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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Parrot fever
From Gale Encyclopedia of Medicine, 4/6/01 by Altha Roberts Edgren

Definition

Parrot fever is a rare infectious disease that causes pneumonia in humans. It is transmitted from pet birds or poultry. The illness is caused by a chlamydia, which is a type of intracellular parasite closely related to bacteria. Parrot fever is also called chlamydiosis, psittacosis or ornithosis.

Description

Parrot fever, which is referred to as avian psittacosis when it infects birds, is caused by Chlamydia psittaci. Pet birds in the parrot family, including parrots, parakeets, macaws, and cockatiels, are the most common carriers of the infection. Other birds that may also spread C. psittaci include pigeons, doves, mynah birds, and turkeys. Birds that are carrying the organism may appear healthy, but can shed it in their feces. The symptoms of avian psittacosis include inactivity, loss of appetite and ruffled feathers, diarrhea, runny eyes and nasal discharge, and green or yellow-green urine. Sick birds can be treated with antibiotics by a veterinarian.

C. psittaci is usually spread from birds to humans through exposure to infected bird feces during cage cleaning or by handling infected birds. In humans, parrot fever can range in severity from minor flu-like symptoms to severe and life-threatening pneumonia.

Causes & symptoms

Parrot fever is usually transmitted by inhaling dust from dried bird droppings or by handling infected birds. Humans can also spread the disease by person-to-person contact, but that is very rare. The symptoms usually develop within 5-14 days of exposure and include fever, headache, chills, loss of appetite, cough, and tiredness. In the most severe cases of parrot fever, the patient develops pneumonia. People who work in pet shops or who keep pet birds are the most likely to become infected.

Diagnosis

Only 100-200 cases of parrot fever are reported each year in the United States. It is possible, however, that the illness is more common since it is easily confused with other types of influenza or pneumonia. Doctors are most likely to consider a diagnosis of parrot fever if the patient has a recent history of exposure to birds. The diagnosis can be confirmed by blood tests for antibodies, usually complement fixation or immunofluorescence tests. The organism is difficult to culture. A chest x ray may also be used to diagnose the pneumonia caused by C. psittaci.

Treatment

Psittacosis is treated with an antibiotic, usually tetracycline (Achromycin, Sumycin); doxycycline (Doxy, Vibramycin); or erythromycin (Eryc, Ilotycin). Oral medication is typically prescribed for at least 10-14 days. Severely ill patients may be given intravenous antibiotics for the first few days of therapy.

Prognosis

The prognosis for recovery is excellent; with antibiotic treatment, more than 99% of patients with parrot fever will recover. Severe infections, however, may be fatal to the elderly, untreated persons, and persons with weak immune systems.

Prevention

As of 1998, there is no vaccine that is effective against parrot fever. Birds that are imported into the country as pets should be quarantined to ensure that they are not infected before they can be sold. Health authorities recommend that breeders and importers feed imported birds a special blend of feed mixed with antibiotics for 45 days to ensure that any C. psittaci organisms are destroyed. In addition, bird cages and food and water bowls should be cleaned daily.

Key Terms

Avian chlamydiosis
An illness in pet birds and poultry caused by . It is also known as parrot fever in birds.
An organism related to bacteria that infects some types of birds and can be transmitted to humans to cause parrot fever.
Chlamydiosis, psittacosis or ornithosis
Other names for parrot fever in humans.

Further Reading

For Your Information

    Books

  • "Psittacosis." In The Merck Manual of Diagnosis and Therapy, edited by Robert Berkow. Rahway, NJ: Merck Research Laboratories, 1992.

    Periodicals

  • "Compendium of Psittacosis (Chlamydiosis) Control, 1997." Morbidity & Mortality Weekly Report 46 (July 18, 1997): 1-13.
  • Gregory, D. W., and W. Schaffner. "Psittacosis." Seminars in Respiratory Infection 12, no. 1(March 1997): 7-11.
  • Huges, C., et al. "Possible nosocomial transmission of psittacosis." Infection Control Hospital Epidemiology 18, no. 3 (March 1997): 165-168.

    Organizations

  • U. S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia 30333. http://www.cdc.gov.

    Other

  • Psittacosis (Parrot Fever; Ornithosis). http://www.thriveonline.com.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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