Oral Erythromycin and the Risk of Sudden Death from Cardiac Causes

Ray, Wayne A.; Murray, Katherine T.; Meredith, Sarah; Narasimhulu, Sukumar Suguna; Hall, Kathi; Stein, C. Michael

doi:10.1056/nejmoa040582

Cited by 460 publications

(256 citation statements)

References 43 publications

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“…Macrolides should be only a third-line therapy because streptococcus A resistance to them is increasing worldwide [14]. Moreover, erythromycin should not be used as it has been associated with a higher risk of sudden death, whether prescribed alone or in combination with cytochrome P-450 3A4 inihibitors [15]. …”

Section: Discussionmentioning

confidence: 99%

Recurrent Erysipelas: 47 Cases

et al. 2006

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Background:Recurrence is a common complication of erysipelas (cellulitis). Objectives:Todescribe the characteristics of patients with recurrent erysipelas and thereby, identify potential risk factors and evaluate prophylaxis efficacy. Methods:Data were retrospectively recorded from the files of 47 patients admitted to hospital between 1995 and 2003 for erysipelas recurrence. Studied variables included: general condition, regional and local factors, e.g. broken cutaneous barrier. Patient characteristics were used to construct tree-based models according to the classification and regression tree methodology. Results: Our patients suffered a mean of 4.1 recurrences. Cutaneous barrier disruption was observed in 81%, mainly intertrigo (60%). Antibiotic prophylaxis was taken by 68% of the patients for 30.6 months. After 1 and 2 years, 84 and 72% of the patients, respectively, were recurrence-free. Conclusion: Our results showed that erysipelas recurrence has the same risk factors as single episodes and underlines the potential benefit of oral or parenteral antibiotic prophylaxis to prevent recurrences.

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Section: Discussionmentioning

confidence: 99%

Recurrent Erysipelas: 47 Cases

et al. 2006

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“…macrolide antibiotics prolonging the repolarization period of the action potential by blocking the HERG potassium channels [116] and (2) inhibition of the metabolism of other proarrhythmogenic drugs by acting on cytochrome P450 in the liver. When, for instance, EM and other inhibitors of cytochrome P450 were concurrently prescribed, a 5-fold greater risk of cardiac sudden death was reported [35]. Patient characteristics associated with a greater risk of developing cardiac arrhythmias following macrolide use are shown in table 2 [115,117,118].…”

Section: Cardiac Toxicitymentioning

confidence: 99%

“…Intravenous use of EM has been associated with a particularly high risk of arrhythmias, probably due to the poorer absorption of oral preparations [114,115]. One large cohort study in 2004 found a 2-fold increased risk of sudden death from cardiac causes among patients currently using EM compared to those who had not used any of the antibiotic medications studied [35]. TdP is a polymorphic ventricular tachycardia, usually preceded by a prolongation of the QT interval, caused by altered cardiac repolarization.…”

Section: Cardiac Toxicitymentioning

confidence: 99%

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Immunomodulatory Effects of Macrolide Antibiotics – Part 2: Advantages and Disadvantages of Long-Term, Low-Dose Macrolide Therapy

et al. 2010

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The available evidence for long-term, low-dose treatment with 14- and 15-membered ring macrolides in non-cystic fibrosis (CF) bronchiectasis, COPD, chronic sinusitis, and asthma is reviewed with special attention to possible adverse effects and the emergence of resistance during long-term macrolide treatment. Macrolide maintenance therapy has been proven to be of benefit in diffuse panbronchiolitis and CF, presumably due to an anti-inflammatory mechanism of action in addition to its direct antimicrobial effect. Solid evidence to justify this treatment regimen for non-CF bronchiectasis, asthma, or sinusitis is still lacking, although a beneficial effect of long-term macrolide therapy has been found in small clinical trials on these subjects. Data from randomized trials of long-term macrolide treatment in COPD are conflicting. A sufficiently long duration of treatment and the careful selection of patients appears to be crucial. Aside from its beneficial effects, possible side effects of macrolide treatment should be taken into account, the most important of these being gastrointestinal upset and cardiac arrhythmias. Development of macrolide resistance among respiratory pathogens is very common during long-term macrolide treatment. Whether this finding is clinically significant is a matter of debate.

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“…Tolerance is known to occur with chronic use. An increased incidence of sudden cardiac death in patients using erythromycin has been reported [28]. …”

Section: Treatmentmentioning

confidence: 99%

Treatment of Gastroparesis: An Update

Gumaste

Baum²

2008

Digestion

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Gastroparesis is a chronic disorder of gastric motility that is characterized by delayed emptying of either solids or liquids from the stomach in the absence of any mechanical obstruction. Nausea, vomiting, early satiety and bloating are some of the manifestations of gastroparesis. Idiopathic, diabetes mellitus and postsurgical states account for the majority of cases. Gastroparesis is a difficult condition to treat. Prokinetic drugs like metoclopramide and erythromycin form the mainstay of therapy but are less than ideal. Some patients may benefit from endoscopic botolinium toxin injection. Gastric electrical stimulation, though promising, is not ready for prime time yet.

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Oral Erythromycin and the Risk of Sudden Death from Cardiac Causes

Abstract: The concurrent use of erythromycin and strong inhibitors of CYP3A should be avoided.

Cited by 460 publications

References 43 publications

Recurrent Erysipelas: 47 Cases

Recurrent Erysipelas: 47 Cases

Immunomodulatory Effects of Macrolide Antibiotics – Part 2: Advantages and Disadvantages of Long-Term, Low-Dose Macrolide Therapy

Treatment of Gastroparesis: An Update

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