Intravenous Prophylaxis of surgical infections, Respiratory tract infections, Skin and soft tissue infections, Susceptible infections
Adult: As erythromycin lactobionate: 25-50 mg/kg daily or 15-20 mg/kg daily in divided doses. Max: 4 g daily. Doses may be given as continuous or via intermittent infusion over 20-60 minutes 6 hourly. Replace with oral preparation immediately. Treatment and dosing recommendations may vary among individual products and between countries (refer to detailed product guidelines). Child: As erythromycin lactobionate: Same as adult dose.
Ophthalmic Superficial ocular infections
Adult: As 0.5% ointment: Apply approx 1 cm length to the affected eye(s) up to 6 times daily depending on the severity of the infection.
Oral Prophylaxis of recurrent rheumatic fever
Adult: As erythromycin base: 250 mg bid. As erythromycin ethylsuccinate: 400 mg bid.
Oral Prophylaxis of surgical infections, Respiratory tract infections, Skin and soft tissue infections, Susceptible infections
Adult: As erythromycin base or erythromycin stearate: 250-500 mg 6-12 hourly; may be increased up to 4 g daily for severe infections. As erythromycin ethylsuccinate: 400-800 mg 6-12 hourly; may be increased up to 4 g daily for severe infections. Doses >1 g daily should be given in more than 2 divided doses. Treatment and dosing recommendations may vary among individual products and between countries (refer to detailed product guidelines). Child: As erythromycin base, erythromycin ethylsuccinate or erythromycin stearate: 30-50 mg/kg daily in 2-4 divided doses; may be doubled in severe infections.
Topical/Cutaneous Acne vulgaris
Adult: As 2% gel: Apply onto the affected areas 1-2 times daily. Discontinue treatment if condition worsens or if there is no improvement after 6-8 weeks. As 2% solution or pads: Apply onto the affected areas bid.
Administration
Should be taken on an empty stomach. Best taken on an empty stomach at least 30 min & preferably 2 hr before meals.
Reconstitution
Powder or granules for oral susp: Reconstitute with the appropriate volume of water as indicated on the label. Invert and shake well until suspended. IV: Add appropriate amount of sterile water for inj to prepare a concentration of 50 mg/mL; further dilute with ≥100 mL of suitable diluent to a final concentration of 1 mg/mL (continuous infusion) or 1-5 mg/mL (intermittent infusion).
Contraindications
Hypersensitivity. History of QT prolongation (congenital or documented acquired QT prolongation) or ventricular cardiac arrhythmia, including torsades de pointes; electrolyte disturbances (e.g. hypokalaemia, hypomagnesaemia). Concomitant use with amisulpride, astemizole, simvastatin, lovastatin, tolterodine, mizolastine, terfenadine, domperidone, pimozide, cisapride, ergotamine, dihydroergotamine, class IA (e.g. quinidine, procainamide) and class III (e.g. dofetilide, amiodarone, sotalol) antiarrhythmic agents.
Special Precautions
Patient with CAD, severe cardiac insufficiency, conduction disturbances, clinically relevant bradycardia, myasthenia gravis. Hepatic impairment. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Hepatic dysfunction including increased liver enzymes and/or cholestatic hepatitis, with or without jaundice; exacerbation or new onset of symptoms of myasthenia gravis; infantile hypertrophic pyloric stenosis; overgrowth of non-susceptible bacteria or fungi (prolonged or repeated therapy). Rarely, serious allergic reactions (including acute generalised exanthematous pustulosis). Blood and lymphatic system disorders: Eosinophilia. Cardiac disorders: Chest pain. Ear and labyrinth disorders: Tinnitus, deafness. Eye disorders: Mitochondrial optic neuropathy; minor ocular irritation (ophthalmic). Gastrointestinal disorders: Nausea, vomiting, diarrhoea, pancreatitis, upper abdominal pain. General disorders and administration site conditions: Fever, malaise. Topical: Application site irritation (e.g. local dryness, localised burning, erythema or tenderness, stinging of the skin). Metabolism and nutrition disorders: Anorexia. Nervous system disorders: Seizures, vertigo. Psychiatric disorders: Confusion, hallucinations. Renal and urinary disorders: Interstitial nephritis. Skin and subcutaneous tissue disorders: Pruritus, urticaria. Vascular disorders: Hypotension. Potentially Fatal: Pseudomembranous colitis, Clostridium difficile-associated diarrhoea, QT interval prolongation, torsades de pointes, severe skin reactions (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme), angioneurotic oedema, anaphylaxis.
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor liver and renal function (prolonged use); blood pressure, heart rate. Observe for changes in frequency of bowel movements.
Overdosage
Symptoms: Hearing loss, severe nausea, vomiting and diarrhoea. Management: Supportive treatment. Perform gastric lavage.
Drug Interactions
May increase serum concentration of acenocoumarol, alfentanil, bromocriptine, carbamazepine, cilostazol, ciclosporin, digoxin, dihydroergotamine, disopyramide, ergotamine, hexobarbitone, methylprednisolone, midazolam, omeprazole, phenytoin, quinidine, rifabutin, sildenafil, tacrolimus, domperidone, theophylline, tolterodine, triazolam, valproic acid, vinblastine, antifungals (e.g. ketoconazole, itraconazole, fluconazole), zopiclone. Increased serum concentration with cimetidine. Decreased serum concentration resulting in decreased effect with CYP3A4 inducers (e.g. rifampicin, phenytoin, carbamazepine, phenobarbital). Increased risk for CV events with hydroxychloroquine or chloroquine. Increased risk for rhabdomyolysis with HMG-CoA reductase inhibitors (e.g. lovastatin, simvastatin). Increased anticoagulant effects with oral anticoagulants (e.g. rivaroxaban, warfarin). May increase the pharmacological effect of triazolam, midazolam and related benzodiazepines. Increased risk for acute ergot toxicity (characterised by vasospasm and ischaemia of the CNS, extremities and other tissues) with ergotamine or dihydroergotamine. May increase serum concentrations of theophylline which may result in theophylline toxicity. Increased risk for hypotension, bradyarrhythmias, and lactic acidosis with Ca channel blockers. Potentially Fatal: Increased risk for CV events including cardiac arrest, torsades de pointes and other ventricular arrhythmias with cisapride, terfenadine, astemizole, pimozide, class IA (e.g. quinidine, procainamide) and class III (e.g. dofetilide, amiodarone, sotalol) antiarrhythmic agents. Increased risk for colchicine toxicity with colchicine.
Food Interaction
Decreased serum concentration resulting in decreased effect with St. John's wort.
Lab Interference
May give a false-positive result for urinary catecholamines, 17-hydroxycorticosteroids and 17-ketosteroids.
Action
Description: Mechanism of Action: Erythromycin inhibits protein synthesis by binding to the 50S ribosomal subunit of susceptible organisms resulting in blockage of transpeptidation. Pharmacokinetics: Absorption: Variable and unreliable due to instability in gastric acid. Time to peak plasma concentration: 4 hours (as erythromycin base); 0.5-2.5 hours (as erythromycin ethylsuccinate); 3 hours (as erythromycin stearate). Distribution: Widely distributed throughout body tissues and fluids; diffused into CSF (minimal). Crosses the placenta, enters breast milk. Volume of distribution: 0.64 L/kg. Plasma protein binding: 73-81% (as erythromycin base). Metabolism: Partly metabolised in the liver by CYP3A4 isoenzyme via N-demethylation into inactive, unidentified metabolites. Excretion: Mainly via faeces; urine (2-15% as unchanged drug). Elimination half-life: Approx 1.5-2.5 hours.
Chemical Structure
Erythromycin Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 12560, Erythromycin. https://pubchem.ncbi.nlm.nih.gov/compound/Erythromycin. Accessed Aug. 22, 2023.
S01AA17 - erythromycin ; Belongs to the class of antibiotics. Used in the treatment of eye infections. D10AF02 - erythromycin ; Belongs to the class of topical antiinfective preparations used in the treatment of acne. J01FA01 - erythromycin ; Belongs to the class of macrolides. Used in the systemic treatment of infections.
References
Committee on Infectious Diseases, American Academy of Pediatrics, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH. "Tables of Antibacterial Drug Dosages", Red Book: 2021-2024 Report of the Committee on Infectious Diseases. American Academy of Pediatrics [online]. Accessed 17/04/2023.AFT Pharmaceuticals Ltd. Era Filmtabs 250 mg and 500 mg Tablets data sheet 30 June 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 12/04/2023.AFT Pharmaceuticals Ltd. Erythrocin - IV 1 g Powder for Injection data sheet 24 June 2020. Medsafe. http://www.medsafe.govt.nz. Accessed 12/04/2023.Anon. Erythromycin (Ophthalmic) (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/04/2023.Anon. Erythromycin (Ophthalmic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/04/2023.Anon. Erythromycin (Systemic) (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/04/2023.Anon. Erythromycin (Systemic). AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 17/04/2023.Anon. Erythromycin (Systemic). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/04/2023.Anon. Erythromycin (Topical) (Pediatric and Neonatal Lexi-Drugs). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 17/04/2023.Anon. Erythromycin (Topical). Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 12/04/2023.Buckingham R (ed). Erythromycin. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/04/2023.Eomycin Granules 200 mg/5 mL (Teraputics Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/04/2023.Eritrotex Injection 500 mg (Averroes Pharmaceuticals Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/04/2023.Ery Swab (Padagis Israel Pharmaceuticals Ltd). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erymycin Dry Syrup 200 (Dynapharm [M] Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/04/2023.Erysol for Oral Suspension (Xepa-Soul Pattinson [Malaysia] Sdn Bhd). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/04/2023.Eryson Tablet 250 (Duopharma [M] Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 12/04/2023.Erythrocin I.V. Lactobionate 1 g Powder for Solution for Infusion (Amdipharm UK Limited). MHRA. https://products.mhra.gov.uk. Accessed 12/04/2023.Erythrocin Stearate Tablet, Film Coated (PD-Rx Pharmaceuticals, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythrolar Tablets 250 mg (Ennogen Pharma Limited). MHRA. https://products.mhra.gov.uk. Accessed 12/04/2023.Erythromycin 250 mg/5 mL Oral Suspension (Chelonia Healthcare Limited). MHRA. https://products.mhra.gov.uk. Accessed 12/04/2023.Erythromycin Capsule, Delayed Release Pellets (Mayne Pharma Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Ethylsuccinate 500 mg Film-coated Tablets (Dawa Limited). MHRA. https://products.mhra.gov.uk. Accessed 12/04/2023.Erythromycin Ethylsuccinate Suspension (Amneal Pharmaceuticals NY LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Ethylsuccinate Tablet (Azurity Pharmaceuticals, Inc). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Gel (Bryant Ranch Prepack). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Lactobionate Injection, Powder, Lyophilized, for Solution (Nexus Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Ointment (Akorn). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Solution (Micro Labs Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Tablet, Coated (Torrent Pharmaceuticals Limited). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Tablet, Delayed Release (Amneal Pharmaceuticals NY LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 12/04/2023.Erythromycin Tablets BP 250 mg (Waymade plc). MHRA. https://products.mhra.gov.uk. Accessed 12/04/2023.Erythromycin. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 17/04/2023.Joint Formulary Committee. Erythromycin. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 12/04/2023.Paediatric Formulary Committee. Erythromycin. BNF for Children [online]. London. BMJ Group, Pharmaceutical Press, and RCPCH Publications. https://www.medicinescomplete.com. Accessed 17/04/2023.Viatris Ltd. E-mycin 200 mg/5 mL and 400 mg/5 mL Granules for Oral Suspension; E-mycin 400 mg Film Coated Tablets data sheet 5 August 2021. Medsafe. http://www.medsafe.govt.nz. Accessed 12/04/2023.
Sign Out
