Adverse effects of macrolide antibacterials.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing clinical reports and mechanistic characteristics without systematic review methodology
PubMed 8280403 · doi:10.2165/00002018-199309050-00004
What was done
This narrative review analyzed published clinical literature over a 40-year period evaluating the tolerability and adverse effects of macrolide antibacterials in adult and pediatric patients. It excluded drug interactions and compared older compounds (e.g., erythromycins, troleandomycin) with newer derivatives (e.g., roxithromycin, clarithromycin, dirithromycin, azithromycin, rokitamycin).
What was found
Gastrointestinal reactions occurred in 15% to 20% of patients on erythromycins compared to 5% or fewer on newer macrolides that rarely or never induce motilin release. Hepatotoxicity risk was low to absent for newer agents, but elevated for troleandomycin and high-dose, long-term erythromycins. Transient deafness and allergic reactions were reported more frequently with erythromycins. Among 51 case reports over 30 years detailing uncommon or dubious adverse effects with older compounds, 3 had an unfavorable outcome, all involving rapid or high-dose intravenous erythromycin lactobionate.
Why it matters
The review summarizes the improved safety and tolerability profile of newer generation macrolides relative to older erythromycin formulations, specifically regarding gastrointestinal distress and hepatotoxicity.
Limits
The review is narrative rather than systematic, lacking standardized study selection, data pooling, or risk of bias assessments. Drug interactions—a major clinical concern for macrolides—were excluded from the analysis. The abstract does not provide exact total sample sizes and is truncated.
Cited by
- supports Azithromycin is associated with liver and kidney damage and has negative interactions with approximately 62 other medications.