The difference between erythromycin and penicillin

Alternative names: Erythromycin; Fuaili; Xinhongkang;

Foreign names: Erythromycin, EM, EMU-V, Eryc, Ethryn, E-Mycin, Gluceptate, Ilotycin

Ingredients

Produced by Stretomyces erythreus, it is an alkaline antibiotic. The free base is for oral use and the lactobionic acid salt is for injection. In addition, its ethyl succinate (erythromycin ethyl succinate) and dodecyl sulfate of the propionate ester (erythromycin etonol) are available for medicinal use.

Characteristics

Erythromycin is white or off-white crystal or powder; odorless, bitter in taste; slightly hygroscopic. Easily soluble in methanol, ethanol or acetone, very slightly soluble in water.

Pharmacological effects

The antibacterial spectrum is similar to that of penicillin, and is effective against Gram-positive bacteria, such as Staphylococcus aureus, Streptococcus pyogenes, Streptococcus viridans, Streptococcus pneumoniae, Streptococcus faecalis, and Clostridium faecalis. Bacillus spp., Bacillus diphtheriae, etc. have strong inhibitory effects. It also has considerable inhibitory effects on Gram-negative bacteria, such as Neisseria gonorrhoeae, Helicobacter, Bordetella pertussis, Brucella, Legionella, Haemophilus influenzae, and Bacteroides. In addition, it has inhibitory effects on mycoplasma, actinomycetes, spirochetes, rickettsiae, chlamydia, nocardia, a few mycobacteria and amoeba. Staphylococcus aureus is easily resistant to this product.

Indications The antibacterial spectrum is similar to that of penicillin, and it has antibacterial effects against mycoplasma, chlamydia, rickettsiae, and Legionella. Suitable for mycoplasma pneumonia, neonatal conjunctivitis caused by Chlamydia trachomatis, infant pneumonia, genitourinary tract infections (including non-gonococcal urethritis), Legionnaires' disease, diphtheria (adjuvant treatment) and diphtheria carriers, skin and soft tissue infections, whooping cough, Long-term prevention of respiratory tract infections (including pneumonia), streptococcal angina, listeria infection, rheumatic fever and endocarditis caused by sensitive bacteria (influenza bacilli, pneumococci, hemolytic streptococci, staphylococci, etc.) , Campylobacter jejuni enteritis, as well as gonorrhea, syphilis, acne, etc.

Adverse reactions and precautions Gastrointestinal reactions include diarrhea, nausea, vomiting, gastric colic, mouth and tongue pain, anorexia, etc. The incidence is related to the dose. Allergic reactions manifest as drug fever, rash, eosinophilia, etc., with an incidence rate of 0.5 to 1%. Use with caution by pregnant and lactating women.

It must be noted: 1. Erythromycin is a bacteriostatic drug and should be administered at certain intervals to maintain the concentration of the drug in the body and facilitate its effect. 2. Erythromycin tablets should be swallowed whole. If the powder is taken, it will be destroyed by gastric acid and become less effective. Young children can take acid-stable esterified erythromycin. Staphylococcus aureus is easily resistant to this product. 3. Combined application with β-lactam drugs. It is generally believed that efficacy reduction may occur. 4. This product can block the enterohepatic circulation of sex hormones, and combined use with oral contraceptives can make them less effective. 5. Erythromycin will be destroyed and lose efficacy in acidic infusions and should generally not be combined with low pH glucose infusions. In 500ml of 5% to 10% glucose infusion, add vitamin C injection (1g sodium ascorbate) or 0.5ml of 5% sodium bicarbonate injection to raise the pH to about 6, then add erythromycin lactobionate. Helps stabilize.

Drug interactions

1. When β-lactam drugs are used in combination with this product, it is generally believed that a decrease in efficacy may occur. 2. This product can block the enterohepatic circulation of sex hormones, and combined use with oral contraceptives can make them less effective. 3. Erythromycin will be destroyed and lose efficacy in acidic infusions and should generally not be combined with low pH glucose infusions. In 500ml of 5-10 glucose infusion, add vitamin C injection (1g of ascorbic acid) or 0.5ml of 5-sodium bicarbonate injection to raise the pH to about 6, and add erythromycin lactose salt to help stabilize it.

Erythromycin

Erythromycin (Ilotycin, Erycin)

Function and use

This product is a macrolide antibiotic. The antibacterial spectrum is similar to that of penicillin, and it has strong antibacterial effects mainly against Gram-positive bacteria such as Staphylococcus aureus, hemolytic Streptococcus, pneumococcus, Bacillus diphtheriae, Bacillus anthracis and Clostridium difficile. It has certain effects on Gram-negative bacteria such as Neisseria meningitidis, Neisseria gonorrhoeae, Bacillus pertussis, Bacillus influenzae, Brucella, some Shigella dysenteriae and Escherichia coli. It is characterized by strains that are resistant to penicillin and are sensitive to this product. The main mechanism of action is to combine with the 50S subunit of the ribonucleosome, inhibit peptide acyltransferase, affect the translocation process of the ribonucleosome, hinder the growth of the peptide chain, inhibit bacterial protein synthesis, and is a bacteriostatic agent.

Clinically it is mainly used for penicillin-resistant Staphylococcus aureus infections and penicillin-allergic Staphylococcus aureus infections. It is also used for respiratory tract, Legionella pneumonia, mycoplasma pneumonia, skin and soft tissue infections caused by hemolytic streptococci and pneumococci. In addition, for patients with diphtheria, the combination of this product and diphtheria antitoxin has a significant effect.

Dosage and usage

Erythromycin tablets (enteric-coated tablets), taken orally, 1g to 2g/day for adults; 30mg to 50mg/kg for children daily, divided into 3 to 4 times . Erythromycin Lactobionate can be used for intravenous injection or intravenous infusion, 1g~2g/day for adults; 20mg~30mg/kg per day for children, divided into 2 to 3 times.

Side effects

1 Gastrointestinal reactions, including nausea, vomiting, abdominal pain and diarrhea, are related to the dose.

2 Allergic reactions may include urticaria and drug fever.

3 It can cause liver damage, such as increased serum alanine aminotransferase and jaundice.

4 Intravenous injection or intravenous infusion of erythromycin lactobionate can cause thrombophlebitis, and intravenous injection is more likely to occur. Intramuscular injection is highly irritating to the local area and can cause pain and induration, so intramuscular injection is not suitable.

Notes

1 This product is unstable in acid and can be destroyed by gastric acid, so it is necessary to take the acid-suppressing agent sodium bicarbonate at the same time. This can be avoided if taking enteric-coated tablets.

2 Erythromycin lactobionate should be dissolved in water for injection first. It must not be dissolved in physiological saline or other inorganic salt solutions, because inorganic ions can cause precipitation. After dissolving, it can be diluted with isotonic glucose injection or physiological saline for intravenous infusion. The concentration should not be greater than 0.1 to prevent thrombophlebitis.

3 When used together with sodium bicarbonate, a drug that alkalinizes urine, the antibacterial activity of this product in the urinary system increases with the increase in pH value.

4 This product has antagonistic effects with lincomycin and beta-lactam drugs, so combined use should be avoided.

5 Mixing erythromycin lactobionate with aminophylline, coenzyme A, cytochrome C, vancomycin, sulfadiazine sodium, penicillin, ampicillin sodium, cephalothin sodium and sodium bicarbonate may produce Turbidity, precipitation or loss of efficacy, so intravenous infusion at the same time is not advisable.

6 Erythromycin can inhibit the metabolism of warfarin and carbamazepine in the liver and enhance the effects or toxicity of the two drugs. Caution should be exercised when using these two drugs together. 7 Erythromycin can inhibit the metabolic clearance of theophylline and increase its blood concentration. This often occurs after several days of combined use. Attention should be paid to monitoring.

A representative antibiotic of the macrolide series produced by Streptomyces erythreus. Mainly antibacterial against Gram-positive bacteria. LD50 is 200-400 mg/kg. Its mechanism of action is to bind to bacterial polyribosomes and inhibit the extension of the peptide chain.

Penicillin refers to a class of antibiotics that contain penicillane in the molecule, which can destroy the cell wall of bacteria and play a bactericidal role during the reproduction period of bacterial cells.

Penicillin is also known as penicillin G, peillin G, penicillin, penicillin, penicillin sodium, benzylpenicillin sodium, penicillin potassium, and benzylpenicillin potassium.

Penicillin is a type of antibiotic. It refers to a molecule extracted from the culture medium of Penicillium that contains penicillane, which can destroy the cell wall of bacteria and play a bactericidal role during the reproduction period of bacterial cells. Antibiotics are the first antibiotics that can treat human diseases. Penicillin antibiotics are the general name for a large class of antibiotics in the β-lactam class. However, it cannot tolerate the enzymes produced by drug-resistant strains (such as drug-resistant Staphylococcus aureus) and is easily destroyed by them. Its antibacterial spectrum is narrow and it is mainly effective against Gram-positive bacteria. Penicillin G is divided into potassium salt and sodium salt. Not only can potassium salt not be directly injected intravenously, but the amount of potassium ions must be carefully calculated during intravenous infusion to avoid injecting it into the human body and causing hyperkalemia, which may inhibit heart function and cause death.

The toxicity of penicillin antibiotics is very low. Since β-lactams act on the cell wall of bacteria, and humans only have cell membranes without cell walls, they are less toxic to humans except for causing severe allergic reactions. , under normal dosage, its toxicity is not obvious. It is the antibiotic with the largest chemotherapy index. However, the most common allergic reactions to penicillin antibiotics rank first among various drugs, with an incidence rate of up to 5% to 10%. They are skin reactions, manifesting as rash, angioedema, and the most severe cases are anaphylactic shock, mostly after injection. It occurs within a few minutes. Symptoms include dyspnea, cyanosis, drop in blood pressure, coma, limb rigidity, and finally convulsions. Failure to rescue in time can cause death. Various routes of administration or preparations can cause anaphylactic shock, but injections have the highest incidence rate. The occurrence of allergic reactions has nothing to do with the dose of the drug. For those who are highly allergic to this product, even trace amounts can cause shock. Injection into the body can cause epileptiform seizures. Long-term injection of large doses is toxic to the central nervous system (such as causing convulsions, coma, etc.), and recovery can be achieved by stopping the drug or reducing the dose.

An intradermal test must be done before using this product. Penicillin allergy test includes skin test method (referred to as penicillin skin test) and in vitro test method, among which intradermal injection is more accurate. Skin testing itself also has certain risks. About 25% of patients who die from anaphylactic shock die from skin testing. Therefore, adequate rescue preparations should be made during skin testing or injection administration. When switching to a different batch of penicillin, the skin test also needs to be repeated. Injections and skin test solutions are unstable, so it is better to prepare them freshly. And for patients with renal excretion and poor renal function, the dosage should be adjusted appropriately. In addition, topical application has many chances of sensitization and bacteria can easily develop drug resistance, so it is not recommended.

English description

Penicillin (sometimes abbreviated PCN) refers to a group of beta-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. The name “penicillin” can also be used in reference to a specific member of the penicillin group Penam Skeleton, which has the molecular formula R-C9H11N2O4S, where R is a variable side chain.

Classification

According to their characteristics, they can be divided into:

Penicillin G: such as penicillin G potassium, penicillin G sodium, long-acting cillin, etc.

Penicillin V: (alias: phenoxymethylpenicillin, 6-phenoxyacetamidopenicillanic acid) such as penicillin V potassium (including multiple dosage forms).

Enzyme-resistant penicillins: such as oxacillin (Xinqing Ⅱ), cloxacillin, etc.

Broad-spectrum penicillins: such as ampicillin, ampicillin, etc.

Broad-spectrum penicillins against Pseudomonas aeruginosa: such as carbenicillin, oxypiperazine penicillin, and benzyl penicillin.

Azapicillin: such as mecillin and its ester mecillin, etc., which are characterized by being relatively enzyme-resistant and effective against certain negative bacilli (such as coli, Klebsiella and salmonella), but are not effective against green bacteria. Pseudomonas is less effective.

Features

Penicillin antibiotics are the general name for a large class of antibiotics among β-lactams. Because β-lactams act on the cell wall of bacteria, humans only have cell membranes and no cell walls. , so it is less toxic to humans. In addition to causing severe allergic reactions, its toxicity is not very obvious at normal dosages. However, it cannot tolerate the enzymes produced by drug-resistant strains (such as drug-resistant Staphylococcus aureus) and can easily It is destroyed by it, and its antibacterial spectrum is narrow, and it is mainly effective against Gram-positive bacteria. Penicillin G is divided into potassium salt and sodium salt. Not only can potassium salt not be directly injected intravenously, but the amount of potassium ions must be carefully calculated during intravenous infusion to avoid injecting it into the human body and causing hyperkalemia, which may inhibit heart function and cause death.

Penicillin antibiotics have very little toxicity and are the antibiotics with the largest chemotherapy index. However, the most common allergic reactions to penicillin antibiotics rank first among various drugs, with an incidence rate of up to 5% to 10%. They are skin reactions, manifesting as rash, angioedema, and the most severe cases are anaphylactic shock, mostly after injection. It occurs within a few minutes. Symptoms include dyspnea, cyanosis, drop in blood pressure, coma, limb rigidity, and finally convulsions. Failure to rescue in time can lead to death. Various routes of administration or preparations can cause anaphylactic shock, but injections have the highest incidence rate. The occurrence of allergic reactions has nothing to do with the dose of the drug. For those who are highly allergic to this product, even trace amounts can cause shock. Injection into the body can cause epileptiform seizures. Long-term injection of large doses is toxic to the central nervous system (such as causing convulsions, coma, etc.), and recovery can be achieved by stopping the drug or reducing the dose.