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Clinical Pediatrics
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Erythromycin-induced Drug Interactions

An Illustrative Case and Review of the Literature

Basil J. Zitelli

Schools of Medicine and Pharmacy, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Denise L. Howrie

Schools of Medicine and Pharmacy, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Harold Altman

Schools of Medicine and Pharmacy, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

Thomas J. Maroon

Schools of Medicine and Pharmacy, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

The authors report a case of erythromycin-induced carbamazepine toxicity in a 6-year-old child following use of erythromycin ethylsuccinate (50 mg/kg/day). Within 5 days of erythromycin use, vomiting, weakness, lethargy, ataxia, nystagmus, and cogwheeling movements developed. A serum carbamazepine concentration had increased from 11.9 mg/L (measured 1 week prior to antibiotic use) to 25.8 mg/L. Following erythromycin withdrawal, serum concentrations returned toward baseline, and symptoms resolved.

Erythromycin has known effects on hepatic enzyme function, with altered cytochrome P-450 function. The dramatic reduction in carbamazepine clearance observed in this patient is similar to that reported when erythromycin is used concurrently with other drugs. A brief review of potentially significant erythromycin drug interactions is presented.

Clinical Pediatrics, Vol. 26, No. 3, 117-119 (1987)
DOI: 10.1177/000992288702600302
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