erythromycin

REMS

IV: PO: Infections caused by susceptible organisms, including:
- Upper and lower respiratory tract infections,
- Otitis media (with sulfonamides),
- Skin and skin structure infections,
- Pertussis,
- Diphtheria,
- Erythrasma,
- Intestinal amebiasis,
- Pelvic inflammatory disease,
- Nongonococcal urethritis,
- Syphilis,
- Legionnaires’ disease,
- Rheumatic fever.
Useful when penicillin is the most appropriate drug but cannot be used because of hypersensitivity, including:
- Streptococcal infections,
- Syphilis or gonorrhea.
Topical Acne.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Concurrent use of dihydroergotamine, ergotamine, lovastatin, pimozide, or simvastatin;
Long QT syndrome;
Hypokalemia;
Hypomagnesemia;
HR <50 bpm;
Known alcohol intolerance (most topicals);
Tartrazine sensitivity (some products contain tartrazine: FDC yellow dye #5);
Pedi: Products containing benzyl alcohol should be avoided in neonates.

Use Cautiously in:

Renal impairment;
Hepatic impairment;
Myasthenia gravis (may worsen symptoms);
OB: May be used in pregnancy to treat chlamydial infections or syphilis;
Geri: ↑risk of ototoxicity if parenteral dose >4 g/day and ↑ risk of QTc interval prolongation in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: QT interval prolongation, TORSADES DE POINTES, VENTRICULAR ARRHYTHMIAS

Derm: rash

EENT: ototoxicity

GI: nausea, vomiting, abdominal pain, CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), cramping, diarrhea, hepatitis, infantile hypertrophic pyloric stenosis, pancreatitis (rare)

GU: interstitial nephritis

Local: phlebitis

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Pimozide may ↑ levels and risk for serious arrhythmias; concurrent use contraindicated; similar effects may occur with diltiazem, verapamil, ketoconazole, itraconazole, nefazodone, and protease inhibitors; concurrent use with pimozide contraindicated.
May ↑ levels and risk for ergot toxicity of ergotamine and dihydroergotamine; concurrent use contraindicated.
Lovastatin or simvastatin may ↑ risk of rhabdomyolysis; concurrent use contraindicated.
Amiodarone, dofetilide, or sotalol may ↑ risk of torsades de pointes; avoid concurrent use.
May ↑ verapamil levels and risk for hypotension, bradycardia, and lactic acidosis.
May ↑ levels and risk of toxicity of sildenafil, tadalafil, and vardenafil; use lower doses.
Rifabutin or rifampin may ↓ levels and effectiveness.
May ↑ levels and risk of toxicity of alprazolam, bromocriptine, carbamazepine, cyclosporine, cilostazol, diazepam, disopyramide, ergot alkaloids, felodipine, methylprednisolone, midazolam, quinidine, rifabutin, tacrolimus, triazolam, or vinblastine.
May ↑ levels and risk of toxicity of digoxin.
Theophylline may ↓ levels and effectiveness.
May ↑ levels and risk of toxicity of colchicine; use lower starting and maximum dose of colchicine.
May ↑ levels and risk of toxicity of theophylline; ↓ theophylline dose.
May ↑ levels of and risk of bleeding with warfarin.

Availability ⬆ ⬇

(Generic available)

Erythromycin Base

Delayed-release capsules: 250 mg; 333 mg
Delayed-release tablets: 250 mg; 333 mg; 500 mg

Erythromycin Ethylsuccinate

Oral suspension fruit, cherry, orange, or banana flavor: 200 mg/5 mL; 400 mg/5 mL
Tablets: 400 mg

Erythromycin Lactobionate

Powder for injection (requires reconstitution and dilution): 500 mg/vial; 1 g

Erythromycin Topical Preparations

Gel: 2%
Pledgets: 2%
Solution: 2%
In combination with: benzoyl peroxide (Benzamycin). See Appendix [not included in this PDA edition].

Route/Dosage ⬆ ⬇

250 mg of erythromycin base = 400 mg of erythromycin ethylsuccinate.

Most Infections

PO (Adults ): Base: 250 mg every 6 hr, or 333 mg every 8 hr, or 500 mg every 12 hr. Ethylsuccinate: 400 mg every 6 hr or 800 mg every 12 hr.
PO (Children >1 mo): Base and ethylsuccinate: 30–50 mg/kg/day divided every 6–8 hr (max = 2 g/day as base or 3.2 g/day as ethylsuccinate).
PO (Neonates ): Ethylsuccinate: 20–50 mg/kg/day divided every 6–12 hr.
IV (Adults ): 250–500 mg (up to 1 g) every 6 hr.
IV (Children >1 mo): 15–50 mg/kg/day divided every 6 hr (max = 4 g/day).

Acne

(Adults and Children >12 yr): 2% gel, solution, or pledgets twice daily.

US Brand Names ⬆ ⬇

erythromycin base: ~~E-Mycin,~~ Ery-Tab, ~~PCE,~~

erythromycin ethylsuccinate: E.E.S, EryPed,

erythromycin lactobionate: Erythrocin,

erythromycin (topical): ~~Erygel~~

Action ⬆ ⬇

Suppresses protein synthesis at the level of the 50S bacterial ribosome.

Therapeutic effects:

Bacteriostatic action against susceptible bacteria.

Spectrum:

Active against many gram-positive cocci, including:
- Streptococci,
- Staphylococci.
Gram-positive bacilli, including:
- Clostridioides,
- Corynebacterium.
Several gram-negative pathogens, notably:
- Neisseria,
- Legionella pneumophila.
Mycoplasma and Chlamydia are also usually susceptible.

Classifications ⬆ ⬇

Therapeutic Classification: anti-infectives

Pharmacologic Classification: macrolides

Pharmacokinetics ⬆ ⬇

Absorption: Variable absorption from the duodenum after oral administration (dependent on salt form). Absorption of enteric-coated products is delayed. Minimal absorption may follow topical or ophthalmic use.

Distribution: Widely distributed. Minimal CNS penetration.

Protein Binding: 70–80%.

Metabolism/Excretion: Partially metabolized by the liver, excreted mainly unchanged in the bile; small amounts excreted unchanged in the urine.

Half-Life: Neonates: 2.1 hr; Adults: 1.4–2 hr.

Canadian Brand Names ⬆ ⬇

erythromycin base: Eryc

Time/Action Profile ⬆ ⬇

(plasma concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	1 hr	1–4 hr	6–12 hr
IV	rapid	end of infusion	6–12 hr

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of erythromycin. Instruct patient to take medication around the clock and to finish the drug completely as directed, even if feeling better. Take missed doses as soon as remembered, with remaining doses evenly spaced throughout day. Advise patient to read Patient Information before starting therapy.
Pedi: Teach parents or caregivers to calculate and measure doses accurately. Reinforce importance of using measuring device supplied by pharmacy or with product, not household items.
Instruct the patient to notify health care provider if symptoms do not improve.
Advise patient to report the signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools) and allergy.
Instruct patient to notify health care provider immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care provider before taking other medications.
May cause nausea, vomiting, diarrhea, or stomach cramps; notify health care provider if these effects persist or if severe abdominal pain, yellow discoloration of the skin or eyes, darkened urine, pale stools, or unusual tiredness develops. May cause infantile hypertrophic pyloric stenosis in infants; notify health care provider if vomiting and irritability occur.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇