Streptococcal Pharyngitis Therapy

Abstract

The recommended dosage of erythromycin, without regard to the formulation prescribed, for children with streptococcal pharyngitis is 30 to 40 mg/kg/day. We previously reported an acceptable streptococcal eradication rate among patients with pharyngitis treated with erythromycin estolate, 20 mg/kg/day. In this study, an extension of the earlier one, the efficacy of this same dosage of erythromycin estolate was compared with a 40 mg/kg/day dosage of erythromycin ethylsuccinate. Streptococcal eradication rates were nearly identical in the two groups of patients. The efficacy of erythromycin estolate at a dosage lower than that recommended for children is most likely explained on pharmacologic grounds: better absorption and higher levels in serum and tissue than those achieved with other erythromycin formulations. It seems rational to calculate required dosages of erythromycin on the basis of the formulation being administered.

Pharmacokinetic advantages of erythromycin estolate over ethylsuccinate as determined by high-pressure liquid chromatography

“…The pharmacokinetic data presented in this study reinforce the clinical advantages of erythromycin estolate over erythromycin ethylsuccinate. In fact, erythromycin estolate twice a day was clinically and bacteriogically more effective than ethylsuccinate in the treatment of strep-tococcal pharyngitis (13,15,16). Moreover, the lower efficacy of erythromycin ethylsuccinate may be explained by undetectable erythromycin base concentration at 12 h. Additional pharmacokinetic and efficacy studies should be conducted in patients to further examine these data.…”

“…Recent clinical trials suggest that erythromycin estolate is more effective than erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis (13,15), even at a lower dosage (16). To be active, the esters of erythromycin need to be hydrolyzed to erythromycin base (35).…”

Pharmacokinetic advantages of erythromycin estolate over ethylsuccinate as determined by high-pressure liquid chromatography

“…The pharmacokinetic data presented in this study reinforce the clinical advantages of erythromycin estolate over erythromycin ethylsuccinate. In fact, erythromycin estolate twice a day was clinically and bacteriogically more effective than ethylsuccinate in the treatment of strep-tococcal pharyngitis (13,15,16). Moreover, the lower efficacy of erythromycin ethylsuccinate may be explained by undetectable erythromycin base concentration at 12 h. Additional pharmacokinetic and efficacy studies should be conducted in patients to further examine these data.…”

“…Recent clinical trials suggest that erythromycin estolate is more effective than erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis (13,15), even at a lower dosage (16). To be active, the esters of erythromycin need to be hydrolyzed to erythromycin base (35).…”

Plasma Levels following Single and Repeated Doses of Erythromycin Estolate and Erythromycin Stearate

“…The dose of the suspension in Treatment 4 was selected on the basis of a recent recommendation that erythromycin suspension should be dosed at a level of 20 mg/ml/day for the treatment of streptococcal pharyngitis in children (20). Although this dosage is somewhat lower than that of the tablets and capsules, the dosage range was similar for a given individual.…”

Pharmacokinetic advantages of erythromycin estolate over ethylsuccinate as determined by high-pressure liquid chromatography

“…The pharmacokinetic data presented in this study reinforce the clinical advantages of erythromycin estolate over erythromycin ethylsuccinate. In fact, erythromycin estolate twice a day was clinically and bacteriogically more effective than ethylsuccinate in the treatment of strep-tococcal pharyngitis (13,15,16). Moreover, the lower efficacy of erythromycin ethylsuccinate may be explained by undetectable erythromycin base concentration at 12 h. Additional pharmacokinetic and efficacy studies should be conducted in patients to further examine these data.…”

“…Recent clinical trials suggest that erythromycin estolate is more effective than erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis (13,15), even at a lower dosage (16). To be active, the esters of erythromycin need to be hydrolyzed to erythromycin base (35).…”

Plasma Levels following Single and Repeated Doses of Erythromycin Estolate and Erythromycin Stearate

“…The dose of the suspension in Treatment 4 was selected on the basis of a recent recommendation that erythromycin suspension should be dosed at a level of 20 mg/ml/day for the treatment of streptococcal pharyngitis in children (20). Although this dosage is somewhat lower than that of the tablets and capsules, the dosage range was similar for a given individual.…”

Pharmacokinetic advantages of erythromycin estolate over ethylsuccinate as determined by high-pressure liquid chromatography

“…The pharmacokinetic data presented in this study reinforce the clinical advantages of erythromycin estolate over erythromycin ethylsuccinate. In fact, erythromycin estolate twice a day was clinically and bacteriogically more effective than ethylsuccinate in the treatment of strep-tococcal pharyngitis (13,15,16). Moreover, the lower efficacy of erythromycin ethylsuccinate may be explained by undetectable erythromycin base concentration at 12 h. Additional pharmacokinetic and efficacy studies should be conducted in patients to further examine these data.…”

“…Recent clinical trials suggest that erythromycin estolate is more effective than erythromycin ethylsuccinate in the treatment of streptococcal pharyngitis (13,15), even at a lower dosage (16). To be active, the esters of erythromycin need to be hydrolyzed to erythromycin base (35).…”

Plasma Levels following Single and Repeated Doses of Erythromycin Estolate and Erythromycin Stearate

“…The dose of the suspension in Treatment 4 was selected on the basis of a recent recommendation that erythromycin suspension should be dosed at a level of 20 mg/ml/day for the treatment of streptococcal pharyngitis in children (20). Although this dosage is somewhat lower than that of the tablets and capsules, the dosage range was similar for a given individual.…”