Erythromycin and other
macrolides have enjoyed a renaissance in the 1970s, 1980s and 1990s secondary to the discovery of "new' pathogens such as Chlamydia, Legionella, Campylobacter and Mycoplasma spp.
Erythromycin is an important therapeutic agent in the paediatric age group for several reasons: (a) it exhibits proven efficacy for a wide range of
infections (upper and lower
respiratory tract infections, skin/skin structure
infections, prophylaxis of
endocarditis/
acute rheumatic fever/
ophthalmia neonatorum and pre-colonic surgery,
campylobacteriosis, chlamydial and ureaplasmal
infections,
diphtheria,
whooping cough, streptococcal
pharyngitis) and gastrointestinal (GI) dysmotility states; (b) intravenous formulations are widely available; and (c) it is available in a number of formulations as a generic product, which is likely to result in significant cost savings. Nevertheless,
erythromycin and similar earlier
macrolides are characterised by a number of drawbacks including a narrow spectrum of antimicrobial activity, unfavourable pharmacokinetic properties and poor GI tolerability. Newer
macrolides such as
clarithromycin and
azithromycin are useful in serving the needs of paediatric patients who are
erythromycin-intolerant or who have
infections caused by organisms that are intrinsically
erythromycin-resistant, or for which a high percentage of strains are resistant (e.g. Haemophilus influenzae, Helicobacter pylori, Mycobacterium avium complex). In addition, these newer
macrolides may be considered as alternatives to oral
amoxicillin-clavulanic acid, second or
third generation cephalosporins, or
erythromycin plus sulphonamide in this patient population. Selection between specific
macrolides and between
macrolides and other
antibiotics in the paediatric population is likely to depend, at least for the immediate future, on separate comparisons of product availability, cost, effectiveness and tolerability profiles.