestinal bleeding. Intravenous erythromycin before endoscopy improves the visualization of gastric and duodenal mucosa in these patients. Use of oral erythromycin is more easy and convenient, so the objective of our study was to assess the effects of oral erythromycin on quality of endoscopy in upper gastrointestinal bleeding patients.MethodsThis interventional study was conducted at the Department of Medicine, POF Hospital Wah Cantt, Pakistan from January 2019 to December 2019. Patients with clinical evidence of acute upper gastrointestinal bleeding within 12 hours were inducted consecutively. Patients were randomly assigned to erythromycin (500 mg) suspension or placebo, orally three hours before endoscopy. One endoscopist performed all the procedures with the same double-channel video endoscope. The primary endpoint was endoscopic quality. The secondary endpoints were the need for second-look endoscopy within 48 hours, endoscopy related complications, therapeutic procedure performed or not during endoscopy, number of blood transfusions, and length of hospital stay.ResultsA total of 60 patients were included in the study; 30 received erythromycin and 30 received placebo. Out of these, 60% were male and 40% were female. The mean age was 53.68 ± 16.64. Quality of endoscopy was much better in the erythromycin group (83.3%) as compared to placebo (40%). Erythromycin did not shorten the endoscopic duration (15.53 vs. 14.33 minutes in the placebo group; p=0.216) and length of hospital stay (5.23 in erythromycin vs. 5.40 days in placebo group; p=0.807). Statistically no significant association was found between use of erythromycin and establishment of cause of bleed, need for second-look endoscopy, number of blood transfusions and number of endoscopic therapeutic procedures.ConclusionErythromycin oral suspension before endoscopy in patients with acute upper gastrointestinal bleeding produced good quality of endoscopy in our study. It improved the visualization of gastric and duodenal mucosa significantly. However, it did not shorten the duration of endoscopy or hospital stay. There was no significant difference in number of second-look endoscopies and blood transfusions as well.

Oral erythromycin in pityriasis lichenoides chronica and pityriasis lichenoides et varioliformis acuta.

Pityriasis lichenoides (PL) is an uncommon cutaneous disorder. Oral erythromycin is proposed to be effective in treating the disease. Here, we reported 16 pediatric patients with PL and systematically reviewed published literatures on erythromycin treatment response in pediatric PL patients, to observe the different treatment response to erythromycin in the pityriasis lichenoides chronica (PLC) and the pityriasis lichenoides et varioliformis acuta (PLEVA) groups. Sixteen patients, 8 with PLC and 8 with PLEVA, were treated with erythromycin. In the PLC group, 25% (n = 2) patients responded to erythromycin, while in the PLEVA group, 87.5% (n = 7) patients responded to erythromycin. The response rate was higher in the PLEVA group than the PLC group (P =.05). No side effect was reported in the 16 patients. A total of 34 children including 16 from our studies were included for further descriptive analysis, in which 12 had PLC and 22 had PLEVA. In the PLC group, 41.7% (n = 5) of patients responded to erythromycin while in the PLEVA group, 90.9 % (n = 20) of patients responded. The response rate was higher in the PLEVA group than the PLC group (P = .004). In conclusion, erythromycin is effective and safe in the treatment of children with PL, and erythromycin was more effective in patients with PLEVA than PLC.

Effect of oral erythromycin in the treatment of preterm infants with feeding intolerance

Background It usually takes several days or even weeks to establish full enteral feeding (FEF) in preterm infants because of feeding intolerance (FI) related to gastrointestinal hypomotility. Clinical trials on prokinetic agents in preterm neonates, especially erythromycin, have reported conflicting results. There are limited data on prokinetic effect of erythromycin in preterm infants. Objective The authors aimed to evaluate the effect of oral administration of erythromycin in the treatment of preterm infants born at 30 weeks of gestation or more. Patients and methods A clinical trial was conducted on 60 preterm neonates born equal or more than 30 weeks of gestational age and admitted to the neonatal ICU at Kafr El-Shiekh General Hospital. Infants with FI were randomly divided into two groups: group A received oral erythromycin and group B did not receive treatment with erythromycin. Time to achieve FEF was considered as a primary outcome measure. Duration of parenteral nutrition (PN) expressed in number of days; number of days that feeds were withheld owing to FI; and duration of hospitalization were the other outcomes. Results Erythromycin group attained FEF earlier than the group without treatment with erythromycin. Therefore, PN duration was shorter in erythromycin group than the group without treatment. Moreover, the duration of hospitalization was shorter in erythromycin group than the other group. Conclusion This data suggest that oral erythromycin effectively reduces the time required to reach FEF, duration of PN, and length of hospital stay in stable preterm infants.

Bacillary angiomatosis triggered by severe trauma in a healthy Caucasian patient: A case report.

Bacillary angiomatosis represents a cutaneous and systemic infection caused by Bartonella species, typically described in the past in HIV-positive patients or associated with immunodeficiencies. More recent case reports had brought into attention the probability that this entity may manifest in otherwise healthy individuals, triggered by trauma and skin burns. The physiopathology of this neoproliferative process is based on the production of angiogenetic molecules, such as vascular endothelial growth factor (VEGF) and IL-8. In case of an inadequate treatment, the evolution can be fatal, with a systemic dissemination of the abscesses within the gastro-intestinal tract, respiratory tract, brain and bones. The appropriate therapy is with oral erythromycin and doxycycline, but several treatments such as cephalosporins, penicillins, macrolides, aminoglycosides, rifampin, dapsone, ciprofloxacin, have been tried with favorable results. Herein we present the case of a Caucasian patient, seronegative for HIV, who developed multiple vascular papules and nodules on the face, after a severe trauma and which healed after an adequate antibiotic therapy with oral clarithromycin.

Patterns of placental antimicrobial resistance in preterm birth before 30 completed weeks gestation complicated by preterm prelabour rupture of membranes.

While many guidelines recommend a 10-day course of oral erythromycin following preterm prelabour rupture of membranes (PPROM) as derived from the ORACLE I trial, evidence is emerging that this may encourage a state of antenatal genital tract dysbiosis. In addition, erythromycin's lack of efficacy toward Gram-negative microorganisms may promote colonisation and infection, conveying more significant unrecognised risk for very and extremely preterm newborns. To define patterns of placental infection or colonisation in newborns born before 30 completed weeks gestation following PPROM. Retrospective cohort study of mother-infant dyads who delivered at<30 completed weeks gestation following PPROM in a South Australian tertiary perinatal centre between January 2012 and December 2015. Main outcome measures included placental and neonatal culture and sensitivities within 72h of delivery and histologic chorioamnionitis. Categorical characteristics were analysed using two-sided Fisher's exact test and numerical characteristics via analysis of variance. During the four years studied, 126 infant-mother dyads were identified. Where a placental swab was taken, 23.9% cultured Gram-negative organisms and the majority (58.8%) were antimicrobial-resistant. Those that received erythromycin had increased incidence of antimicrobial-resistant Gram-negative organisms on placental swab (P=0.02). All cases of neonatal early-onset sepsis (EOS), including two cases of multi-resistant Gram-negative EOS, occurred in those who received erythromycin. The current antibiotic recommendations for PPROM may promote selection of unhindered antimicrobial-resistant Gram-negative organisms and may increase risk of Gram-negative EOS in very and extremely preterm newborns. Further wide-scale examination of antibiotic recommendations in PPROM is necessary.