Erythromycin
| Evidence Level: L5 | Predicted Indications: 4 |
Table of Contents
Erythromycin: Punctate epithelial keratoconjunctivitis
One-Sentence Summary
Erythromycin is a macrolide antibiotic originally used for a range of bacterial infections, including respiratory, skin, genital and eye infections such as conjunctivitis. The TxGNN model predicts it may be effective for punctate epithelial keratoconjunctivitis, but there are currently no registered clinical trials and only 1 publication (a paediatric management review) supporting this direction.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Punctate epithelial keratoconjunctivitis |
| TxGNN Prediction Score | 0.9989 |
| Evidence Level | L5 |
| Australia Market Status | Listed on the PBS Schedule (1 of 1 items) – TGA (ARTG) registration status is not included in this data |
| Number of PBS Items | 1 (valid: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. Based on known information, erythromycin is a macrolide antibiotic with antibacterial activity (bacterial 50S ribosomal subunit inhibition) and anti-inflammatory and immunomodulatory effects. Its efficacy in bacterial eye infections such as conjunctivitis is established, and mechanistically it may be applicable to punctate epithelial keratoconjunctivitis.
Chronic blepharokeratoconjunctivitis with punctate epithelial keratopathy may respond to macrolide therapy by reducing bacterial load and controlling inflammation at the lid margin and meibomian glands. The link is indirect and rests on a single paediatric management review. It does not show that erythromycin works for this specific condition.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 11495307 | 2001 | Review | J Pediatr Ophthalmol Strabismus | Describes the history, symptoms and clinical signs of chronic blepharokeratoconjunctivitis in children and discusses its treatment. No erythromycin-specific efficacy data |
Australia Market Information
| ARTG Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| ARTG 10780J | Mayne Pharma Erythromycin | Capsule 250 mg (containing enteric coated pellets) | Not available in the data compiled for this report |
Safety Considerations
Based on knowledge graph contraindication links (not label text), erythromycin has been associated with caution or avoidance in:
- Cardiac rhythm: long QT syndrome (including familial), torsades de pointes
- Metabolic: porphyria (including inherited forms)
- Organ disease: kidney disease, liver disease, gallbladder disease, haematological disease
- Gastrointestinal: Clostridium difficile colitis, perinatal necrotising enterocolitis
- Skin: exfoliative dermatitis, dermatitis
- Neuromuscular: myasthenia gravis, neuromuscular junction disease
- Other: folic acid deficiency anaemia, hearing disorder, auditory system disease
Drug interactions: The data compiled for this report show 100 recorded interactions, of which 20 are listed. Major interactions include:
- Clarithromycin (Major)
- Loperamide (Major)
Moderate interactions include corticosteroids (hydrocortisone, dexamethasone, betamethasone, budesonide, triamcinolone), aprepitant, cimetidine, famotidine, pioglitazone, chlorpropamide and alosetron.
Please also refer to the TGA-approved Product Information (PI) for full safety information, as label warnings and contraindications were not available.
Conclusion and Next Steps
Decision: Hold
Rationale: The prediction score is high, but evidence is limited to model prediction and one indirect paediatric review, with no clinical trials. Erythromycin is already used for conjunctivitis, so any benefit may overlap with existing use.
To proceed, the following is needed:
- Mechanism of action data
- Australian approved indication text from the Product Information
- Label warnings and contraindications from the PI (a blocking gap for safety screening)
- Controlled clinical evidence for erythromycin in punctate epithelial keratoconjunctivitis
- Confirmation of route compatibility, since the only Australian product is an oral capsule and ocular use would usually need a topical formulation
- Review of other predictions: lymphogranuloma venereum is the strongest alternative candidate (review-level evidence, but close to existing anti-chlamydial use), while the other predictions have little or no support
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.