Erythromycin

What is Erythromycin?

• Erythromycin is an oral macrolide antibiotic used to treat certain infections caused by bacteria, such as infections of the respiratory tract, including bronchitis, pneumonia, Legionnaires' disease (a type of lung infection), and pertussis (whooping cough; a serious infection that can cause severe coughing); diphtheria (a serious infection in the throat); sexually transmitted diseases (STD), including syphilis; and ear, intestine, gynecological, urinary tract, and skin infections. It also is used to prevent recurrent rheumatic fever.

Erythromycin A skeletal

Erythromycin 3d structure

What are the uses of this medicine?

Erythromycin tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the diseases listed below:

• Upper respiratory tract infections of mild to moderate degree caused by Streptococcus pyogenes; Streptococcus pneumoniae; Haemophilus influenzae.
• Lower respiratory tract infections of mild to moderate severity caused by Streptococcus pyogenes or Streptococcus pneumoniae.
• Listeriosis caused by Listeria monocytogenes.
• Respiratory tract infections due to Mycoplasma pneumoniae.
• Skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus
• Pertussis (whooping cough) caused by Bordetella pertussis.
• Infections due to Corynebacterium diphtheriae
• In the treatment of infections due to Corynebacterium minutissimum (Erythrasma).
• Intestinal amebiasis caused by Entamoeba histolytica (oral erythromycins only)
• Acute pelvic inflammatory disease caused by Neisseria gonorrhoeae
• infections caused by Chlamydia trachomatis
• Primary syphilis caused by Treponema pallidum
• Legionnaires' Disease caused by Legionella pneumophila.

• When tetracyclines are contraindicated or not tolerated, erythromycin is indicated for the treatment of nongonococcal urethritis caused by Ureaplasma urealyticum.

As Prophylaxis:

• Prevention of Initial Attacks of Rheumatic Fever.
• Prevention of Recurrent Attacks of Rheumatic Fever.

How does this medicine work?

• Erythromycin (e rith" roe mye' sin) is a semisynthetic macrolide antibiotic used widely for many decades to treat mild-to-moderate bacterial infections caused by sensitive agents.
• Erythromycin acts by inhibition of protein synthesis by binding 50 S ribosomal subunits of susceptible organisms.
• It does not affect nucleic acid synthesis.

Who Should Not Use this medicine ?

This medicine cannot be used in patients with:

• known hypersensitivity to this antibiotic.
• in patients taking terfenadine, astemizole, pimozide, or cisapride.

What drug interactions can this medicine cause?

• Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

Be sure to mention any of the following:

• astemizole (Hismanal), cisapride (Propulsid), dihydroergotamine (DHE 45, Migranal), ergotamine (Ergomar, in Cafergot, in Migergot), pimozide (Orap), or terfenadine (Seldane)
• alprazolam (Xanax), amlodipine (Norvasc, in Caduet, in Lotrel), anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven), bromocriptine (Cycloset), carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), cilostazol (Pletal), colchicine (Colcrys, Mitigare), cyclosporine (Neoral, Sandimmune), digoxin (Lanoxin), diltiazem (Cardizem, Cartia, Diltzac, Tiazac), disopyramide (Norpace), dofetilide (Tikosyn), lovastatin (Altoprev), midazolam, phenytoin (Dilantin, Phenytek), procainamide (Procanbid), quinidine, sildenafil (Revatio, Viagra), simvastatin (Zocor, in Vytorin), sotalol (Betapace), valproic acid (Depakene, Depakote), verapamil (Calan, Covera, in Tarka, Verelan), theophylline (Elixophyllin, Theochron, Theo-Dur), and triazolam (Halcion).

Is this medicine FDA approved?

• Erythromycin was approved for use in the United States in 1967, and currently more than 1.5 million prescriptions are filled yearly.

How should this medicine be used?

Recommended dosage: Adults:

• The usual dosage of Erythromycin Base Filmtab is one 250 mg tablet four times daily in equally spaced doses or one 500 mg tablet every 12 hours.
• Dosage may be increased up to 4 g per day according to the severity of the infection.

Children:

• The usual dosage is 30 to 50 mg/kg/day, in equally divided doses.
• For more severe infections this dosage may be doubled but should not exceed 4 g per day.

• In the treatment of streptococcal infections of the upper respiratory tract (e.g., tonsillitis or pharyngitis), the therapeutic dosage of erythromycin should be administered for at least ten days.

Conjunctivitis of the Newborn Caused by Chlamydia trachomatis:

• Oral erythromycin suspension 50 mg/kg/day in 4 divided doses for at least 2 weeks.

Pneumonia of Infancy Caused by Chlamydia trachomatis:

• Although the optimal duration of therapy has not been established, the recommended therapy is oral erythromycin suspension 50 mg/kg/day in 4 divided doses for at least 3 weeks.

Urogenital Infections During Pregnancy Due to Chlamydia trachomatis:

• Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of erythromycin by mouth four times a day on an empty stomach for at least 7 days.
• For adults with uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis, when tetracycline is contraindicated or not tolerated
• 500 mg of erythromycin by mouth four times a day for at least 7 days.

Primary Syphilis:

• 30 to 40 g given in divided doses over a period of 10 to 15 days.
• For patients with nongonococcal urethritis caused by Ureaplasma urealyticum when tetracycline is contraindicated or not tolerated
• 500 mg of erythromycin by mouth four times a day for at least seven days.

Acute Pelvic Inflammatory Disease Caused by N. gonorrhoeae:

• 500 mg Erythrocin® Lactobionate-I.V. (erythromycin lactobionate for injection, USP) every 6 hours for 3 days, followed by 500 mg of erythromycin base orally every 12 hours for 7 days.

Intestinal Amebiasis: Adults:

• 500 mg every 12 hours or 250 mg every 6 hours for 10 to 14 days.

Children:

• 30 to 50 mg/kg/day in divided doses for 10 to 14 days.

Pertussis:

• Although optimal dosage and duration have not been established, doses of erythromycin utilized in reported clinical studies were 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days.

Legionnaires' Disease:

• Although optimal dosage has not been established, doses utilized in reported clinical data were 1 to 4 g daily in divided doses.

Administration:

• Erythromycin comes as a capsule, tablet, delayed-release (releases the medication in the intestine to prevent break-down of the medication by stomach acids) capsule, delayed-release tablet, and an oral suspension (liquid) to take by mouth.
• It usually is taken with or without food every 6 hours (four times a day), every 8 hours (three times a day), or every 12 hours (twice a day).
• Shake the suspension well before each use to mix the medication evenly.
• Swallow the capsules and tablets whole with a full glass of water; do not chew or crush them.

What are the dosage forms and brand names of this medicine?

This medicine is available in fallowing doasage form:

• As a capsule, tablet, delayed-release (releases the medication in the intestine to prevent break-down of the medication by stomach acids) capsule, delayed-release tablet, and an oral suspension (liquid) to take by mouth.

This medicine is available in fallowing brand namesː

• EES
• ERY-C
• Ery-Tab
• Erythrocin
• PCE
• Pediamycin

What side effects can this medication cause?

The most common side effects of this medicine include:

• nausea
• vomiting
• abdominal pain
• diarrhea
• anorexia
• Symptoms of hepatitis, hepatic dysfunction and/or abnormal liver function test
• pseudomembranous colitis symptoms
• QT prolongation
• ventricular arrhythmias, including ventricular tachycardia and torsades de pointes
• urticaria
• anaphylaxis
• erythema multiforme
• Stevens-Johnson syndrome
• toxic epidermal necrolysis
• pancreatitis
• convulsions
• reversible hearing loss

What special precautions should I follow?

• Patients should be counseled that antibacterial drugs including Erythromycin Base Filmtab tablets should only be used to treat bacterial infections. They do not treat viral infections (e.g., the common cold).
• Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by Erythromycin Base Filmtab tablets or other antibacterial drugs in the future.
• Since erythromycin is principally excreted by the liver, caution should be exercised when erythromycin is administered to patients with impaired hepatic function.
• There have been reports that erythromycin may aggravate the weakness of patients with myasthenia gravis.
• There have been reports of infantile hypertrophic pyloric stenosis (IHPS) occurring in infants following erythromycin therapy. 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.
• There have been reports of hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice, occurring in patients receiving oral erythromycin products.
• Rhabdomyolysis with or without renal impairment has been reported in seriously ill patients receiving erythromycin concomitantly with lovastatin. Therefore, patients receiving concomitant lovastatin and erythromycin should be carefully monitored for creatine kinase (CK) and serum transaminase levels.
• Pseudomembranous colitis has been reported with nearly all antibacterial agents, including erythromycin, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.
• Treatment with antibacterial agents alters the normal flora of the colon and may permit overgrowth of clostridia.
• Erythromycin has been linked to rare instances of acute liver injury that are usually self-limited, but can result in severe injury and death.

What to do in case of emergency/overdose?

Management of overdosage:

• In case of overdosage, erythromycin should be discontinued.
• Overdosage should be handled with the prompt elimination of unabsorbed drug and all other appropriate measures should be instituted.
• Erythromycin is not removed by peritoneal dialysis or hemodialysis.

Can this medicine be used in pregnancy?

• Pregnancy Category B.
• There are, however, no adequate and well-controlled studies in pregnant women.
• This drug should be used during pregnancy only if clearly needed.

Can this medicine be used in children?

• Safety or effectiveness of Erythromycin in pediatric patients have been established.
• Age, weight, and severity of the infection are important factors in determining the proper dosage.

What are the active and inactive ingredients in this medicine?

Active ingredients:

• ERYTHROMYCIN

Inactive Ingredients:

• COLLOIDAL SILICON DIOXIDE
• CROSCARMELLOSE SODIUM
• CROSPOVIDONE
• HYDROXYPROPYL CELLULOSE
• HYPROMELLOSES
• MAGNESIUM STEARATE
• CELLULOSE, MICROCRYSTALLINE
• POVIDONE
• POLYETHYLENE GLYCOL
• PROPYLENE GLYCOL
• SODIUM CITRATE
• SODIUM HYDROXIDE
• SORBIC ACID
• SORBITAN MONOOLEATE
• TITANIUM DIOXIDE

Who manufactures and distributes this medicine?

• Arbor Pharmaceuticals, LLC
• Atlanta, GA

What should I know about storage and disposal of this medication?

• Store below 86°F (30°C).

• Dailymed label info on Erythromycin
• FDA Erythromycin

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