A systematic review including 13 studies with a total of 942 patients receiving roxithromycin and 15 studies with a total of 1 253 patients receiving erythromycin was abstracted in DARE. There were 3 direct comparisons. The proportion of patients reporting adverse effects related to therapy with roxithromycin was 10.1% (95% CI 8 to 12%), and for erythromycin 24.8% (95% CI 22 to 27%). However, the biggest difference was found in a comparative study evaluating the use of erythromycin stearate which, as the authors state, seems to be associated with a high incidence of adverse events.
Comment: The quality of evidence is downgraded by indirectness (only three studies were direct comparisons) and review quality (limited literature search).