AbstractBackgroundEffective management of drug–food interactions is crucial for enhancing antibiotics’ efficacy/safety. Adhering to PRISMA guidelines, we conducted a systematic review to assess the impact of dietary interventions on the bioavailability of 15 macrolides and 10 tetracyclines.MethodsWe included studies examining the influence of food, beverages, antacids, and mineral supplements on the pharmacokinetic parameters of orally administered macrolides and tetracyclines. We searched Medline (via PubMed), Embase and Cochrane Library databases up to December 2022. Risk of bias was assessed using Cochrane and NIH tools. Quantitative analyses were conducted if two or more comparable food-effect studies were available; otherwise, a qualitative summary was provided.ResultsWe included 120 studies from 97 reports. Meta-analyses were conducted for 8 macrolides and 4 tetracyclines, with qualitative synthesis for 10 and 9, respectively. About 64% of the studies were open-label, crossover designs. Our assessment found that 37% of the studies had a high risk of bias, while only 6% had low risk. Food significantly affected 10 of 13 macrolides (77%) and 6 of 7 tetracyclines (86%). High positive effects on bioavailability were seen with extended-release azithromycin and clarithromycin, and erythromycin estolate. High negative impacts were observed with erythromycin propionate and stearate, azithromycin capsules, demeclocycline and omadacycline. Antacids and mineral supplements significantly decreased tetracyclines absorption. Milk and grapefruit juice showed variable impacts on absorption.DiscussionInteractions depend on antibiotics’ physicochemical characteristics, intervention type, drug formulation and potential patient factors. The quality of evidence was rated low due to outdated studies, methodological diversity and unequal data availability.

01 Aug 2021·Journal of Parenteral and Enteral NutritionQ2 · MEDICINE

Efficacy and Safety of Enteral Erythromycin Estolate in Combination With Intravenous Metoclopramide vs Intravenous Metoclopramide Monotherapy in Mechanically Ventilated Patients With Enteral Feeding Intolerance: A Randomized, Double‐Blind, Controlled Pilot Study

Q2 · MEDICINE

Article

Author: Pattharachayakul, Sutthiporn ; Navasakulpong, Asma ; Charoensareerat, Taniya ; Bhurayanontachai, Rungsun ; Boonpeng, Apinya ; Lerkiatbundit, Sanguan ; Sitaruno, Sirima

AbstractBackgroundIn this pilot study, we aimed to determine the efficacy and safety of enteral erythromycin estolate in combination with intravenous metoclopramide compared to intravenous metoclopramide monotherapy in mechanically ventilated patients with enteral feeding intolerance.MethodsThis randomized, double‐blind, controlled pilot study included 35 mechanically ventilated patients with feeding intolerance who were randomly assigned to receive 10‐mg metoclopramide intravenously every 6–8 hours in combination with 250‐mg enteral erythromycin estolate (study group) or placebo every 6 hours for 7 days. The primary outcome was an administered‐to‐target energy ratio of ≥80% at 48 hours, indicating a successful feeding. Secondary, prespecified outcomes were daily average gastric residual volume (GRV), total energy intake, administered‐to‐target energy ratio, hospital length of stay, in‐hospital mortality, and 28‐day mortality.ResultsThe rate of successful feeding was not significantly different between the study and placebo groups (47.1% and 61.1%, respectively; P = .51). The average daily GRV was significantly lower in the study group than in the placebo group (β = 91.58 [95% Wald CI, −164.35 to −18.8]), determined by generalized estimating equation. Other secondary outcomes were comparable, and the incidence of adverse events was not significantly different between the 2 groups. One common complication was cardiac arrhythmia, which was mostly self‐terminated.ConclusionAlthough the combination therapy of enteral erythromycin estolate and intravenous metoclopramide reduced GRV, the successful feeding rate and other patient‐specific outcomes did not improve in mechanically ventilated patients with feeding intolerance.

31 Dec 2020·VirulenceQ2 · BIOLOGY

Identification of FDA-approved antivirulence drugs targeting thePseudomonas aeruginosaquorum sensing effector protein PqsE

Q2 · BIOLOGY

ArticleOA

Author: D’Angelo, Francesca ; Visca, Paolo ; Pavoncello, Viola ; Rampioni, Giordano ; Fiscarelli, Ersilia Vita ; Leoni, Livia ; Baldelli, Valerio

The ability of the bacterial pathogen Pseudomonas aeruginosa to cause both chronic and acute infections mainly relies on its capacity to finely modulate the expression of virulence factors through a complex network of regulatory circuits, including the pqs quorum sensing (QS) system. While in most QS systems the signal molecule/receptor complexes act as global regulators that modulate the expression of QS-controlled genes, the main effector protein of the pqs system is PqsE. This protein is involved in the synthesis of the QS signal molecules 2-alkyl-4(1H)-quinolones (AQs), but it also modulates the expression of genes involved in virulence factors production and biofilm formation via AQ-independent pathway(s). P. aeruginosa pqsE mutants disclose attenuated virulence in plant and animal infection models, hence PqsE is considered a good target for the development of antivirulence drugs against P. aeruginosa. In this study, the negative regulation exerted by PqsE on its own transcription has been exploited to develop a screening system for the identification of PqsE inhibitors in a library of FDA-approved drugs. This led to the identification of nitrofurazone and erythromycin estolate, two antibiotic compounds that reduce the expression of PqsE-dependent virulence traits and biofilm formation in the model strain P. aeruginosa PAO1 at concentrations far below those affecting the bacterial growth rate. Notably, both drugs reduce the production of the PqsE-controlled virulence factor pyocyanin also in P. aeruginosa strains isolated from cystic fibrosis patients, and do not antagonize the activity of antibiotics commonly used to treat P. aeruginosa infection.

100 Deals associated with Erythromycin Estolate

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KEGG	Wiki	ATC	Drug Bank
D00851	Erythromycin Estolate	J01FA01 D10AF02 S01AA17	DBSALT001358

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Indication	Country/Location	Organization	Date
Bacterial Infections	CN	Huangshi Huangkang Pharmaceutical Co. Ltd.	01 Jan 1981

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