erythromycin-estolate and Jaundice

Using prescription-event monitoring to determine whether erythromycin estolate was a more frequent cause of jaundice than erythromycin stearate or tetracycline 12 208 patients, for whom 5343 doctors had prescribed one of the three drugs, were identified by the Prescription Pricing Authority. Of the questionnaires sent to general practitioners about the possible occurrence of jaundice, 76% were returned. There were 16 reports of jaundice, of which four were attributable to gall stones, three to cancer, six to viral hepatitis, and only three were possibly related to an antibiotic. All three patients, in whom the antibiotic was a possible cause, had been treated with erythromycin stearate. No case was attributable to the estolate which had previously been suspected of being a more frequent cause of jaundice. Although the incidence is unknown, it is very unlikely to be more than one in 100.

Topics: Adolescent; Adult; Aged; Erythromycin; Erythromycin Estolate; Female; Humans; Jaundice; Male; Middle Aged; Tetracycline

A combined cholestatic and hepatocellular injury occurred in nine patients, following therapy with erythromycin estolate (EE) or other erythromycin derivatives. Eight of the nine patients developed jaundice within three weeks after initiation of treatment; pain was one of the main symptoms in five patients while fever and itching were noted in four patients. Symptoms and signs subsided and abnormal tests of liver function returned to normal after withdrawal of the drug. The major histologic finding was cholestasis, but the majority of cases also had evidence of hepatocellular injury of variable severity; one biopsy specimen showed centrilobular necrosis. Ultrastructural findings in one case included changes related to cholestasis as well as hepatocellular injury with striking mitochondrial abnormalities. Our data are compared with those of the literature, with special reference to morphologic features.

Topics: Adolescent; Adult; Cholestasis; Drug Hypersensitivity; Erythromycin; Erythromycin Estolate; Female; Histocytochemistry; Humans; Jaundice; Liver; Male; Microscopy, Electron; Middle Aged; Mitochondria, Liver; Necrosis; Racial Groups; Time Factors

Topics: Erythromycin; Erythromycin Estolate; Humans; Jaundice

A 53-year-old housewife who had developed severe cholestatic hepatitis following the administration of erythromycin estolate therapy two-and-a-half years previously, was studied by an in vitro "challenge" test in which peripheral venous lymphocytes were cultured in the presence of erythromycin estolate, erythromycin stearate and erythromycin base. Evidence of blastogenesis was observed in response to erythromycin estolate, but not to erythromycin stearate of erythromycin base. This test thus provided evidence that the patient was "sensitized" to erythromycin estolate without exposing her to the risk of in vivo challenge. Furthermore, in contrast to previous studies, the findings provide evidence that erythromycin estolate jaundice is mediated by immunological mechanisms.

Topics: Drug Hypersensitivity; Erythromycin; Erythromycin Estolate; Female; Humans; Jaundice; Lymphocyte Activation; Middle Aged

A 43-year-old male developed abdominal pain and jaundice after the administration of erythromycin estolate. The diagnosis was strongly suspected on clinical grounds, but ultimate confirmation depends upon the demonstration of biochemical and morphological alterations after challenge with the drug.

Topics: Abdomen; Acute Disease; Adult; Bile Ducts; Biopsy, Needle; Endoplasmic Reticulum; Erythromycin; Erythromycin Estolate; Glycogen; Humans; Jaundice; Liver; Liver Function Tests; Male; Microscopy, Electron; Microscopy, Fluorescence; Pain; Pharyngitis; Recurrence

Topics: Alkaline Phosphatase; Bilirubin; Chemical and Drug Induced Liver Injury; Clinical Enzyme Tests; Drug Hypersensitivity; Erythromycin; Erythromycin Estolate; Hepatitis A; Jaundice; Liver Diseases; Liver Function Tests; Sodium Dodecyl Sulfate; Toxicology; Transaminases

Topics: Cholestasis, Intrahepatic; Erythromycin; Erythromycin Estolate; Jaundice; Jaundice, Obstructive; Toxicology

Topics: Erythromycin; Erythromycin Estolate; Humans; Jaundice; Jaundice, Obstructive

Topics: Abdominal Pain; Cholestasis, Intrahepatic; Drug Hypersensitivity; Erythromycin; Erythromycin Estolate; Humans; Jaundice

Topics: Erythromycin; Erythromycin Estolate; Humans; Jaundice; Sodium Dodecyl Sulfate