Adverse Effects

The incidence of side effects associated with erythro-mycin therapy is very low. Mild gastrointestinal upset with nausea, diarrhea, and abdominal pain are reported to occur more commonly when the propionate and es-tolate salts are used. Rashes are seen infrequently but may be a part of a general hypersensitivity reaction that includes fever and eosinophilia. Thrombophlebitis may follow intravenous administration, as may transient impairment of hearing.

Cholestatic hepatitis may occur when drug therapy lasts longer than 10 days or repeated courses are prescribed. The hepatitis is characterized by fever, enlarged and tender liver, hyperbilirubinemia, dark urine, eosinophilia, elevated serum bilirubin, and elevated transaminase 1evels. Hepatitis has been associated with the estolate salt of erythromycin but not with other formulations. Although the hepatitis usually occurs 10 to 20 days after the initiation of therapy, it can occur within hours in a patient who has had such a reaction in the past. The hepatitis is believed to be the result of both a hepatotoxic effect and a hypersensitivity reaction; this latter effect is reversible on withdrawal of the drug. Erythromycin and derivatives induce hepatic mi-crosomal enzymes and interfere with the actions of various drugs, including theophylline and carbamazepine.

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