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Related Experiment Videos

Adverse effects of macrolide antibacterials

P Periti1, T Mazzei, E Mini

  • 1Department of Preclinical and Clinical Pharmacology, University of Florence, Italy.

Drug Safety
|November 1, 1993
PubMed
Summary

Newer macrolide antibacterials offer improved tolerability compared to older erythromycins, with reduced gastrointestinal and hepatotoxic effects. Continuous research aims for safer macrolide antibiotics with enhanced bioavailability.

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Area of Science:

  • Pharmacology
  • Microbiology
  • Clinical Medicine

Background:

  • Macrolide antibacterials are a well-established class, comprising 10-15% of the oral antibiotic market.
  • Despite being generally safe, research continues for macrolides with enhanced bioavailability and fewer adverse effects.
  • Increased usage and expanded indications necessitate ongoing evaluation of macrolide tolerability.

Purpose of the Study:

  • To review the tolerability of clinically available macrolide antibacterials.
  • To compare adverse effects of newer macrolide derivatives with older compounds.
  • To differentiate expected, unusual, and rare adverse effects of macrolides.

Main Methods:

  • Analysis of adverse effects reported over the last 40 years in adult and pediatric patients.

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  • Comparison of recently developed macrolide derivatives with older macrolide compounds.
  • Review of case reports on uncommon or dubious adverse effects.

    • Main Results:

    • Gastrointestinal reactions are most frequent with erythromycins (15-20%), but less common with newer macrolides (≤5%).
    • Hepatotoxicity is low for most newer macrolides, negligible for azithromycin and dirithromycin.
    • Unusual adverse effects, including transient deafness and allergic reactions, are more common with older erythromycins.

    Conclusions:

    • Newer macrolide antibacterials demonstrate improved tolerability profiles compared to older agents.
    • Gastrointestinal disturbances and hepatotoxicity are significantly reduced in newer macrolide derivatives.
    • While severe adverse events are rare, vigilance for cardiac, hepatic, and CNS effects is warranted.