Studies of Prematures Given Erythromycin Estolate

Abstract

Erythromycin has been recommended for the treatment of staphylococcal and streptococcal infections in newborn infants even though few studies of its use in this age group have been reported. Fujii et al1 published serum levels for various doses of erythromycin in the full-term infant. No similar study has been reported for the premature infant. Reichelderfer et al2 noted no toxic reaction or accumulation of erythromycin in a study of 11 newborn infants of whom four were premature. He obtained serum levels on two of the prematures. Isenberg et al3 reported the recovery without toxic reactions of eight infected premature infants treated with erythromycin.Michael et al4,5 reported animal studies showing that chloramphenicol, penicillin, novobiocin, and tetracycline were more toxic for the newborn rat than the adult rat, while streptomycin was not. That the newborn infant may respond to drugs differently than the adult is amply demonstrated by reports

Pharmacokinetics of erythromycin ethylsuccinate and estolate in infants under 4 months of age

“…There have been only two previous studies of erythromycin pharmacokinetics in infants; one was with preterm neonates (1), and one was with older infants (7). From the data in these reports we calculated pharmacokinetic values by using the same methods that we applied to our data ( Table 2).…”

“…Erythromycin is recommended and used for treatment of chlamydial infections and pertussis in young infants. To our knowledge, the only previously reported pharmacokinetic data concerning this age group were from a study in which the estolate salt of erythromycin was given to preterm infants (1). Our study involved a pharmacokinetic evaluation in infants under 4 months of age of the two forms of erythromycin available in suspension, namely, the ethylsuccinate salt and the estolate salt.…”

Mycoplasmas and Ureaplasmas as Neonatal Pathogens

“…A comparison of 33 infants who received intravenous erythromycin for treatment of ureaplasmal infections with 176 matched infants who did not receive this drug showed no evidence of hearing abnormalities, elevated hepatic enzymes or bilirubin, or thrombophlebitis (317). An earlier study of 87 preterm infants (40) who received up to 14 days of oral erythromycin estolate (40 mg/kg/day) also found no evidence of toxicity. Erythromycin is now used much less often in older children and adults due to the availability of newer macrolides such as clarithromycin and azithromycin which allow more convenient once daily dosage and better tolerability.…”

Pharmacokinetics of Anti-Infective Agents in Paediatric Patients

“…McCracken et al (1978) found similar results for AVC of the estolate salt. In addition, Cmax values for the estolate were higher in children aged 3 to 48 months (McCracken et al 1978) than in premature neonates (Burns & Hodgman 1963). This is likely to be due to decreased V d in the older children.…”