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Erythromycin

    Brands

    DEA Class; Rx

    Common Brand Names; Ery-Tab, PCE Dispertab

    • Macrolides

    erythromycin ophthalmic (Rx)

    Brand and Other Names:Ilotycin Ophthalmic
    • Classes: Macrolides, Ophthalmic

    erythromycin topical (Rx)

    Brand and Other Names: AkneMycin, Ery
    • Classes: Acne Agents, Topical; 
    • Antibacterials, Topical

    erythromycin stearate (Rx)

    Brand and Other Names: Erythrocin Stearate
    • Classes: Macrolides

    erythromycin lactobionate (Rx)

    Brand and Other Names: Erythrocin Lactobionate
    • Classes: Macrolides

    erythromycin ethylsuccinate (Rx)

    Brand and Other Names:E.E.S., EryPed
    • Classes: Macrolides

    Oral/parenteral/topical macrolide antibiotic. Active against many microbes, but clinical applications are relatively few. Used for Legionnaire’s disease and Mycoplasma pneumoniae pneumonia, and as an alternative to beta-lactam antibiotics in allergic patients. May have benefits in hypomotility conditions, such as diabetic gastroparesis.

    Indicated for the treatment of acne vulgaris.

    For the treatment of mild to moderately severe lower respiratory tract infections (LRTIs), including community-acquired pneumonia (CAP).
    For the treatment of Legionnaire’s disease.
    For the treatment of mild to moderately severe upper respiratory tract infections, including group A beta-hemolytic streptococcal (GAS) pharyngitis (primary rheumatic fever prophylaxis) and tonsillitis.
    For the treatment of listeriosis.
    For the treatment of non-gonococcal urethritis (NGU) and chlamydia infection, including infant pneumonia.
    For the adjunctive treatment of diphtheria and to prevent establishment of carrier state.
    For the treatment of acute pelvic inflammatory disease (PID).
    For the treatment of pertussis (whooping cough) caused by Bordetella pertussis or for postexposure pertussis prophylaxis.
    For bowel preparation in combination with neomycin in patients undergoing colorectal surgery.
    For the prevention of ophthalmia neonatorum (i.e., ophthalmia neonatorum prophylaxis) due to N. gonorrhoeae or C. trachomatis.
    For the treatment of infectious diarrhea and gastroenteritis, including amebiasis and cholera.
    For the treatment of early Lyme disease (erythema migrans), including solitary and multiple erythema migrans as second line therapy.
    For the treatment of skin and skin structure infections, including erythrasma, impetigo, secondary bacterial infection of eczema, cellulitis, erysipelas, leg ulcer, and diabetic foot ulcer.

    Documented hypersensitivity

    Coadministration with terfenadine

    Coadministration with HMG-CoA reductase inhibitors that are extensively metabolized by CYP3A4 (lovastatin or simvastatin)

    Co-administration of erythromycin with ergotamine or dihydroergotamine

    • Abdominal pain
    • Anaphylaxis
    • Cholestatic hepatitis
    • Confusion
    • Diarrhea
    • Dyspepsia
    • Fever
    • Flatulence
    • Hallucinations
    • Hearing loss
    • Headache
    • Hypertrophic pyloric stenosis
    • Hypotension
    • Interstitial nephritis
    • Mild allergic reactions
    • Nausea
    • Nervous system effects, including seizures
    • Pain
    • Pruritus
    • Pseudomembranous colitis
    • QT prolongation
    • Rash
    • Skin eruptions
    • Tinnitus
    • Torsades de pointes
    • Urticaria
    • Ventricular arrhythmias
    • Ventricular tachycardia
    • Vertigo
    • Vomiting

    Hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice reported in patients receiving oral erythromycin products

    Prescribing therapy in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to patient and increases risk of development of drug-resistant bacteria

    Since erythromycin is principally excreted by the liver, caution should be exercised when erythromycin is administered to patients with impaired hepatic function

    Exacerbation of symptoms of myasthenia gravis and new onset of symptoms of myasthenic syndrome reported in patients receiving erythromycin therapy

    Infantile hypertrophic pyloric stenosis (IHPS) in infants following erythromycin therapy reported; a possible dose-response effect reported; since erythromycin may be used in the treatment of conditions in infants which are associated with significant mortality or morbidity (such as pertussis or neonatal Chlamydia trachomatis infections), the benefit of therapy needs to be weighed against potential risk of developing IHPS; parents should be informed to contact their physician if vomiting or irritability with feeding occurs

    Prolonged or repeated use of erythromycin may result in an overgrowth of nonsusceptible bacteria or fungi; if superinfection occurs, erythromycin should be discontinued, and appropriate therapy instituted

    When indicated, incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy; observational studies in humans have reported cardiovascular malformations after exposure to drug products containing erythromycin during early pregnancy

    Pregnancy category: B

    Lactation: Drug enters breast milk; use with caution (American Academy of Pediatrics committee states that drug is compatible with nursing)

    Adults

    4 g erythromycin base/day PO; 4 g/day IV.

    Geriatric

    4 g erythromycin base/day PO; 4 g/day IV.

    Adolescents

    50 mg/kg/day (Max: 2 g/day) PO is the common maximum dose used in clinical practice; however, up to 100 mg/kg/day PO (Max: 4 g/day) is FDA-approved for the treatment of severe infections. 20 mg/kg/day (Max: 4 g/day) is the FDA-approved IV maximum dose; however, doses up to 40 mg/kg/day (Max: 4 g/day) IV have been used off-label.

    Children

    50 mg/kg/day (Max: 2 g/day) PO is the common maximum dose used in clinical practice; however, up to 100 mg/kg/day PO (Max: 4 g/day) is FDA-approved for the treatment of severe infections. 20 mg/kg/day (Max: 4 g/day) is the FDA-approved IV maximum dose; however, doses up to 40 mg/kg/day (Max: 4 g/day) IV have been used off-label.

    Infants

    50 mg/kg/day PO is the common maximum dose used in clinical practice; however, up to 100 mg/kg/day PO is FDA-approved for the treatment of severe infections. 20 mg/kg/day is the FDA-approved maximum IV dose; however, doses up to 40 mg/kg/day IV have been used off-label.

    Neonates

    50 mg/kg/day PO; safety and efficacy of IV use have not been established, however, doses up to 40 mg/kg/day IV have been used off-label.

    Erythromycin

    tablet

    • 250mg
    • 500mg

    tablet, delayed-release particles

    • 250mg
    • 333mg
    • 500mg

    capsule, delayed release particles

    • 250mg

    ophthalmic ointment

    • 0.5%

    topical ointment (AkneMycin)

    • 2%

    topical pads (Ery)

    • 2%

    topical solution

    • 2%

    topical gel

    • 2%

    injection

    • 500mg

    tablet

    • 400mg

    oral suspension

    • 200mg/5mL
    • 400mg/5mL