Trade Names:Akne-mycin- Ointment, topical 2%
Trade Names:E.E.S. 400- Tablets 400 mg as ethylsuccinate- Suspension, oral 400 mg per 5 mL as ethylsuccinate
Trade Names:E.E.S. Granules- Granules for oral suspension 200 mg per 5 mL when reconstituted as ethylsuccinate
Trade Names:Emgel- Gel 2%
Trade Names:Ery-Tab- Tablets, enteric-coated 250 mg- Tablets, enteric-coated 333 mg- Tablets, enteric-coated 500 mg
Trade Names:Erycette- Pads 2%
Trade Names:Eryderm- Solution 2%
Trade Names:Erygel- Gel 2%
Trade Names:Ery Pads- Pledgets, topical 2%
Trade Names:Ery-Ped 200- Powder for oral suspension 200 mg per 5 mL as ethylsuccinate
Trade Names:Ery-Ped 400- Powder for oral suspension 400 mg per 5 mL as ethylsuccinate
Trade Names:Ery-Ped Drops- Suspension 100 mg per 2.5 mL as ethylsuccinate
Trade Names:Erythromycin Base- Capsules, delayed-release 250 mg
Trade Names:Erythromycin Ethylsuccinate Suspension- Suspension, oral 200 mg per 5 mL- Suspension, oral 400 mg per 5 mL
Trade Names:Erythromycin Ointment- Ointment, ophthalmic 5 mg/g
Trade Names:Erythrocin Lactobionate- Injection, lyophilized powder for solution 500 mg- Injection, lyophilized powder for solution 1 g
Trade Names:Erythrocin Stearate- Tablets, film-coated 250 mg- Tablets, film-coated 500 mg as stearate
Trade Names:PCE Dispertab- Tablets with polymer-coated particles 333 mg- Tablets with polymer-coated particles 500 mg
Trade Names:Romycin- Ointment, ophthalmic 5 mg/gApo-Erythro Base (Canada)Apo-Erythro E-C (Canada)Apo-Erythro-ES (Canada)Apo-Erythro-S (Canada)Novo-Rrythro Estolate (Canada)Novo-Rrythro Ethylsuccinate (Canada)
Interferes with microbial protein synthesis.
Orally administered erythromycin base and its salts are readily absorbed. Because of interindividual variation in absorption, some patients do not achieve optimal serum concentrations.
Erythromycin diffuses into most body fluids. In the absence of meningeal inflammation, low concentrations are achieved in the spinal fluid; however, passage across the blood-brain barrier increases in meningitis. Although erythromycin crosses the placenta, fetal plasma levels are low. Erythromycin is extensively bound to plasma protein.
Erythromycin is not removed by peritoneal dialysis. Erythromycin is concentrated in the liver and excreted in the bile. Less than 5% of the oral dose (12% to 15% IV) is recovered in the active form in the urine.
Treatment of infections of respiratory tract, skin and skin structure, and STDs caused by susceptible organisms; treatment of pertussis, diphtheria, erythrasma, intestinal amebiasis, conjunctivitis of newborn, Legionnaire disease, listeriosis, nongonococcal urethritis, pneumonia of infancy, urogenital infections during pregnancy; treatment of acute pelvic inflammatory disease, syphilis, and uncomplicated urethral, endocervical, or rectal infections in adults; prevention of attacks of rheumatic fever; prevention of bacterial endocarditis (IV).Ophthalmic
Treatment of superficial ocular infections caused by strains of susceptible organism; prophylaxis of neonatal conjunctivitis.Topical
Treatment of acne vulgaris.
Treponema pallidum , Campylobacter jejuni , Lymphogranuloma venereum , Haemophilus ducreyi (chancroid), administration prior to elective colorectal surgery to reduce wound complications, anthrax, Vincents gingivitis, erysipeloid, tetanus, actinomycosis, Nocardia infection, Eikenella corrodens infections, Borrelia infections (including early Lyme disease).Erythromycin estolate oral
Acne vulgaris, bacillary angiomatosis in immunocompromised patients, campylobacter enteritis, erysipelas cellulitis, chancroid, granuloma inguinale, impetigo, ecthyma, inclusion conjunctivitis in adults, extremity infected wounds, leptospirosis, early Lyme disease, lymphogranuloma venereum, relapsing fever, tetanus.
Hypersensitivity to erythromycin or any macrolide antibiotic; coadministration of cisapride or pimozide; preexisting liver disease (with estolate salt); epithelial herpes simplex keratitis; fungal disease of eye; vaccinia or varicella (ophthalmic).
Duration of treatment will vary depending on site of systemic infection (eg, treat pneumonia of infancy for at least 3 wk). For adult dosage calculation of erythromycin ethylsuccinate, use a ratio of 400 mg of erythromycin activity as the ethylsuccinate salt to 250 mg of erythromycin activity as the base, stearate, or estolate. Depending on the severity of the infection, the dosage may be increased up to 4 g/day; however, twice-daily dosing is not recommended for doses larger than 1 g daily. For treatment of severe infections in adults and children, the recommended IV dose of erythromycin lactobionate is 15 to 20 mg/kg/day (max, 4 g/day).Acne VulgarisAdults and Children
Topical Apply twice daily, morning and evening.
Topical Gel Apply sparingly as a thin film to affected areas once or twice daily.
Topical Pads Rub over affected area twice daily, morning and evening.Acute Ocular InfectionAdults and Children
Ophthalmic 1-cm ribbon of ointment placed in eye up to 6 times daily, depending on severity of infection.Acute Pelvic Inflammatory Disease
IV 500 mg every 6 h for 3 days, followed PO by 250 mg every 6 h, 333 mg every 8 h, or 500 mg every 12 h for 7 days.Conjunctivitis of the Newborn
PO 50 mg/kg/day in 4 divided doses for at least 14 days.Intestinal AmebiasisAdults
PO 500 mg every 12 h, 400 mg every 6 h, 333 mg every 8 h, or 250 mg every 6 h for 10 to 14 days.Children
PO 30 to 50 mg/kg/day in equally divided doses for 10 to 14 days (max, 4 g/day).Legionnaire Disease
PO Optimal dose not established; 1 to 4 g in divided doses.Nongonococcal Urethritis
PO 500 mg 4 times daily or 666 mg (two 333 mg tablets) every 8 h for at least 7 days.Pertussis
PO 40 to 50 mg/kg/day in divided doses for 5 to 14 days.Pneumonia of Infancy
PO 50 mg/kg/day in 4 divided doses for at least 21 days.Prevention of Bacterial EndocarditisAdults
PO 1 g 1 h before procedure followed by 500 mg 6 h later.Children
PO 20 mg/kg 1 h before procedure followed by 10 mg/kg 6 h later.Prevention of Initial Attack of Rheumatic Fever
PO , IV 400 mg every 6 h for 10 days.Prevention of Recurrent Attacks of Rheumatic Fever
PO , IV 250 mg twice daily given continuously.Primary Syphilis
PO 30 to 40 g (erythromycin ethylsuccinate 48 to 64 g) in divided doses over a period of 10 to 15 days.Prophylaxis of Neonatal Gonococcal or Chlamydia ConjunctivitisNewborns
Ophthalmic 1-cm ribbon of ointment placed in each conjunctival sac at time of delivery.Skin InfectionsAdults and children
Topical Apply 1 to 4 times daily to affected area.Systemic UseAdults
PO 250 to 500 mg every 6 h, 500 mg every 12 h, or 333 mg every 8 h. IV 15 to 20 mg/kg/day; up to 4 g/day in very severe infections.Children
PO 30 to 50 mg/kg/day in divided doses (max, 4 g/day).Uncomplicated Urethral, Endocervical, or Rectal InfectionsAdults
PO 500 mg 4 times daily or two 333 mg tablets every 8 h for at least 7 days.Children (less than 45 kg)
PO 50 mg/kg/day in 4 divided doses for 14 days.Upper Respiratory Tract InfectionsAdults
PO 250 mg every 6 h, 333 mg every 8 h, or 500 mg every 12 h for at least 10 days.Children
PO 30 to 50 mg/kg/day in equally divided doses for at least 10 days (max, 4 g/day).Urethritis Caused by Chlamydia trachomatis or Ureaplasma urealyticum
800 mg every 8 h for 7 days.Urogenital Infections During PregnancyAdults
PO 500 mg 4 times daily or two 333 mg tablets every 8 h for at least 7 days. For women who cannot tolerate this regimen, 500 mg every 12 h, 333 mg every 8 h, or 250 mg 4 times daily for at least 14 days.
Store erythromycin estolate oral suspension in refrigerator (36° to 46°F) to maintain optimal taste. Store reconstituted erythromycin ethylsuccinate oral suspension in refrigerator to preserve taste and use within 10 days. Store reconstituted erythromycin ethylsuccinate oral drops at or below 77°F and use within 35 days. Store premixed erythromycin ethylsuccinate oral suspension in refrigerator to preserve taste until dispensed. Refrigeration is not required if used within 14 days of initial use.Injection
Store powder for injection at controlled room temperature (59° to 86°F). Reconstituted solution is stable for 2 wk if refrigerated (36° to 46°F) or for 24 h at room temperature. Final diluted solution must be completely administered within 8 h of dilution in order to ensure proper potency.Topical
Store Erygel and Emgel between 59° and 77°F. Store Akne-Mycin ointment below 80°F. Store Eryderm solution below 86°F. Store Ery 2% Pad at 68° to 77°F.Erythromycin base, ethylsuccinate, stearate, and powder for oral suspension
Store below 86°F.Ery-Ped
Prior to mixing, store below 86°F. After reconstitution, store below 77°F and use within 35 days. Refrigeration is not required.Injection Erythrocin lactobionate IV
Store lyophilized powder at 68° to 77°F. Administer final diluted solution within 2 hours to ensure proper potency (in dextrose 5% injection). Administer final diluted solution within 8 h to ensure proper potency (in sodium chloride 0.9% injection).Ophthalmic ointment
Store at 59° to 86°F. Avoid excessive heat. Protect from freezing.
May increase anticoagulant effects.Bromocriptine
May increase serum bromocriptine levels.Cisapride, pimozide, ranolazine
Plasma levels may be elevated, increasing the risk of life-threatening cardiac arrhythmia and torsades de pointes; coadministration with erythromycin is contraindicated.Class 1A antiarrhythmic agents (eg, procainamide, quinidine) and class III antiarrhythmic agents (eg, dofetilide, sotalol)
Risk of life-threatening cardiac arrhythmias, including torsades de pointes, may be increased.Clopidogrel
Antiplatelet effect of clopidogrel may be inhibited.Colchicine
Plasma levels may be elevated by erythromycin, increasing the risk of toxicity.Drugs inhibited by CYP3A metabolism (eg, alfentanil, buspirone, cabergoline, carbamazepine, cilostazol, clozapine, cyclosporine, diltiazem, disopyramide, eletriptan, felodipine, HMG-CoA reductase inhibitors [eg, lovastatin, simvastatin], lidocaine IV, phosphodiesterase type 5 inhibitors [eg, sildenafil, tadalafil, vardenafil], quetiapine, quinidine, repaglinide, tacrolimus, theophyllines, triazolobenzodiazepines [eg, alprazolam, midazolam, triazolam], valproate, verapamil, vinblastine)
Plasma levels may be elevated by erythromycin, increasing the pharmacologic effects and risk of toxicity (eg, rhabdomyolysis with lovastatin or simvastatin).Clindamycin, topical
Antagonism may occur with topical erythromycin; coadministration is not recommended.Digoxin
May cause increased digoxin levels.Ergot derivative
Ergot toxicity may occur.Food Erythromycin base
Administer capsules containing enteric-coated pellets and film-coated tablets at least 2 h before or after a meal to achieve optimal blood levels. Erythromycin was 28% bioavailable following administration of the polymer-coated particle formulation with a high-fat meal.Erythromycin stearate
Plasma concentrations may be reduced when administered with food. Optimum levels are achieved when administered at least 1 h before or 2 h after meals. High blood levels were achieved when administered immediately before a meal.Erythromycin estolate and ethylsuccinate
Food may enhance the absorption; however, may be given without regard to meals.Grapefruit juice
May inhibit erythromycin metabolism, increasing plasma levels and adverse reactions.Methylprednisolone
May decrease Cl of methylprednisolone.Quinolone antibiotics (eg, gatifloxacin, levofloxacin, moxifloxacin, sparfloxacin)
Risk of life-threatening cardiac arrhythmias, including torsades de pointes, may be increased.Rifamycins (eg, rifabutin)
Rifabutin plasma levels may be increased while erythromycin levels and antibiotic activity may be decreased.
Erythromycin interferes with fluorometric urinary catecholamine determinations.
QT prolongation and ventricular arrhythmia (including torsades de pointes).
Dryness, erythema, itching, oiliness, peeling, tenderness, urticaria (topical use); erythema and peeling; erythema multiforme; mild eruptions; Stevens-Johnson syndrome; toxic epidermal necrolysis (topical use).
Eye irritation (topical use); hypersensitivity, minor ocular irritation, redness (ophthalmic use). Reversible hearing loss primarily in patients with renal function impairment.
Abdominal pain; anorexia; diarrhea; nausea; pancreatitis; pseudomembranous colitis; vomiting.
Hepatitis; hepatic function impairment.
Allergic reactions ranging from urticaria to anaphylaxis.
Hepatic function impairment with or without jaundice has occurred primarily in adults in association with erythromycin estolate administration. Symptoms include abdominal colic, fever, malaise, nausea, and vomiting. Severe abdominal pain may stimulate an abdominal surgical emergency.
Before treating gonorrhea, patients suspected of also having syphilis should have a microscopic examination for T. pallidum (ie, immunofluorescence, darkfield) before receiving erythromycin and monthly serologic tests for at least 4 mo thereafter.Response to therapy
Monitor patient's response to therapy.Sensitivity tests
Review results of culture and sensitivity testing as appropriate. Ensure erythromycin is discontinued and another antimicrobial agent is started if sensitivity tests indicate the organism is resistant to erythromycin.Topical
Assess patient's response to therapy. Be prepared to reduce frequency of application if dryness and peeling occurs. Be prepared to discontinue therapy if more severe reactions (eg, burning, allergic reaction, severe peeling, desquamation) occur.
Category B .
Excreted in breast milk.
Safety and efficacy not established.
Serious reactions, including anaphylaxis, have occurred.
Use drug cautiously. Hepatic function impairment, with or without jaundice, has occurred. Cholestatic hepatitis has occurred. Monitor patient for signs and symptoms of liver dysfunction (eg, dark urine, fatigue, flu-like symptoms, persistent nausea, right-upper quadrant abdominal pain, yellowing of skin or eyes). Discontinue therapy immediately if noted or suspected.
Prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible microorganisms.
Cumulative irritant effect may occur.
Has been reported.
Aggravation of myasthenia gravis has been reported.
May slow corneal epithelial healing.
May occur, especially in patients with renal or hepatic function impairment, elderly patients, and patients administered large doses.
Consider possibility in patients in whom diarrhea develops. Immediately report severe diarrhea, diarrhea containing blood or pus, or severe abdominal cramping.
Ensure patient receiving concomitant lovastatin and erythromycin is carefully monitored for development of rhabdomyolysis.
In case of overdosage, discontinue erythromycin.
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