From the Guidelines
Erythromycin and erythromycin succinate are essentially the same antibiotic, with the primary difference being their formulation, where erythromycin succinate is more soluble and potentially better absorbed orally. The key distinction between the two lies in their chemical structure and how this affects their administration and absorption. Erythromycin is the base form of the antibiotic, while erythromycin succinate is an ester salt formulation designed to enhance certain properties, such as solubility [no direct evidence provided in 1].
Key Differences
- Erythromycin succinate has improved water solubility, which is beneficial for intravenous administration and may lead to better oral absorption.
- Both forms of the antibiotic have the same antimicrobial spectrum and are used to treat infections caused by susceptible bacteria.
- The choice between erythromycin and erythromycin succinate often depends on the specific needs of the patient, the route of administration required, and the type of infection being treated.
Clinical Considerations
- While azithromycin and clarithromycin are noted to be as effective as erythromycin for certain treatments, such as pertussis, and are better tolerated with fewer side effects 1, the decision between erythromycin and its succinate form should consider factors like patient tolerance, the need for intravenous administration, and cost.
- Erythromycin, including its succinate form, can cause gastrointestinal side effects like nausea and diarrhea, though some patients may find the succinate form more tolerable.
- The consideration of drug interactions, particularly with erythromycin's potential to interact with other medications due to its effect on the cytochrome P450 enzyme system, is crucial in clinical decision-making 1.
From the Research
Difference between Erythromycin and Erythromycin Succinate
- Erythromycin and erythromycin succinate are two different forms of the antibiotic erythromycin.
- Erythromycin succinate is an ester prodrug of erythromycin, which means it is converted to erythromycin in the body 2.
- The main difference between the two is their bioavailability, with erythromycin succinate having lower bioavailability compared to erythromycin base 2.
Bioavailability and Pharmacokinetics
- Erythromycin ethylsuccinate, a form of erythromycin succinate, has been shown to have lower bioavailability compared to enteric-coated erythromycin base pellets 2.
- The lower bioavailability of erythromycin ethylsuccinate may be due to its instability in the acidic medium of the stomach 2.
Clinical Efficacy and Tolerability
- Both erythromycin and erythromycin succinate have been shown to be effective in the treatment of acute respiratory tract infections 3.
- However, erythromycin base may be less well tolerated than erythromycin succinate, with a higher frequency of gastrointestinal symptoms 3.
- A study comparing the gastrointestinal side effects of erythromycin PCE (particles-in-tablet) and erythromycin ethylsuccinate found no significant differences in the incidence of gastrointestinal side effects, but a higher incidence of moderate to severe nausea with erythromycin ethylsuccinate 4.