Erythromycin Estolate Induced Hepatotoxicity

Abstract

A case of erythromycin estolate induced hepatotoxicity is presented and 65 previous cases reported are reviewed. In spite of numerous reports of liver toxicity from erythromycin estolate, this potentially serious adverse drug reaction is not always recognized by the clinician. The frequency of signs and symptoms and a summary of the laboratory test abnormalities has been prepared to assist the clinician in the differential diagnosis of erythromycin estolate-induced liver disease. The most common clinical manifestations of erythromycin estolate-induced liver disease were severe abdominal pain, nausea and fever which preceded the development of jaundice in most cases. Eosinophilia was frequently present. It is important to consider erythromycin estolate as a potential cause of acute abdomen to avoid unnecessary and potentially dangerous diagnostic tests or surgery. When considering the use of erythromycin, the risk of intrahepatic cholestasis and/or abdominal pain should be weighed against any theoretical benefit to be derived from using the estolate salt.