Chemical structure of erythromycin.
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Eryc

Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma. It is also used to treat outbreaks of chlamydia, syphilis, and gonorrhea. Structurally, this macrocyclic compound contains a 14-membered lactone ring with ten asymmetric centers and two sugars (L-cladinose and D-desoamine), making it a compound very difficult to produce via synthetic methods. more...

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Erythromycin is produced from a strain of the actinomyces Saccaropolyspora erythraea, formerly known as Streptomyces erythraeus.

History

Abelardo Aguilar, a Filipino scientist, sent some soil samples to his employer Eli Lilly in 1949. Eli Lilly’s research team, led by J. M. McGuire, managed to isolate Erythromycin from the metabolic products of a strain of Streptomyces erythreus found in the samples. The product was subsequently launched in 1952 under the brand name Ilosone® (after the Philippine region of Iloilo where it was originally collected from). Erythromycin was formerly also called Ilotycin®. In 1981, Nobel laurate (1965 in chemistry) and Professor of Chemistry at Harvard University (Cambridge, MA) Robert B. Woodward and a large team of researchers reported the first stereocontrolled asymmetric chemical synthesis of Erythromycin A.

Available forms

Erythromycin is available in enteric-coated tablets, oral suspensions, opthalmic solutions, ointments, gels and injections.

Mechanism of action

Erythromycin prevents bacteria from growing, by interfering with their protein synthesis. Erythromycin binds to the subunit 50S of the bacterial ribosome, and thus inhibits the translation of peptides.

Pharmacokinetics

Erythromycin is easily inactivated by gastric acids, therefore all orally administered formulations are given as either enteric coated or as more stable salts or esters. Erythromycin is very rapidly absorbed, and diffused into most tissues and phagocytes. Due to the high concentration in phagocytes, erythromycin is actively transported to the site of infection, where during active phagocytosis, large concentrations of erythromycin are released.

Metabolism

Most of erythromycin is metabolised by demethylation in the liver. Its main elimination route is in the bile, and a small portion in the urine. Erythromycin's half-life is 1.5 hours.

Side-effects

Gastrointestinal intestinal disturbances such as diarrhea, nausea, abdominal pain and vomiting are fairly common so it tends not to be prescribed as a first-line drug. More serious side-effects, such as reversible deafness are rare. Allergic reactions, while uncommon, may occur, ranging from urticaria to anaphylaxis. Cholestatic jaundice, Stevens-Johnson syndrome and toxic epidermal necrolysis are some other rare side effects that may occur.

Erythromycin has been shown to increase the probability of pyloric stenosis in children whose mothers took the drug during the late stages of pregnancy or while nursing.

Contraindications

Earlier case reports on sudden death prompted a study on a large cohort that confirmed a link between erythromycin, ventricular tachycardia and sudden cardiac death in patients also taking drugs that prolong the metabolism of erythromycin (like verapamil or diltiazem) by interfering with CYP3A4 (Ray et al 2004). Hence, erythromycin should not be administered in patients using these drugs, or drugs that also prolong the QT time. Other examples include terfenadine (Seldane, Seldane-D), astemizole (Hismanal), cisapride (Propulsid, withdrawn in many countries for prolonging the QT time) and pimozide (Orap).

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Group Motion Dance Company, Group Motion Theatre, Philadelphia, December 9-12, 1993 - includes descriptions of performances by Leah Stein, December 15,
From Dance Magazine, 4/1/94 by Brenda Dixon

'Twas a cold winter's night in Philadelphia, but visions of joy to the world danced in the air at Movement Theatre International. To a packed house on a Wednesday opening night, Leja Dance Theatre presented its Christmas spectacle, Carols in Color. Described by coartistic director Leon Evans as Leja's answer to The Nutcracker, this rendition of the Nativity is total theater: Drama and music are equal partners with dance. A fine array of contemporary African-American gospel song styles is rendered by Imani, a female doo-wop quintet, and four young soloists whose a cappella work is simply astounding.

The choreography comes with the live voices and recorded music. Mary and Joseph's dances--poignantly performed by Gina Trignani and Evans--have vocal counterparts in the remarkable Carol Riddick and Kairi Styles. Throughout, a joyfully liturgical tone is maintained, aided by a reading of the story of Jesus's birth in the New Testament.

As inspired versions of ballet classics can revitalize that tradition, likewise Leja's dancing reinvigorates the standard African-American concert dance vocabulary. Both idioms are tall on technique, with tradition overshadowing innovation. Leja's choreography shows off the dancers, and their youthful virtuosity exudes passion, conviction, and humility.

Directors Evans and Jaye Allison succeeded in creating a site-specific piece, fully using the altar, balconies, and aisles of this former church. Audience composition reflected Leja's ability to bridge generational, cultural, and ethnic barriers and to satisfy a wide range of aesthetic persuasions. They merged sacred and secular, pop and concert genres with taste and grace.

Leja's performances, along with Pennsylvania Ballet's Nutcracker and Danceteller's Christmas Carol, were the closing offerings of Philadelphia's fall--winter season.

"Transit Dances," a September site-specific series spearheaded by the Philadelphia Dance Alliance, launched the season and involved most of the Philadelphia dance community. Occurring at public transportation locations throughout the city, the free events drew audiences (and, in some cases, performers) who were new to dance. In November, choreographers regrouped for the free public showcases produced for the National Performance Network's tenth annual meeting. "Dance for Life," a benefit presented on November 22 by the University of the Arts and the AIDS Task Force of Philadelphia, brought the community together again.

Changes were also afoot. Last spring Ann Vachon disbanded Dance Conduit after a decade of fighting the economic odds and Zeromoving's founding artistic director, Hellmut Gottschild, left the company to pursue independent solo work. His former partner, Karen Bamonte, reshaped the group and renamed it Amphora: Karen Bamonte and Dancers.

To combat the dollar crunch, already short "seasons" have been scaled down to two nights, instead of three or four. Some groups customarily avoid the money hassle by performing in studios. Group Motion Dance Company concerts have been held chiefly at the company's South Street studios for more than two decades.

Faithful to its 1960s roots, the company remains a choreographic collective. The present group is dominated by recent graduates from local B.F.A. programs who bring energy to the troupe even though they're still cutting their performance teeth. Artistic director Manfred Fischbeck's German modern dance influence shows up in the repertory.

Eryc Jelen's Auslander ("Foreigner"), the program opener, is fraught with recurring themes of manipulation. This and the second piece, Tal, a stunning solo choreographed and danced by Heidi Weiss, seem unfinished and are best regarded as exercises, rather than works in progress. The main problem to be solved in both is how to end--if not conclude--a dance.

Two duets were the most promising offerings on Group Motion's program. The first, IN ANG, choreographed and performed by Monica Favand and Laina Fischbeck, was a compelling use of body and stage space. Even though the compositional problem of how to end a dance recurred here, the piece offered a riveting image in its two totally veiled protagonists, one in black, the other in white. Remaining in place, they mirrored each other's movements, then claimed the stage as they moved out, circling each other, changing positions and reversing patterns as the score (by Front 242) intensified, with angular arms and jutting elbows punctuating the picture.

The second duet--Roots and Wings, choreographed and danced by Weiss and Niki Cousineau--works. It is a study in ecstasy, through repetition and intensification of movement, supported by a collage of Hindi and yoga devotional music. Similar to Weiss's solo movement style, the choreography alternates staccato statements with spates of sustained, sinuous movement. White light, the use of the dancers' shadows on the scrim, and a mystical aura are also carryovers from the solo.

These collective offerings by young choreographers have a long way to go in terms of seasoned choreography, but that is a given. What is significant, as with Leja Dance Theatre, is their efforts at connecting to and making sense of their world through the dance medium.

Seasoned sensemaking emerged from "Open Studio," a session at the Susan Hess Studio. This Wednesday night, weekly event evokes the ethos of the sixties New York City collective Grand Union: informality reigns. It serves as an impressive laboratory and a venue for works in progress. The final 1993 session featured Leah Stein and Steve Krieckhaus, two accomplished postmoderns, each in an untitled, improvised solo. They were intuitive, inventive, and enticing.

In her solo Stein carried with her a little of the Trio A Yvonne Rainer: she almost never faced the audience head on or made direct eye contact. It was a delightful surprise to see Krieckhaus move and, at moments, dance--in the old sense of the word--to Steve Tibbetts's guitar music in a fine half-hour solo. The set concluded with a contact-improvisation-based duet laced with stillnesses, silences, and pairings of body parts--hands, faces, chests.

More umbrella ventures are planned for the spring: the second annual Dance Now! series; the MTI Festival of Four Worlds; and the opening series of the Philadelphia Arts Bank, the first of the new Broad Street venues in a planned "Avenue of the Arts." The crunch is real, but the beat goes on.

COPYRIGHT 1994 Dance Magazine, Inc.
COPYRIGHT 2004 Gale Group

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