Comparative tolerability of erythromycin and newer macrolide antibacterials in paediatric: Patients

The macrolides are a well established group of antibacterials frequently us ed in general practice. The most frequently used macrolides in paediatric p atients are erythromycin, a naturally occurring compound, and clarithromyci n and azithromycin, recently developed macrolides. Overall adverse effect rates of 7 to 26% for erythromycin, 14 to 26% for cl arithromycin, and 6 to 27% for azithromycin have been described in children . Adverse gastrointestinal effects, including nausea, vomiting, diarrhoea a nd ab abdominal cramps, are the most common problems in children. Allergic reactions, hepatotoxicity, ototoxicity and adverse effects involving the ce ntral and peripheral nervous systems have also been observed in children. S tevens-Johnson, Schonlein-Henoch and Churg-Strauss syndromes have been rare ly described in children. Treatment-related laboratory abnormalities have been recorded in 2 to 4% of erythromycin- and in 0 to 1% of both clarithromycin- and azithromycin-trea ted children, Elevation in liver function tests was the most common abnorma lity cited. Increased macrolide use in children in recent years has resulted in a growi ng potential for drug interactions between them and other pharmacologically active agents via the inhibition of cytochrome P450 (CYP) microsomal enzym es. Drug interactions with theophylline, cyclosporin, carbamazepine, terfen adine and warfarin limit erythromycin use. Clarithromycin is a weak inducer of CYP and exhibits fewer drug-drug interactions than erythromycin. Howeve r, its use with theophylline. carbamazepine and terfenadine is contraindica ted. In contrast, no significant interactions have been reported with azith romycin to date. Macrolides have been proven to be well tolerated in the treatment of upper and lower respiratory tract infections, skin and soft tissue infections, an d also in less frequent infections occurring in paediatric patients. In add ition, clarithromycin and azithromycin have shown good tolerability profile s in immunocompromised paediatric patients. In conclusion, macrolides antibacterials have proven to be well tolerated i n paediatric patients. Although the incidence of adverse effects is similar with the use of erythromycin and the newer macrolides, drug interactions o ccur significantly less when clarithromycin or azithromycin are administere d.