Erythromycin acts on protein synthesis at the ribosome and is active against streptococci, Corynebacterium diphtheriae, and most Staph. aureus. Most Gram-negative species are resistant. Mycoplasma species, Chlamydia species, and Legionella species are susceptible. Erythromycin is excreted by the liver and should be avoided in severe liver disease. It is used in the treatment of mycoplasmal and chlamydial pneumonia, legionnaires' disease, whooping cough, diphtheria, and Campylobacter infections. Nausea and vomiting are common adverse effects. Cholestatic jaudice (with estolate) and reversible ototoxicity are reported. Clarithromycin is more active against Hemophilus species. It is given twice daily and has good tissue penetration. It is used in respiratory tract infections and gastrointestinal symptoms are less common than with erythromycin.
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