In vitro antagonism by erythromycin of the bactericidal action of antimicrobial agents against common respiratory pathogens.

Ten strains each of Staphylococcus aureus, Haemophilus influenzae, Enterobacter spp., Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, and Streptococcus pneumoniae were tested in vitro against erythromycin combined with ampicillin, cefamandole, or gentamicin. Antagonism by erythromycin occurred with 47% of the combinations involving strains of S. aureus and to a lesser degree with H. influenzae. Synergy occurred most commonly with H. influenzae (27%). The high frequency of antagonism and synergy with these organisms was associated with a broad range of bacteriostatic action by erythromycin against these same bacteria. The implications for the treatment of pneumonia are discussed.