A pregnant woman treated with an erythromycin preparation for chlamydial cervicitis develops pruritus, dark urine and jaundice in her third trimester. Imaging shows no stones. Which formulation most likely caused this presentation?

• A Erythromycin estolate tablets ✓
• B Erythromycin ethylsuccinate oral suspension
• C Erythromycin lactobionate intravenous infusion
• D Erythromycin base enteric-coated tablets

Explanation

The estolate ester of erythromycin produces a reversible cholestatic hepatitis, characteristically occurring in pregnant women receiving it for more than two weeks. Other erythromycin salts rarely cause this syndrome, which resolves on withdrawal of the drug. Pregnancy is the classic setting tested in examinations, so the estolate is avoided in pregnancy and replaced by safer alternatives such as azithromycin.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.