Erythromycin and the newer macrolides

ABSTRACT

Recent macrolide development has been directed by clinical pharmacology dictates, ethical considerations, and patient concerns. Patient non-compliance, a major repercussion from erythromycin's side-effects, produces lost clientele, resistent bacterial strains, and escalating costs for the patient and healthcare system. Structural alteration of the macrolide molecule (after its macrocyclic lactone ring), has enhanced the antibacterial spectrum, pharmacokinetics, tissue penetration, and drug tolerance. New macrolide derivatives differ from the proto-type (erthromycin) in pharmacokinetic and dynamic profiles, and include roxithromycin, dirithromycin, clarithromycin, and azithromycin. Josamycin is less active than erythromycin. This review discusses the new macrolides widely used in the Caribbean, with reference to erythromycin (AU)