Erythromycin versus Azithromycin: which is the fittest substitute for Penicillin in allergic patients?

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Gabriel Gomes Vieira Ribeiro Leite
Carlos Américo Veiga Damasceno

Abstract

Objective: Since the usage of Penicillin in the early 20th century, limitations to its use such as allergy, began to demand alternatives, cause of life-threatening adverse reactions of Penicillin. Plus, the difficulty and cost to establish patient’s allergic profile and the discrepancy between test results and medical history add to this problem. In order to find a perfect substitute for Penicillin, many articles have reported the successful use of drugs of the macrolide class in treating infections for which Penicillin would normally be indicated as the first line but cannot be used due to allergy. Compiling recent publications, we compared Erythromycin and Azithromycin, as the most prominent macrolide agents which considering efficient against for broad range microbial spectrum beside determine which is the fittest to substitute Penicillin in allergic patients. We were compelled to conclude that although the drugs are fundamentally similar, Azithromycin not only presents better adverse reaction profile, but has proven to be superior in efficacy to Erythromycin in many infections where the substitute is needed, and also widens its appliance against to atypical infections, which are subject of promising for the further investigations.

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How to Cite
Leite, G. G. V. R., & Damasceno, C. A. V. (2022). Erythromycin versus Azithromycin: which is the fittest substitute for Penicillin in allergic patients?. Medical Science and Discovery, 9(3), 196–200. https://doi.org/10.36472/msd.v9i3.694
Section
Review Article
Received 2022-02-17
Accepted 2022-03-07
Published 2022-03-26

References

Pathak A, Nowell RW, Wilson CG, Ryan MJ, Barraclough TG. Comparative genomics of Alexander Fleming's original Penicillium isolate (IMI 15378) reveals sequence divergence of penicillin synthesis genes. Sci Rep. 2020 Sep 24;10(1):15705. DOI: https://doi.org/10.1038/s41598-020-72584-5

Brown LD, Zygmunt WA, Stavely HE. Some active derivatives of Penicillin. Appl Microbiol. 1969 Mar;17(3):339-43. DOI: https://doi.org/10.1128/am.17.3.339-343.1969

Goodman, L. S., Brunton, L. L., Chabner, B., & Knollmann, B. C. (2011). Goodman & Gilman's pharmacological basis of therapeutics. New York: McGraw-Hill.

Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and Management of Penicillin Allergy: A Review. JAMA. 2019 Jan 15;321(2):188-199. DOI: https://doi.org/10.1001/jama.2018.19283

Gonzalez-Estrada A, Radojicic C. Penicillin allergy: A practical guide for clinicians. Cleve Clin J Med. 2015 May;82(5):295-300. DOI: https://doi.org/10.3949/ccjm.82a.14111

Gopalakrishnan PP, Shukla SK, Tak T. Antibiotic prophylaxis and anaphylaxis. Clin Med Res. 2010 Jul;8(2):80-1. DOI: https://doi.org/10.3121/cmr.2010.929

Blumenthal KG, Li Y, Banerji A, Yun BJ, Long AA, Walensky RP. The Cost of Penicillin Allergy Evaluation. J Allergy Clin Immunol Pract. 2018 May-Jun;6(3):1019-1027.e2.

Janier M, Unemo M, Dupin N, Tiplica GS, Potočnik M, Patel R. 2020 European guideline on the management of syphilis. J Eur Acad Dermatol Venereol. 2021 Mar;35(3):574-588. DOI: https://doi.org/10.1111/jdv.16946

Leung AKC, Wong AHC, Hon KL. Community-Acquired Pneumonia in Children. Recent Pat Inflamm Allergy Drug Discov. 2018;12(2):136-144. DOI: https://doi.org/10.2174/1872213X12666180621163821

Fan H, Gilbert R, O'Callaghan F, Li L. Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort study. BMJ. 2020 Feb 19;368:m331. DOI: https://doi.org/10.1136/bmj.m331

Whitman MS, Tunkel AR. Azithromycin and clarithromycin: overview and comparison with erythromycin. Infect Control Hosp Epidemiol. 1992 Jun;13(6):357-68. DOI: https://doi.org/10.1086/646545

Kanatani MS, Guglielmo BJ. The new macrolides. Azithromycin and clarithromycin. West J Med. 1994 Jan;160(1):31-7.

Zuckerman JM, Kaye KM. The newer macrolides. Azithromycin and clarithromycin. Infect Dis Clin North Am. 1995 Sep;9(3):731-45. DOI: https://doi.org/10.1016/S0891-5520(20)30694-2

Blumenthal KG, Li Y, Banerji A, Yun BJ, Long AA, Walensky RP. The Cost of Penicillin Allergy Evaluation. J Allergy Clin Immunol Pract. 2018 May-Jun;6(3):1019-1027.e2. DOI: https://doi.org/10.1016/j.jaip.2017.08.006

Goodman, L. S., Brunton, L. L., Chabner, B., & Knollmann, B. C. (2013) Goodman & Gilman’s Manual of pharmacology and therapeutics, 2nd edition. New York: McGraw-Hill.

Stout JE, Arnold B, Yu VL. Activity of azithromycin, clarithromycin, roxithromycin, dirithromycin, quinupristin/dalfopristin and erythromycin against Legionella species by intracellular susceptibility testing in HL-60 cells. J Antimicrob Chemother. 1998 Feb;41(2):289-91. DOI: https://doi.org/10.1093/jac/41.2.289

Garcia-Vidal C, Sanchez-Rodriguez I, Simonetti AF, Burgos J, Viasus D, Martin MT, Falco V, Carratalà J. Levofloxacin versus azithromycin for treating legionella pneumonia: a propensity score analysis. Clin Microbiol Infect. 2017 Sep;23(9):653-658. DOI: https://doi.org/10.1016/j.cmi.2017.02.030

Karadag AS, Aslan Kayıran M, Wu CY, Chen W, Parish LC. Antibiotic resistance in acne: changes, consequences and concerns. J Eur Acad Dermatol Venereol. 2021 Jan;35(1):73-78. DOI: https://doi.org/10.1111/jdv.16686

Ladhani S, Garbash M. Staphylococcal skin infections in children: rational drug therapy recommendations. Paediatr Drugs. 2005;7(2):77-102. DOI: https://doi.org/10.2165/00148581-200507020-00002

Ausbeck EB, Jauk VC, Boggess KA, Saade GR, Longo S, Clark EAS, Esplin S, Cleary K, Wapner R, Letson K, Owens M, Abramovici A, Ambalavanan N, Szychowski JM, Andrews W, Tita ATN; Cesarean Section Optimal Antibiotic Prophylaxis Trial Consortium. Impact of Azithromycin-Based Extended-Spectrum Antibiotic Prophylaxis on Noninfectious Cesarean Wound Complications. Am J Perinatol. 2019 Jul;36(9):886-890. DOI: https://doi.org/10.1055/s-0039-1679914

Li Y, Jiang G. Azithromycin vs penicillin G benzathine for early syphilis: A meta-analysis of randomised controlled trials. Dermatol Ther. 2020 Nov;33(6):e14025. DOI: https://doi.org/10.1111/dth.14025

Sampaio RN, Lucas IC, Costa Filho AV. The use of azythromycin and N-methyl glucamine for the treatment of cutaneous Leishmaniasis caused by Leishmania (Leishmania) amazonensis in C57BL6 mice. An Bras Dermatol. 2009 Mar-Apr;84(2):125-8. English, Portuguese. DOI: https://doi.org/10.1590/S0365-05962009000200004

Torbahn G, Hofmann H, Rücker G, Bischoff K, Freitag MH, Dersch R, Fingerle V, Motschall E, Meerpohl JJ, Schmucker C. Efficacy and Safety of Antibiotic Therapy in Early Cutaneous Lyme Borreliosis: A Network Meta-analysis. JAMA Dermatol. 2018 Nov 1;154(11):1292-1303. DOI: https://doi.org/10.1001/jamadermatol.2018.3186

Karakonstantis S. Is coverage of S. aureus necessary in cellulitis/erysipelas? A literature review. Infection. 2020 Apr;48(2):183-191. DOI: https://doi.org/10.1007/s15010-019-01382-7

Caetano M, Amorin I. Erisipela [Erysipelas]. Acta Med Port. 2005 Sep-Oct;18(5):385-93. Portuguese. Epub 2005 Oct 16. PMID: 16611543.

Ferreira A, Bolland MJ, Thomas MG. Meta-analysis of randomised trials comparing a penicillin or cephalosporin with a macrolide or lincosamide in the treatment of cellulitis or erysipelas. Infection. 2016 Oct;44(5):607-15. DOI: https://doi.org/10.1007/s15010-016-0895-x

Dalal A, Eskin-Schwartz M, Mimouni D, Ray S, Days W, Hodak E, Leibovici L, Paul M. Interventions for the prevention of recurrent erysipelas and cellulitis. Cochrane Database Syst Rev. 2017 Jun 20;6(6):CD009758. DOI: https://doi.org/10.1002/14651858.CD009758.pub2

Poizeau F, Droitcourt C, Saillard C, Poirot M, Le Gallou T, Perlat A, Dupuy A. Dermo-hypodermite bactérienne « à bascule » chez un patient atteint d'hypogammaglobulinémie liée à l'X [Shifting cellulitis in a patient with X-linked hypogammaglobulinemia]. Ann Dermatol Venereol. 2016 Jun-Jul;143(6-7):453-6. French. DOI: https://doi.org/10.1016/j.annder.2016.03.006

Amsden GW. Erythromycin, clarithromycin, and azithromycin: are the differences real? Clin Ther. 1996 Jan-Feb;18(1):56-72; discussion 55. DOI: https://doi.org/10.1016/S0149-2918(96)80179-2

Cluver C, Novikova N, Eriksson DO, Bengtsson K, Lingman GK. Interventions for treating genital Chlamydia trachomatis infection in pregnancy. Cochrane Database Syst Rev. 2017 Sep 22;9(9):CD010485. DOI: https://doi.org/10.1002/14651858.CD010485.pub2

Adair CD, Gunter M, Stovall TG, McElroy G, Veille JC, Ernest JM. Chlamydia in pregnancy: a randomised trial of azithromycin and erythromycin. Obstet Gynecol. 1998 Feb;91(2):165-8. DOI: https://doi.org/10.1016/S0029-7844(97)00586-3

Dionne-Odom J, Subramaniam A, Aaron KJ, Geisler WM, Tita ATN, Marrazzo J. High rates of persistent and recurrent chlamydia in pregnant women after treatment with azithromycin. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100216. DOI: https://doi.org/10.1016/j.ajogmf.2020.100216

Dukers-Muijrers NHTM, Wolffs PFG, De Vries H, Götz HM, Heijman T, Bruisten S, Eppings L, Hogewoning A, Steenbakkers M, Lucchesi M, Schim van der Loeff MF, Hoebe CJPA. Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women: A Multicenter Observational Study (FemCure). Clin Infect Dis. 2019 Nov 13;69(11):1946-1954. DOI: https://doi.org/10.1093/cid/ciz050

Pitsouni E, Iavazzo C, Athanasiou S, Falagas ME. Single-dose azithromycin versus erythromycin or amoxicillin for Chlamydia trachomatis infection during pregnancy: a meta-analysis of randomised controlled trials. Int J Antimicrob Agents. 2007 Sep;30(3):213-21. DOI: https://doi.org/10.1016/j.ijantimicag.2007.04.015