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Erythromycin
Only small amounts of erythromycin are removed by hemodialysis.
2004 Increasing prevalence of vancomycin-resistant enterococci, and cefoxitin-, imipenem- and fluoroquinolone-resistant gram-negative bacilli: A KONSAR Study in 2002. Lee, K., Kim, Y.A., Park, Y.J., Lee, H.S., Kim, M.Y., Kim, E.-C., Yong, D., . ; , Lee, M. Yonsei Medical Journal 45 4 ; , pp. 598-608 2004 Evolution of erythromycin-resistant Streptococcus pneumoniae from Asian countries that contains erm B ; and mef A ; genes . Kwan, S.K., Song, J.H. Journal of Infectious Diseases 190 4 ; , pp. 739-747 2004 Clinical outcomes of pneumococcal pneumonia caused by antibioticresistant strains in asian countries: A study by the asian network for surveillance of resistant pathogens. Song, J.-H., Jung, S.-I., Ki, H.K., Shin, M.-H., Ko, K.S., Son, J.S., Chang, H.-H., . ; , So, T. Clinical Infectious Diseases 38 11 ; , pp. 1570-1578 2004 High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia an ANSORP study ; Song, J.-H., Jung, S.-I., Ko, K.S., Kim, N.Y., Son, J.S., Chang, H.-H., Ki, H.K., . ; , Shibl, A. Antimicrobial Agents and Chemotherapy 48 6 ; , pp. 2101-2107 2004 Macrolide resistance in Streptococcus pneumoniae: Clonality and mechanisms of resistance in 24 countries. Bozdogan, B., Bogdanovich, T., Kosowska, K., Jacobs, M.R., Appelbaum, P.C. Current Drug Targets Infectious Disorders 4 3 ; , pp. 169-176. Alcohol erythromycinErythromycin is a prototype of the macrolide family of antibiotics, which include the newer azithromycin Zithromax ; , clarithromycin Biaxin ; , dirithromycin Dynabac ; , and roxithromycin Rulid ; . Of the four, only azithromycin has been significantly studied in acne therapy.9, 10 Their mechanism of action is the same for all: bacterial cell wall penetration with reversible binding to the 50S ribosomal unit with RNA-dependent protein synthesis inhibition.2 Antimicrobial Activity The activity of azithromycin against gram-positive organisms such as staphylococci and streptococci is onehalf to a quarter of that of erythromycin. Erythromycinresistant strains of staphylococcus and streptococcus show cross-resistance to the new agents. Anaerobic activity is similar to erythromycin, but gram-negative activity is greater. Azithromycin has activity against pathogens found in human and animal bites, atypical mycobacteria, and Borrelia burdorferi.2 Its minimum inhibitory concentration against P. acnes is similar to other macrolides.10 Pharmacokinetics The newer macrolides' main advantage is consistent oral bioavailability: Clarithromycin - 50%, independent of food Azithromycn - 37%, 1 hr a.c. or 2 hr p.c.
The parallel between the mechanism of erm induction and peptide-mediated macrolide resistance is obvious. In both cases, the mode of ribosome function appears to depend directly on interaction between the short nascent peptide and the drug molecule bound in the exit tunnel. Strikingly, the consensus sequence of the pentapeptides that render cells resistant to erythromycin, M- L ; -L I- F ; -V, has a clear resemblance to the C-terminal amino and floxin. What is erythromycin used for antibioticsEn's higher tendency to be slow acetylators. The same study found Drugs altering activity of the important that women were at sigbiotransformation enzymes * nificantly higher risk for Inducing CYP3A4 Inhibiting CYP3A4 Metabolized by CYP3A4 adverse reactions to one anti-HIV agent, didanocarbamazepine ketoconazole terfenadine sine, while they were dexamethasone cimetidine toremifine less at risk with respect omeprazole erythromycin sibutramine to another such agent, phenobarbital nelfinavir quetiapine zalcitabine. This finding phenytoin felodipine olanzapine supports a proposal that rifabutin flunarizine delavirdine zalcitabine be regarded rifampin isradipine tiagabine as the preferable treatrifapentine nicardipine saquinavir ment for women and troglitazone nifedipine midazolam didanosine preferable for nimodipine triazolam men to minimize toxic nisoldipine indinavir responses of each sex. nitrendipine donepezil No sex differences were found for two other Inhibiting CYP1A2 Metabolized by CYP1A2 agents tested--zidovuciprofloxacin fluvoxamine ropivicaine dine and dapsone. imipramine theophylline This example empharopinirole verapamil sizes the desirability of examining those agents Inhibiting CYP2A9 most prone to cause clopidogrel severe toxicity, and or Sources: R.Z. Harris et al. 1995 ; and varied product literature having a small margin Nonmedical use of safety, for possible * Note: This is presented not as an exhaustive compilation but merely to emphasize of CNS drugs sex-related differences potential problems. This practice, whether in response. The former called "recreational use" problem of epidemic of CNS-active agents or "substance abuse, " has long been "analgesic nephropathy, " which was more prominent in thought to occur much more frequently among males than Europe and Australia than in North America, and which females. There is a recent trend, however, for this to change. peaked in the 1970s, involved women more than men. Nevertheless, concerning perhaps the most important of Some have surmised that this depended upon women's these--alcoholism--it has been said that there clearly are higher incidence of urinary tract infections, a factor "definite differences between the sexes in the presentation amplifying the drug toxicity that was blamed mainly on and longitudinal course" of this disorder. Despite the fact phenacetin. However, the cyclooxygenase-inhibitory that women have long tended to begin drinking heavily at a action of aspirin may have played a role in this produclater age than men, they are prone to develop serious comtion of chronic interstitial nephritis and papillary necroplications at about the same age. Observations that ethanol sis. is more injurious to the liver for women than for men have been attributed to a role of the immunologic mechanisms in CONCLUSION the pathogenesis of hepatic toxicity in alcoholic patients. It is no longer defensible for those involved in the processes of drug development and drug prescribing to SEX-RELATED TOXICITY overlook pharmacological differences between men and It is an important concern if one gender is more liable to women. These may stem from pharmacodynamic faca drug toxicity in the course of therapy. An outstanding tors, but they are especially likely to arise from pharmainstance of this was reported in 1996 with respect to cokinetic variations, which have been demonstrated to AIDS therapies Moore et al., J Med 1996; 101: 34bear clinical significance. 40 ; . This study confirmed prior evidence that women Greater attention must be paid to the gender factor in have a higher risk than men for cutaneous hypersensitividrug therapy. As more extensive and reliable data ty reactions to cotrimoxazole. It was suggested that this become available, pharmacists should be prepared to may result from a greater output of a toxic metabolite, access them and to aid prescribers to optimize medicahydroxylamine, in metabolism of the sulfamethoxazole tion regimens for patients of either sex. component of the product in women because of womReferences are available upon request and metformin. Erythromycin treats chlamydiaEpinephrine, 240t, 242, 243248 absorption, fate, and excretion of, 247 actions of, termination of, 164, 165f and adrenergic receptor antagonists, 851 adverse effects of, 247, 17231724 for asthma, 246 and barbiturates, 417 and blood pressure, 243244, 243t, 244t calorigenic action of, 246 cardiac effects of, 243f, 245246, 244t, in cardiopulmonary resuscitation, 261 CNS effects of, 246 contraindications to, 247 formulations of, 247 for glaucoma, 1723 hematological effects of, 246 hyperglycemic effects of, 1633t, 1634 for hypersensitivity reactions, 263, 640 641 in hypoglycemia, 1631 and local anesthesia, 247, 375, 377, local vascular effects of, 262 mechanism of action, 243 metabolic effects of, 246 metabolism of, 164, 165f for muscarinic receptor agonist toxicity, 188 as neurotransmitter, 139, 146, 158171, versus norepinephrine, 244t ophthalmic use of, 1721t and plasma volume, 246 positive chronotropic action of, 247 positive inotropic action of, 243 as prototypical sympathomimetic drug, 237 receptors for. See Adrenergic receptor s Adrenergic receptor s Adrenergic receptor s ; release of, 158161, 160f, 163 respiratory effects of, 246 skeletal muscle effects of, 247 smooth muscle effects of, 245246 storage of, 158163, 160f synthesis of, 158161, 158f, 159t, therapeutic uses of, 240t, 248 topical, 380 toxicity of, 247 uterine effects of, 246 vascular effects of, 244245, 244t and vasopressin, 775 Epiphora, 1729 Epipodophyllotoxin s ; , 13591361 for cancer chemotherapy, 1318t Epirubicin, 13571359 Epithelial keratopathy, antipsychotics and, 481 Epithelial structure, vitamin A and, 1733 1734 EPIVIR lamivudine ; , 1276t Eplerenone, 760, 760t, 761762, for congestive heart failure, 875 pharmacokinetics of, 1821t Epoetin alfa, 14371439 pharmacokinetics of, 1822t EPOGEN epoetin alfa ; , 1437 Epoprostenol, for pulmonary hypertension, 666 Epoxide hydrolases EHs ; , 7374, 79, 79f fraction of clinically used drugs metabolized by, 78f Epoxyeicosatrienoic acids EETs ; , 654f, 657 Eprosartan, 812f, 813, 814 chemistry of, 812f for hypertension, 859860 pharmacological effects of, 810 Epstein-Barr virus, acyclovir for, 1250 Eptastigmine, for Alzheimer's disease, 214 Eptifibatide, 14831484 for angina, 841 for myocardial ischemia infarction, 824, 14821483 therapeutic use of, 14831484 Equilin, 1542t erbB oncogene, 32 ERBITUX cetuximab ; , 1379 Erectile dysfunction. See Impotence Erethism, 1761 ERGAMISOL levamisole ; , 1421 Ergocalciferol, 1652, 1653f, 16541655 therapeutic uses of, 1664 Ergocornine, 310t Ergocryptine, 310t ERGOMAR ergotamine tartrate ; , 310 Ergonovine, 309, 309t, 310, for postpartum hemorrhage, 311, 1509 Ergosterol, 1652, 1653f Ergostine, 310t Ergotamine, 308309, 310t, 310311 for migraine, 310 pharmacological actions of, 309t Ergotamine tartrate, 310 Ergot ergot alkaloids, 271, 308311 for dementia, 430 interactions of with adrenergic receptors, 309t with dopaminergic receptors, 309t with tryptaminergic receptors, 309t for migraine, 310 natural and semisynthetic, 310t for Parkinson's disease, 535536 pharmacological actions of, 308, 309t for postpartum hemorrhage, 311, 1509 Ergotoxines, 310t Erlotinib, 1369 Errors, in prescription orders, 17811782 ERTACZO sertaconazole ; , 1239 Ertapenem, 1151 ERYC erythromycinn ; , 1690 Erysipelas, 1690 Erysipeloid, penicillin G for, 1137 Erysipelothrix rhusiopathiae, 1137 Erythema multiforme clindamycin and, 1190 penicillins and, 1141 sulfonamides and, 1116. Epilepsy: lifetime treatment. Do not stop treatment abruptly, even if changing treatment to another antiepileptic. Neuropathic pain: continue several months after pain relief is obtained, then attempt to stop treatment. Do not administer to patients with atrioventricular block, history of bone marrow depression. Administer with caution to patients with glaucoma, urinary retention, hepatic or renal impairment, heart failure or blood disorders and to elderly patients. May cause: headache, dizziness, gastrointestinal and visual disturbances, rash, leucopenia, confusion and agitation in elderly patients, drowsiness use with caution when driving or operating machinery ; , exceptionally: Lyell's and Stevens-Johnson syndromes, agranulocytosis, anaemia, bone marrow depression, pancreatitis, hepatitis, cardiac conduction defect. If so, stop treatment. Do not drink alcohol during treatment. Do not combine with: erythromycin, isoniazid, valproic acid increased carbamazepine plasma concentrations ; , oestroprogestogens reduced contraceptive efficacy ; , saquinavir reduced efficacy of saquinavir ; . Monitor combination with: oral anticoagulants, corticosteroids, antidepressants, haloperidol, protease inhibitors, aminophylline, rifampicine, itraconazole, etc. Pregnancy: Epilepsy: do not start treatment during the first trimester, except if vital and there is no alternative risk of neural tube defect ; . However, if treatment has been started before a pregnancy, do not stop treatment. The administration of folic acid before conception and during the first trimester seems to reduce the risk of neural tube defect. Due to the risk of haemorrhagic disease of the newborn, administer vitamin K to the mother and the newborn infant. Neuropathic pain: not recommended Breast-feeding: no contra-indication Storage and indocin. Erythromycin pads reviewErythromycin no prescription canada
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