Propionyl Erythromycin Ester Lauryl Sulfate and Jaundice

To the Editor:— In the past 6 months we have received clinical and laboratory data from physicians, indicating that on rare occasions a patient receiving propionyl erythromycin ester lauryl sulfate (Ilosone) may develop sensitivity to the drug manifested by reversible jaundice and liver function test changes of the intrahepatic cholestasis type. Laboratory studies in 7 well-studied patients have been characterized by increased direct-reacting bilirubin levels, negative or weakly positive cephalin flocculation and thymol turbidity tests, elevated serum glutamic oxalacetic transaminase levels (in the range of 100 to 300 units), peripheral eosinophilia, normal cholecystograms, and in some instances elevated alkaline phosphatase levels. In 4 of these 7 patients, symptoms of abdominal distress and jaundice recurred on administration of a second course of the antibiotic, and in one, the symptoms reappeared on readministration of a third course of therapy. A fifth patient developed jaundice following a course of therapy, and then received