A 26-year-old woman in her second trimester of pregnancy receiving an oral macrolide for a respiratory infection develops right upper quadrant pain, dark urine, and a direct bilirubin of 4 mg/dL with normal ultrasound. Cholestatic hepatitis has been classically linked to which formulation?
- A Erythromycin base
- B Erythromycin estolate ✓
- C Azithromycin
- D Roxithromycin
Correct answer: B. Erythromycin estolate
Explanation
Erythromycin estolate is the ester formulation classically associated with reversible cholestatic hepatitis, occurring mainly in adults and particularly in pregnant women receiving it beyond the first trimester. The reaction is considered a hypersensitivity or toxic effect of the estolate moiety itself, and it usually resolves on stopping the drug. Other erythromycin salts cause far less hepatotoxicity, and azithromycin-associated cholestasis is rare. This association is the standard reason estolate is avoided in pregnancy in Indian teaching.
Reference: KD Tripathi's Essentials of Medical Pharmacology, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.