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Erythromycin

Oral
Ophthalmic
Topical
Class
Antibiotics
Subclass
Penicillins
Substance name
Erythromycin
Brand names
Ery®
Common formulations
Tablet
See also
Erythromycin DR (Ery-Tab®)
Erythromycin ethylsuccinate
Erythromycin lactobionate
Erythromycin stearate (Erythrocin®)
Dosage and administration
Adults patients
Treatment
Listeriosis • Caused by L. monocytogenes
•
Maintenance: 250 mg PO QID
•
Maximum: 4,000 mg per day
Lower respiratory tract infections • Mild-to-moderate
•
Maintenance: 500 mg PO BID
•
Maximum: 4,000 mg per day
Twice daily dosing not recommended for doses above 1g/day.
Non-gonococcal urethritis • Caused by U. urealyticum
•
500 mg PO QID for 7 days
Pelvic inflammatory disease • Caused by N. gonorrhoeae
•
Start at: 500 mg IV QID for 3 days
•
Maintenance: 500 mg PO BID for 7 days
Respiratory tract infections • Caused by Mycoplasma pneumoniae
•
250 mg PO QID
SSTIs • Mild, moderate severity, caused by S. pyogenes, caused by S. aureus
•
250 mg PO QID
Upper respiratory tract infections • Mild-to-moderate, caused by S. pyogenes, caused by Streptococcus pnemoniae, caused by H. influenzae
•
250 mg PO QID
Urogenital infections in pregnant females • Caused by C. trachomatis, during pregnancy
•
500 mg PO QID for 7 days
On empty stomach.
Acne vulgaris • Off-label
•
250-500 mg PO BID
Treatment should ideally be limited to 3 to 4 months to minimize the risk of resistance.
Chancroid • Off-label
•
500 mg PO TID for 7 days
Adjunctive treatment
Adjunctive treatment for diphtheria
•
Maintenance: 250 mg PO QID
•
Maximum: 4,000 mg per day
Prevention
Prevention of rheumatic fever in patients with penicillin allergy
•
250 mg PO BID
Other off-label uses
•
Treatment of Lyme disease (erythema migrans)
•
Treatment of gastroparesis
•
Treatment of granuloma inguinale
•
Treatment of PPROM
•
Prevention of COPD in patients with acute exacerbations of COPD
Indications for use
Labeled indications
Adults
•
Treatment of Legionnaire's disease
•
Treatment of intestinal amebiasis
•
Treatment of listeriosis (caused by L. monocytogenes)
•
Treatment of lower respiratory tract infections (mild-to-moderate)
•
Treatment of non-gonococcal urethritis (caused by U. urealyticum)
•
Treatment of pelvic inflammatory disease (caused by N. gonorrhoeae)
•
Treatment of pertussis
•
Treatment of respiratory tract infections (caused by Mycoplasma pneumoniae)
•
Treatment of SSTIs (mild, moderate severity, caused by S. pyogenes, caused by S. aureus)
•
Treatment of syphilis (penicillin allergy)
•
Treatment of upper respiratory tract infections (mild-to-moderate, caused by S. pyogenes, caused by Streptococcus pnemoniae, caused by H. influenzae (when used concomitantly with adequate doses of sulfonamide))
•
Treatment of urogenital infections in pregnant females (caused by C. trachomatis, in patients undergoing pregnancy)
•
Adjunctive treatment for diphtheria
•
Prevention of rheumatic fever in patients with penicillin allergy
Off-label indications
Adults
•
Treatment of Lyme disease (erythema migrans)
•
Treatment of acne vulgaris
•
Treatment of chancroid
•
Treatment of gastroparesis
•
Treatment of granuloma inguinale
•
Treatment of PPROM
•
Prevention of COPD in patients with acute exacerbations of COPD
Safety risks
Contraindications
Hypersensitivity to erythromycin or any of its components or macrolides
Concomitantly with 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase inhibitors (statins)
Concomitantly with terfenadine or astemizole, cisapride, pimozide, ergotamine, or dihydroergotamine
Warnings and precautions
C. difficile infection
•
Use caution in patients with a history of diarrhea after antibiotic use.
Exacerbation of myasthenia gravis
•
Use extreme caution in patients with myasthenia gravis.
Hepatotoxicity
•
Use caution in patients receiving oral erythromycin products as erythromycin is principally excreted by the liver.
Seizures
•
Use caution in patients with a history of seizure disorder.
Ventricular arrhythmias, torsades de pointes, prolonged QT interval
•
Use extreme caution in patients with known prolongation, those with hypokalemia, and with other drugs that prolong the QT interval.
Specific populations
Renal impairment
eGFR 20-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for ototoxicity.
eGFR 10-20 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required. Monitor for ototoxicity.
eGFR < 10 mL/min/1.73 m²
•
Use with caution. Monitor for ototoxicity. Avoid peaks produced by oral twice-daily dosing, i.e. dose 4 times daily.
Renal replacement therapy
Continuous renal replacement
•
Use acceptable. No dose adjustment required. Monitor for thrombophlebitis and ototoxicity.
Intermittent hemodialysis
•
Use acceptable. No dose adjustment required. Monitor for thrombophlebitis and ototoxicity.
Peritoneal dialysis
•
Use acceptable. No dose adjustment required. Monitor for thrombophlebitis and ototoxicity.
Hepatic impairment
Any severity
•
Use with caution. Monitor serum aminotransferases.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: A
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in humans. Observational studies in pregnant women have reported cardiovascular malformations after exposure to systemic erythromycin in early pregnancy.
•
Macrolide use in the first trimester was associated with increased risk of any malformation, and in particular, cardiovascular malformations.
•
Borderline association with gastrointestinal malformations was observed. Macrolide use in any trimester was associated with an increased risk of genital malformations, mainly hypospadias. Additionally, in another large population-based cohort study (n = 139,938 live births) assessing systemic antibiotic exposure during the first trimester of pregnancy and the risk of major birth defects, macrolide exposure was associated with an increased risk of digestive system malformations.
•
Erythromycin use was also associated with an increased risk of urinary system malformations.
Breastfeeding
Acceptable for use during breastfeeding.
Unknown drug levels in breastfed infants.
May potentially cause adverse effects in breastfed infants.
Adverse reactions
Common 1-10%
•
Acute pancreatitis, cardiac arrest, erythema multiforme, hepatitis, ↑ liver enzymes, interstitial nephritis, jaundice, ↑QT interval, pyloric stenosis, abdominal pain, diarrhea, hearing loss, itching, loss of appetite, nausea, seizure, vomiting, skin dryness, skin erythema, Stevens-Johnson syndrome, torsade de pointes, toxic epidermal necrolysis
Uncommon < 1%
•
↓ WBC count, ↓ platelet count, ↑ blood eosinophil count
Unknown frequency
•
Pseudomembranous colitis, skin rash, urticaria, ventricular arrhythmia
Interactions
Drug(s)
Check Interactions
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