Erythromycin Ethylsuccinate Hepatotoxicity

David Sullivan, MD; Mary Ellen Csuka, MD; Bradford Blanchard, MD
JAMA. 1980;243(10):1074. doi:10.1001/jama.1980.03300360046027.
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ERYTHROMYCIN is available to the clinician in several forms, each of which differs primarily because of a single substitution at the two-prime position of the desoamine moiety. All commonly available forms can be associated with mild abdominal cramping, nausea and vomiting, diarrhea, and hypersensitivity reactions. Hepatotoxicity presenting dramatically with fever and abdominal pain suggesting an acute surgical abdomen has been associated only with the estolate form of the antibiotic. The following case illustrates a similar syndrome related to the ethylsuccinate preparations.1

Report of a Case  A 45-year-old woman was given erythromycin ethylsuccinate (EES-400), 400 mg orally four times daily, after two weeks of rhinitis and productive cough. On the ninth day of therapy, the patient had sudden onset of severe right upper quadrant pain, fever (temperature, 40 °C), shaking chills, nausea, and vomiting. Erythromycin administration was discontinued. As the acute symptoms lessened over the next 24 hours, dark urine


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