Use
Macrolides are generally safe and serious adverse events are rare. A notable exception is erythromycin estolate, which is hepatotoxic and may cause severe hepatitis, probably as a result of the mixture of lauryl sulfate and the 2′-propionyl ester. Gastrointestinal complaints (nausea, vomiting, abdominal pain or, less frequently, diarrhea) are most common; they present a problem mainly with erythromycin doses higher than those recommended and are partly due to a hemiketal degradation product that acts on motilin, an intestinal endopeptide. The semisynthetic 14- and 15-membered-ring macrolides are more acid stable than erythromycin A and are better tolerated.