Erythromycin is the first and most widely used macrolide antibiotic; it was discovered at a time when resistance of staphylococci to penicillin was first becoming a serious problem. It was at first used as a reserve antistaphylococcal agent or for streptococcal infections in patients allergic to penicillin, because there was a fear that resistance would have overtaken its antibacterial usefulness.

Erythromycin base is broken down in the acid conditions of the stomach and it is administered in the form of enteric-coated tablets. Alternatively, the stearate salt or esterified prodrugs are used for oral administration. Two ester formulations are in general use: the ethylsuccinate and the estolate. Erythromycin lactobionate and erythromycin gluceptate are available for intravenous use. Although the estolate is generally regarded as the most toxic formulation because of its propensity to cause reversible cholestatic jaundice, this uncommon complication can arise with any of the preparations. Erythromycin is liable to cause nausea and abdominal cramps and this has diminished its popularity.


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