study on erythromycin

allnurses Guide · Sep 13, 2004

Yep, read it today in the paper. Not alot of details though. My oldest son was on that for his break-outs a few years ago and I took it too.

Weird.

steph

peruviannurse25 · Sep 13, 2004

Yeah,

Read it about a week ago in the Dallas Morning News. As one thread said , not a lot of detail, but alarming! It is/was a drug that tx everything! :uhoh21:

Have any of you heard the new study out related to e-mycin? They are claiming that it increases a pts chance of sudden cardiac arrest by 30%? I havent heard the details. I was hoping someone here knew more about it. I use it a lot.

smk1, LPN · Sep 13, 2004

im not a nurse yet, but i always remember this particular antibiotic because it made me so sick i thought i was dying. i spent an entire week holed up on the floor of the bathroom after taking it for an infection. THAT IS SOME STRONG STUFF!

allnurses Guide · Sep 13, 2004

im not a nurse yet, but i always remember this particular antibiotic because it made me so sick i thought i was dying. i spent an entire week holed up on the floor of the bathroom after taking it for an infection. THAT IS SOME STRONG STUFF!

It didn't bother my son or me . . we took it with food and didn't lay down.

Now, I once took codeine on an empty stomach and ended up prone on the floor thinking I was going to die.

Side effects can kill ya! :)

steph

jemb · Sep 13, 2004

The increased risk occurs when erythro is given concurrently with certain other drugs.

From the New England Journal of Medicine:

Oral Erythromycin and the Risk of Sudden Death from Cardiac Causes

Wayne A. Ray, Ph.D., Katherine T. Murray, M.D., Sarah Meredith, M.B., B.S., Sukumar Suguna Narasimhulu, M.B., B.S., M.P.H., Kathi Hall, M.S., and C. Michael Stein, M.B., Ch.B.

ABSTRACT

Background Oral erythromycin prolongs cardiac repolarization and is associated with case reports of torsades de pointes. Because erythromycin is extensively metabolized by cytochrome P-450 3A (CYP3A) isozymes, commonly used medications that inhibit the effects of CYP3A may increase plasma erythromycin concentrations, thereby increasing the risk of ventricular arrhythmias and sudden death. We studied the association between the use of erythromycin and the risk of sudden death from cardiac causes and whether this risk was increased with the concurrent use of strong inhibitors of CYP3A.

Methods We studied a previously identified Tennessee Medicaid cohort that included 1,249,943 person-years of follow-up and 1476 cases of confirmed sudden death from cardiac causes. The CYP3A inhibitors used in the study were nitroimidazole antifungal agents, diltiazem, verapamil, and troleandomycin; each doubles, at least, the area under the time-concentration curve for a CYP3A substrate. Amoxicillin, an antimicrobial agent with similar indications but which does not prolong cardiac repolarization, and former use of erythromycin also were studied, to assess possible confounding by indication.

Results The multivariate adjusted rate of sudden death from cardiac causes among patients currently using erythromycin was twice as high (incidence-rate ratio, 2.01; 95 percent confidence interval, 1.08 to 3.75; P=0.03) as that among those who had not used any of the study antibiotic medications. There was no significant increase in the risk of sudden death among former users of erythromycin (incidence-rate ratio, 0.89; 95 percent confidence interval, 0.72 to 1.09; P=0.26) or among those who were currently using amoxicillin (incidence-rate ratio, 1.18; 95 percent confidence interval, 0.59 to 2.36; P=0.65). The adjusted rate of sudden death from cardiac causes was five times as high (incidence-rate ratio, 5.35; 95 percent confidence interval, 1.72 to 16.64; P=0.004) among those who concurrently used CYP3A inhibitors and erythromycin as that among those who had used neither CYP3A inhibitors nor any of the study antibiotic medications. In contrast, there was no increase in the risk of sudden death among those who concurrently used amoxicillin and CYP3A inhibitors or those currently using any of the study antibiotic medications who had formerly used CYP3A inhibitors.

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

Source Information

From the Division of Pharmacoepidemiology, Department of Preventive Medicine (W.A.R., S.M., K.H.), and the Departments of Medicine and Pharmacology, Divisions of Cardiology (K.T.M.), Clinical Pharmacology (K.T.M., S.S.N., C.M.S.), and Rheumatology (C.M.S.), Vanderbilt University School of Medicine; and the Geriatric Research, Education, and Clinical Center, Nashville Veterans Affairs Medical Center (W.A.R.)-both in Nashville.