WEBVTT 00:00:00.000 --> 00:00:02.480 Think for a moment about infections. I mean, 00:00:02.779 --> 00:00:06.040 today we often just pop a pill and expect to 00:00:06.040 --> 00:00:08.619 get better. Yeah, it feels almost routine sometimes. 00:00:08.839 --> 00:00:10.939 But it wasn't always that simple, was it? And 00:00:10.939 --> 00:00:14.539 even now, this whole issue of increasing antibiotic 00:00:14.539 --> 00:00:17.420 resistance, it's something health organizations 00:00:17.420 --> 00:00:20.280 keep warning us about. Definitely. It really 00:00:20.280 --> 00:00:22.379 highlights how crucial these medications are, 00:00:22.559 --> 00:00:25.500 a precious resource. Exactly. It makes you wonder 00:00:25.500 --> 00:00:29.649 about the stories behind these drugs. So today, 00:00:29.750 --> 00:00:32.429 we're taking a deep dive into one of the real 00:00:32.429 --> 00:00:36.750 workhorses in the fight against bacteria, erythromycin. 00:00:36.890 --> 00:00:39.950 Ah, erythromycin, yeah. It's got quite a history, 00:00:39.990 --> 00:00:43.509 but it's still incredibly relevant. Right. So 00:00:43.509 --> 00:00:45.509 that's our plan for you today. Absolutely. And 00:00:45.509 --> 00:00:47.649 this isn't just like a dusty history lesson. 00:00:47.950 --> 00:00:50.450 It's really about understanding a molecule that 00:00:50.450 --> 00:00:52.649 still impacts how we treat illness every day. 00:00:52.789 --> 00:00:54.700 So what have we looked at? We've gathered a whole 00:00:54.700 --> 00:00:56.899 range of sources to really unpack erythromycin 00:00:56.899 --> 00:00:59.820 for you, where it came from, how we use it, the 00:00:59.820 --> 00:01:01.820 really quite fascinating process of making it. 00:01:01.880 --> 00:01:04.060 The manufacturing side, yeah. The rules that 00:01:04.060 --> 00:01:06.840 govern it, its economic weight, and even its 00:01:06.840 --> 00:01:09.719 broader impact on society and culture. OK. And 00:01:09.719 --> 00:01:12.459 the mission. As always. The mission is to give 00:01:12.459 --> 00:01:15.459 you a really solid understanding of this essential 00:01:15.459 --> 00:01:18.579 medicine, pulling out the most important bits 00:01:18.579 --> 00:01:21.180 without getting bogged down in, you know, excessive 00:01:21.180 --> 00:01:24.879 detail. Make you feel well informed fast. Perfect. 00:01:25.180 --> 00:01:27.599 OK, let's dive in then. It's it's almost hard 00:01:27.599 --> 00:01:29.920 to imagine a world without antibiotics now. It 00:01:29.920 --> 00:01:32.219 really is. Simple infections could be deadly. 00:01:32.420 --> 00:01:35.920 So into that world comes erythromycin. What exactly 00:01:35.920 --> 00:01:38.480 is it? How does it actually work against bacteria? 00:01:38.780 --> 00:01:41.599 Okay, so erythromycin belongs to a class of antibiotics 00:01:41.599 --> 00:01:44.340 called macrolides. And the way it works is, well, 00:01:44.439 --> 00:01:47.200 pretty clever. It specifically targets the bacteria. 00:01:47.540 --> 00:01:49.900 How so? Think of a bacterial cell like a tiny 00:01:49.900 --> 00:01:52.739 factory, okay? It's constantly building proteins 00:01:52.739 --> 00:01:57.239 that it needs to survive and multiply. Right, 00:01:57.500 --> 00:01:59.680 essential building blocks. Exactly. Yeah. Erythromycin 00:01:59.680 --> 00:02:01.560 essentially jams the assembly line in that factory. 00:02:01.739 --> 00:02:03.659 It binds to a really crucial part called the 00:02:03.659 --> 00:02:06.829 50S ribosomal subunit. The 50S subunit. Yeah. 00:02:06.849 --> 00:02:09.590 And by latching onto that, it stops the bacteria 00:02:09.590 --> 00:02:12.050 from making those vital proteins. But importantly, 00:02:12.129 --> 00:02:14.669 it doesn't mess with the bacteria's DNA or anything 00:02:14.669 --> 00:02:17.750 like that. Ah, OK. So it stops protein production 00:02:17.750 --> 00:02:20.009 specifically. And that's how it can tackle a 00:02:20.009 --> 00:02:22.069 whole bunch of different bacterial invaders. 00:02:22.289 --> 00:02:24.430 That's the broad spectrum part, right? Provisely. 00:02:24.490 --> 00:02:28.590 Yeah. If you look at the official FDA label for 00:02:28.590 --> 00:02:32.530 one form, erythromycin ethylsuccine, it lists 00:02:32.530 --> 00:02:34.770 quite a range of bacteria it's effective against. 00:02:34.969 --> 00:02:37.620 Like what? Any familiar names? Oh, definitely. 00:02:38.060 --> 00:02:40.599 It includes gram -positive bacteria like Streptococcus 00:02:40.599 --> 00:02:42.560 pyogenesus, the one usually behind strep throat. 00:02:42.599 --> 00:02:44.500 Right, strep throat, okay. And Streptococcus 00:02:44.500 --> 00:02:46.819 pneumonia, which is a really common cause of 00:02:46.819 --> 00:02:49.349 pneumonia. And does it work on other types, too? 00:02:49.409 --> 00:02:51.710 Gram -negative. It does, yes. It shows activity 00:02:51.710 --> 00:02:54.289 against certain gram -negative bacteria as well. 00:02:55.189 --> 00:02:57.110 Morexella catarallis, for instance, that often 00:02:57.110 --> 00:03:00.629 pops up in respiratory infections. And also haemophilus 00:03:00.629 --> 00:03:03.129 influenza, another common cause of those infections, 00:03:03.530 --> 00:03:06.270 especially when erythromycin is used alongside 00:03:06.270 --> 00:03:09.530 sulfonamide medications. The label also mentions 00:03:09.530 --> 00:03:12.610 its use for listeriosis, which is caused by listeria 00:03:12.610 --> 00:03:16.789 monocytogenes. Wow. OK, so. From a simple sore 00:03:16.789 --> 00:03:19.530 throat to potentially really serious stuff like 00:03:19.530 --> 00:03:22.449 pneumonia and listeriosis, that's quite a range. 00:03:22.550 --> 00:03:25.270 It really is, and there's more. Erythromycin 00:03:25.270 --> 00:03:27.889 in an eye ointment form is actually critical 00:03:27.889 --> 00:03:31.389 for preventing neonatal conjunctivitis. In newborns? 00:03:31.569 --> 00:03:34.449 Yes, specifically the type caused by Neisseria 00:03:34.449 --> 00:03:37.729 gonorrhea. It's a standard, really important 00:03:37.729 --> 00:03:40.840 preventative measure right after birth. I didn't 00:03:40.840 --> 00:03:43.000 know about that specific use. Are there other 00:03:43.000 --> 00:03:45.500 maybe less obvious applications, things we wouldn't 00:03:45.500 --> 00:03:47.939 normally think of for an antibiotic? Well, interestingly, 00:03:48.280 --> 00:03:51.159 yes. Erythromycin has a known side effect. It 00:03:51.159 --> 00:03:54.180 actually speeds up gut movement, motility. Oh, 00:03:54.180 --> 00:03:57.340 really? Yeah. So because of that, it's sometimes 00:03:57.340 --> 00:04:00.259 used off -label to treat gastroparesis. That's 00:04:00.259 --> 00:04:02.139 a condition where the stomach empties really 00:04:02.139 --> 00:04:04.810 slowly. Okay. And it can even be given intravenously, 00:04:04.969 --> 00:04:07.469 sometimes during an endoscopy, just to help clear 00:04:07.469 --> 00:04:09.349 out the stomach contents so the doctor can get 00:04:09.349 --> 00:04:11.449 a better look. That is interesting. So, okay, 00:04:11.550 --> 00:04:14.389 we take the pill, or get the ointment, or maybe 00:04:14.389 --> 00:04:17.730 the IV. What happens then? How does our body 00:04:17.730 --> 00:04:20.529 actually handle it? Where does it go? Well, what's 00:04:20.529 --> 00:04:23.029 quite notable is that very little of it, less 00:04:23.029 --> 00:04:26.750 than 5 % of an oral dose, actually gets excreted 00:04:26.750 --> 00:04:29.709 in its active form through urine. Oh. So where 00:04:29.709 --> 00:04:32.389 does it go? It actually spreads quite readily 00:04:32.389 --> 00:04:36.230 into most body fluids, tissues, you know. However, 00:04:36.230 --> 00:04:38.149 it doesn't tend to build up high concentrations 00:04:38.149 --> 00:04:40.589 in the spinal fluid. Around the brain. Exactly. 00:04:41.069 --> 00:04:43.490 Unless there's an active infection like meningitis, 00:04:44.009 --> 00:04:46.129 then the levels can be higher. But generally, 00:04:46.290 --> 00:04:48.649 the drug tends to concentrate in the liver. Ah, 00:04:48.670 --> 00:04:50.509 the liver. Makes sense. Yeah, the liver is where 00:04:50.509 --> 00:04:52.189 it's mainly broken down, and then it's excreted 00:04:52.189 --> 00:04:54.629 into the bile. It can also cross the placenta, 00:04:54.750 --> 00:04:56.129 getting to the fetus, although the levels are 00:04:56.129 --> 00:04:59.129 usually low. And it does pass into breast milk, 00:04:59.230 --> 00:05:01.319 too. OK, so the liver is the main processing 00:05:01.319 --> 00:05:03.740 plant. Got it. Now, how do we actually get this 00:05:03.740 --> 00:05:05.939 stuff? How is it manufactured? You said it wasn't 00:05:05.939 --> 00:05:08.540 just synthesized chemically. Right. Unlike a 00:05:08.540 --> 00:05:10.459 lot of drugs that are built from chemical blocks 00:05:10.459 --> 00:05:15.220 in a lab, erythromycin is produced through fermentation. 00:05:15.600 --> 00:05:18.279 It's a biological process. Fermentation. Like 00:05:18.279 --> 00:05:21.410 yeast for bread. Sort of. Yeah, it involves using 00:05:21.410 --> 00:05:24.370 a specific microorganism, a bacterium called 00:05:24.370 --> 00:05:27.529 Saccharopolispera erythraea. You basically cultivate 00:05:27.529 --> 00:05:29.389 this microbe under controlled conditions. And 00:05:29.389 --> 00:05:32.089 it just produces erythromycin. It does. Think 00:05:32.089 --> 00:05:34.490 of it like the microbe eating nutrients and transforming 00:05:34.490 --> 00:05:36.810 them into the drug. That's the fermentation. 00:05:36.949 --> 00:05:39.149 So it's a natural product, harnessed from medicine. 00:05:39.329 --> 00:05:41.629 Exactly. And of course, researchers are always 00:05:41.629 --> 00:05:43.610 looking for ways to make this whole process more 00:05:43.610 --> 00:05:45.370 efficient, more cost effective. How do they do 00:05:45.370 --> 00:05:50.259 that? Well, studies have looked at using agricultural 00:05:50.259 --> 00:05:52.660 byproducts, things like beet molasses or corn 00:05:52.660 --> 00:05:55.959 -steeped liquor, as cheaper food sources for 00:05:55.959 --> 00:05:58.560 the bacteria in these big tanks called bioreactors. 00:05:58.579 --> 00:06:00.819 Okay. And they fine -tune things like how fast 00:06:00.819 --> 00:06:03.360 you stir the mixture, the exact nutrient recipe. 00:06:03.759 --> 00:06:06.180 All these factors can significantly affect the 00:06:06.180 --> 00:06:08.220 yield, you know, how much erythromycin you get 00:06:08.220 --> 00:06:10.819 out at the end. And when we get it from the pharmacy, 00:06:10.980 --> 00:06:13.019 it's not always the same form, is it? Correct. 00:06:13.040 --> 00:06:15.000 It comes in various formulations depending on 00:06:15.000 --> 00:06:17.360 how it needs to be used. You've got capsules. 00:06:17.500 --> 00:06:19.639 which usually contain the erythromycin base. 00:06:19.759 --> 00:06:22.000 Right. Then there's the liquid oral suspension, 00:06:22.439 --> 00:06:24.319 often as the ethyl succinate salt that's common 00:06:24.319 --> 00:06:26.579 for kids. And then there's a powder form that 00:06:26.579 --> 00:06:30.279 gets mixed with liquid for injections, typically 00:06:30.279 --> 00:06:32.720 the lactobionate form. Different forms for different 00:06:32.720 --> 00:06:35.560 needs. Makes sense. Yeah, like looking at info 00:06:35.560 --> 00:06:38.279 from places like Perth Children's Hospital, they 00:06:38.279 --> 00:06:41.279 list things like 250 milligram base capsules 00:06:41.279 --> 00:06:43.939 and a one gram powder for injection using the 00:06:43.939 --> 00:06:45.759 lactobionate. It just shows the variety available. 00:06:45.920 --> 00:06:49.120 OK, so from a tiny microbe in a giant tank to 00:06:49.120 --> 00:06:52.160 the pills and liquids on the shelf, quite a process. 00:06:52.680 --> 00:06:55.209 Now, speaking of the pharmacy shelf. How does 00:06:55.209 --> 00:06:57.689 a drug like this even get approved? What's the 00:06:57.689 --> 00:07:00.209 regulatory side look like? Yeah, the regulatory 00:07:00.209 --> 00:07:02.889 landscape. That's absolutely crucial for ensuring 00:07:02.889 --> 00:07:07.569 safety and effectiveness. In the U .S., the main 00:07:07.569 --> 00:07:09.649 player is the Food and Drug Administration, the 00:07:09.649 --> 00:07:12.230 FDA. For a brand new drug, the company submits 00:07:12.230 --> 00:07:15.089 what's called a new drug application, or NDA. 00:07:15.810 --> 00:07:18.430 Aeriped, for example, which is erythromycin ethyl 00:07:18.430 --> 00:07:22.430 succinate, got approved under NDA 050207. OK, 00:07:22.430 --> 00:07:24.860 that's the brand name. What about generics? For 00:07:24.860 --> 00:07:27.459 generics... Companies usually file an abbreviated 00:07:27.459 --> 00:07:30.800 new drug application, an ANDA. We saw a reference, 00:07:30.860 --> 00:07:35.519 for instance, to ANDA 062055 for a generic version 00:07:35.519 --> 00:07:37.740 of that same ethyl succinate form. And that's 00:07:37.740 --> 00:07:39.819 where this idea of reference listed drugs comes 00:07:39.819 --> 00:07:42.800 in, RLDs. Exactly. So if you want to market a 00:07:42.800 --> 00:07:45.720 generic, you have to show the FDA that your version 00:07:45.720 --> 00:07:48.300 is bioequivalent to the original brand name drug, 00:07:48.420 --> 00:07:51.040 the RLD. Bioequivalent meaning? Meaning it gets 00:07:51.040 --> 00:07:52.920 absorbed into the bloodstream at the same rate 00:07:52.920 --> 00:07:55.160 and to the same extent. So it performs the same 00:07:55.160 --> 00:07:57.259 way in the body. Ariepad, in this case, would 00:07:57.259 --> 00:07:59.399 be the RLD that generics are compared against. 00:07:59.540 --> 00:08:01.899 And the FDA checks this thoroughly. Oh, absolutely. 00:08:02.000 --> 00:08:04.439 They scrutinize the generic applications to make 00:08:04.439 --> 00:08:06.339 sure they meet the same high standards. This 00:08:06.339 --> 00:08:08.579 usually involves lab tests, like dissolution 00:08:08.579 --> 00:08:10.839 testing, how quickly the pill dissolves, and 00:08:10.839 --> 00:08:13.600 also bioequivalent studies in healthy volunteers, 00:08:14.040 --> 00:08:16.800 often done under fasting conditions, to directly 00:08:16.800 --> 00:08:19.540 compare absorption. Sounds rigorous. And what 00:08:19.540 --> 00:08:21.639 about the actual factories? The places making 00:08:21.639 --> 00:08:24.209 the drug. Are there rules for them, too? Definitely. 00:08:24.970 --> 00:08:26.970 Making sure the manufacturing process itself 00:08:26.970 --> 00:08:29.389 is up to snuff is just as important. That's where 00:08:29.389 --> 00:08:31.990 good manufacturing practice or GMP comes in. 00:08:32.169 --> 00:08:35.250 GMP, okay. It's a whole set of guidelines that 00:08:35.250 --> 00:08:38.090 pharmaceutical manufacturers must follow. The 00:08:38.090 --> 00:08:40.750 FDA provides really detailed guidance on GMP 00:08:40.750 --> 00:08:43.549 for the active pharmaceutical ingredients, the 00:08:43.549 --> 00:08:46.399 APIs, that's the raw drug substance itself. What 00:08:46.399 --> 00:08:48.980 sort of things do GMP rules cover? Oh, everything. 00:08:49.259 --> 00:08:50.799 From the cleanliness of the buildings and the 00:08:50.799 --> 00:08:53.399 equipment, to meticulous record keeping for every 00:08:53.399 --> 00:08:55.879 step, and rigorous quality control testing. Within 00:08:55.879 --> 00:08:57.960 the company, there's usually a dedicated quality 00:08:57.960 --> 00:09:00.759 unit that has the final say. They approve or 00:09:00.759 --> 00:09:03.259 reject all the raw API before it can even be 00:09:03.259 --> 00:09:05.080 used. Right. Checks and balances all the way. 00:09:05.679 --> 00:09:07.779 So once a drug is approved and out there being 00:09:07.779 --> 00:09:11.159 used, does the oversight stop? Not at all. No, 00:09:11.340 --> 00:09:14.019 there's ongoing monitoring. For example, in Europe, 00:09:14.539 --> 00:09:16.279 companies holding the marketing authorization 00:09:16.279 --> 00:09:19.080 for erythromycin products say topical creams 00:09:19.080 --> 00:09:21.919 have to submit periodic safety update reports, 00:09:22.279 --> 00:09:25.039 PSERs, to the European Medicines Agency, the 00:09:25.039 --> 00:09:28.379 EMA. PSURs, what are those? They basically summarize 00:09:28.379 --> 00:09:30.860 all the safety data that's been collected since 00:09:30.860 --> 00:09:33.220 the drug was first approved, or since the last 00:09:33.220 --> 00:09:36.240 report. It helps regulators track the drug's 00:09:36.240 --> 00:09:38.659 safety profile in the real world with lots of 00:09:38.659 --> 00:09:40.950 patients using it. So it's continuous. monitoring. 00:09:41.210 --> 00:09:44.370 Yes, and even established manufacturers might 00:09:44.370 --> 00:09:47.529 need approvals for changes. We saw mention of 00:09:47.529 --> 00:09:50.409 ANI pharmaceuticals submitting a supplement to 00:09:50.409 --> 00:09:53.299 their ANDA for erythromycinethylsuccinate. What 00:09:53.299 --> 00:09:55.279 would that be for? It likely means they made 00:09:55.279 --> 00:09:57.519 some change, maybe to the manufacturing process 00:09:57.519 --> 00:10:00.639 or packaging or the testing facility. Any significant 00:10:00.639 --> 00:10:02.639 change like that needs regulatory review and 00:10:02.639 --> 00:10:04.740 approval, including making sure the drug remains 00:10:04.740 --> 00:10:07.139 stable with the change. It really is a constant 00:10:07.139 --> 00:10:09.259 cycle of oversight, isn't it? Ensuring these 00:10:09.259 --> 00:10:12.580 medicines stay safe and effective. OK, let's 00:10:12.580 --> 00:10:14.639 shift gears a bit now. Think bigger picture. 00:10:15.299 --> 00:10:17.820 What kind of economic impact are we talking about 00:10:17.820 --> 00:10:21.360 with a drug like erythromycin? Is it significant 00:10:21.360 --> 00:10:23.799 globally? Oh, it's substantial. Yeah. You see 00:10:23.799 --> 00:10:27.000 market analysis firms regularly putting out reports 00:10:27.000 --> 00:10:29.500 sizing up the global erythromycin market. Really? 00:10:29.980 --> 00:10:32.200 Yeah. They often break it down by the different 00:10:32.200 --> 00:10:36.200 dosage forms, tablets, liquids, and also by application, 00:10:36.419 --> 00:10:38.539 like whether it's used in humans or for veterinary 00:10:38.539 --> 00:10:41.700 purposes. These reports also identify the key 00:10:41.700 --> 00:10:43.700 companies involved in making and selling it. 00:10:43.860 --> 00:10:45.779 Can you give us a sense of scale? Are we talking? 00:10:46.809 --> 00:10:49.909 Millions, billions. While the exact figures shift 00:10:49.909 --> 00:10:52.490 year to year, the fact that specialized firms 00:10:52.490 --> 00:10:54.950 invest in analyzing this market tells you it's 00:10:54.950 --> 00:10:56.789 significant. We're definitely talking about a 00:10:56.789 --> 00:10:59.190 multi -billion dollar global industry when you 00:10:59.190 --> 00:11:01.710 consider everything, manufacturers, raw material 00:11:01.710 --> 00:11:05.110 suppliers, distributors worldwide, and you see 00:11:05.110 --> 00:11:07.809 signs of its ongoing importance. There was a 00:11:07.809 --> 00:11:09.649 recent announcement, for instance, from Nexus 00:11:09.649 --> 00:11:12.960 Pharmaceuticals about launching their own erythromycin 00:11:12.960 --> 00:11:15.299 lactobionate for injection. It's the injectable 00:11:15.299 --> 00:11:17.600 form. Right. And they specifically mentioned 00:11:17.600 --> 00:11:20.340 it as part of an effort to boost domestic production 00:11:20.340 --> 00:11:24.279 of essential medicines in the US. That really 00:11:24.279 --> 00:11:26.940 underlines the continuing economic relevance 00:11:26.940 --> 00:11:29.519 of this particular antibiotic. So it's clearly 00:11:29.519 --> 00:11:32.059 more than just a medicine. It's a major economic 00:11:32.059 --> 00:11:35.019 player. OK, finally, let's think about the broader 00:11:35.019 --> 00:11:38.679 cultural influence. How has a drug like erythromycin 00:11:38.679 --> 00:11:41.620 actually shaped things for us? As a society? 00:11:41.980 --> 00:11:43.980 Well, erythromycin, like, you know, the first 00:11:43.980 --> 00:11:46.820 wave of effective antibiotics, has had a truly 00:11:46.820 --> 00:11:49.279 transformative impact on public health. It's 00:11:49.279 --> 00:11:51.460 hard to overstate it. How so? It dramatically 00:11:51.460 --> 00:11:53.659 improved our ability to treat infectious diseases, 00:11:54.019 --> 00:11:55.759 things that used to be major killers or causes 00:11:55.759 --> 00:11:58.240 of long -term illness, think pneumonia, strep 00:11:58.240 --> 00:12:01.039 complications. It led to huge reductions in mortality 00:12:01.039 --> 00:12:04.500 rates. Saved countless lives. Absolutely. But 00:12:04.500 --> 00:12:08.690 there's a flip side. It's widespread use. over 00:12:08.690 --> 00:12:11.649 decades now, has been a major contributor to 00:12:11.649 --> 00:12:15.149 the really serious problem we face today. Antimicrobial 00:12:15.149 --> 00:12:18.549 resistance. Ah, yes. The resistance issue. It's 00:12:18.549 --> 00:12:21.009 a huge global health challenge. And it's why 00:12:21.009 --> 00:12:23.009 you see international organizations developing 00:12:23.009 --> 00:12:25.450 action plans promoting antibiotic stewardship 00:12:25.450 --> 00:12:28.080 programs. Yeah. basically trying to preserve 00:12:28.080 --> 00:12:30.000 the effectiveness of the antibiotics we still 00:12:30.000 --> 00:12:32.460 have left. And things like the World Health Organization's 00:12:32.460 --> 00:12:35.080 AWARE classification fit into that. Exactly. 00:12:35.600 --> 00:12:38.740 AWARE categorizes antibiotics, access, watch, 00:12:39.039 --> 00:12:42.480 reserve, to help guide appropriate use, trying 00:12:42.480 --> 00:12:44.799 to ensure access to essential ones while being 00:12:44.799 --> 00:12:46.820 more careful with others that are more prone 00:12:46.820 --> 00:12:48.860 to driving resistance if they're overused or 00:12:48.860 --> 00:12:50.679 misused. It really is a double -edged sword, 00:12:50.679 --> 00:12:52.980 isn't it? This revolutionary drug saves lives, 00:12:53.179 --> 00:12:55.639 but its very success, its overuse, is now creating 00:12:55.639 --> 00:12:58.320 these massive new problems. That's the critical 00:12:58.320 --> 00:13:01.049 dilemma we face. Interestingly, though, research 00:13:01.049 --> 00:13:03.370 isn't only focused on resistance. Scientists 00:13:03.370 --> 00:13:05.649 are also exploring other potential roles for 00:13:05.649 --> 00:13:08.190 erythromycin. Beyond killing bacteria. Yeah. 00:13:08.370 --> 00:13:10.470 For example, some studies have looked at its 00:13:10.470 --> 00:13:13.450 potential effects on the immune system. Immunomodulatory 00:13:13.450 --> 00:13:16.309 effects, particularly in very sick patients like 00:13:16.309 --> 00:13:19.309 those with sepsis. Even at low doses? Yes, even 00:13:19.309 --> 00:13:21.570 at the low doses sometimes used for its gut motility 00:13:21.570 --> 00:13:24.990 effects. But this is still a pretty new area 00:13:24.990 --> 00:13:26.809 of investigation. The findings are still being 00:13:26.809 --> 00:13:30.289 debated and... Honestly, more research is definitely 00:13:30.289 --> 00:13:33.409 needed. Huh. That's really unexpected, so it 00:13:33.409 --> 00:13:35.850 might have other benefits working. It's a possibility 00:13:35.850 --> 00:13:38.850 being explored. But, and this is crucial, we 00:13:38.850 --> 00:13:41.669 also have to remember that erythromycin can interact 00:13:41.669 --> 00:13:43.950 with other medications someone might be taking. 00:13:44.110 --> 00:13:47.009 Right. Drug interactions. Our sources definitely 00:13:47.009 --> 00:13:49.730 flag known interactions. Things like the asthma 00:13:49.730 --> 00:13:52.509 drug, pheofalene, the heart medications, digoxin 00:13:52.509 --> 00:13:55.750 and verapamol, anticoagulants like warfarin, 00:13:56.190 --> 00:13:58.490 even oral contraceptives. Okay. That's important 00:13:58.490 --> 00:14:00.590 for patients and doctors to know. Absolutely. 00:14:00.909 --> 00:14:02.629 And there's also evidence, at least from lab 00:14:02.629 --> 00:14:05.350 studies, in vitro, suggesting that erythromycin 00:14:05.350 --> 00:14:07.710 can actually work against or be antagonistic 00:14:07.710 --> 00:14:11.070 to other antibiotics like clindamycin, lincomycin, 00:14:11.470 --> 00:14:13.600 and chloramphenicol. So they might... cancel 00:14:13.600 --> 00:14:15.820 each other out or interfere. Potentially, yeah. 00:14:16.240 --> 00:14:18.480 It just underscores how important it is for healthcare 00:14:18.480 --> 00:14:21.580 professionals to consider the whole picture when 00:14:21.580 --> 00:14:24.340 prescribing and for patients to be aware if they're 00:14:24.340 --> 00:14:27.559 taking multiple medications. Okay. So, to kind 00:14:27.559 --> 00:14:29.820 of wrap up our deep dive here, we followed the 00:14:29.820 --> 00:14:32.879 story of erythromycin, this macrolide antibiotic. 00:14:33.379 --> 00:14:35.679 It came out of a world desperate for treatments 00:14:35.679 --> 00:14:38.500 for infection. Discovered from soil bacteria. 00:14:38.639 --> 00:14:41.740 It came this incredibly versatile tool, tackling 00:14:41.740 --> 00:14:44.289 everything from, you know... common respiratory 00:14:44.289 --> 00:14:47.909 bugs to really serious conditions in newborns. 00:14:47.929 --> 00:14:49.450 Yeah, a real work where... He looked at how it's 00:14:49.450 --> 00:14:51.889 made through that cool fermentation process, 00:14:52.090 --> 00:14:54.450 the strict regulatory hoops it has to jump through. 00:14:54.710 --> 00:14:58.129 The NDAs, NDAs, GMP, all that. It's undeniable 00:14:58.129 --> 00:15:00.990 economic weight globally. And then this really 00:15:00.990 --> 00:15:03.809 complex cultural impact the lives saved balanced 00:15:03.809 --> 00:15:06.149 against the massive challenge of antibiotic resistance 00:15:06.149 --> 00:15:08.090 it helped create. And what's really striking 00:15:08.090 --> 00:15:10.740 is that the story isn't over, is it? We're still 00:15:10.740 --> 00:15:12.860 grappling with resistance, but we're also still 00:15:12.860 --> 00:15:16.179 finding out new things about it, exploring potential 00:15:16.179 --> 00:15:19.059 non -antibiotic effects, understanding its interactions 00:15:19.059 --> 00:15:21.399 better. Right. So maybe a final thought for you, 00:15:21.419 --> 00:15:24.279 the listener. We touched on how erythromycin 00:15:24.279 --> 00:15:27.500 and another common antibiotic, doxycycline, can 00:15:27.500 --> 00:15:30.259 have this weird relationship against E. coli 00:15:30.259 --> 00:15:32.460 first working together, then potentially working 00:15:32.460 --> 00:15:34.539 against each other. Yeah, that synergistic, then 00:15:34.539 --> 00:15:37.179 antagonistic effect. It's complex. It really 00:15:37.179 --> 00:15:39.179 is. And it's just one small example, isn't it? 00:15:39.179 --> 00:15:41.299 It highlights the incredible complexity of this 00:15:41.299 --> 00:15:43.919 battle between microbes and medicine. It's a 00:15:43.919 --> 00:15:45.879 powerful reminder that the story of antibiotics 00:15:45.879 --> 00:15:49.570 is constantly evolving. there are definitely 00:15:49.570 --> 00:15:51.269 still many chapters left to write.