about Erythromycin class, uses, side effects contraindications
Erythromycin
Short Description
Erythromycin is one of the safest and most widely used antibiotics.
Category
Chemical class: Macrolide
Therapeutic class: Antiacne agent, antibiotic
Pregnancy category: B
Indications
To treat mild to moderate upper respiratory tract infections caused by Haemophilus influenzae, Streptococcus pneumoniae, or Streptococcus pyogenes (group A betahemolytic streptococcus) , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults. 250 to 500 mg (base) every 6 hr for 10 days. Children.250 to 500 mg (base) q.i.d. or 20 to 50 mg (base)/kg daily in divided doses for 10 days. For H. influenzae infections, erythromycin ethylsuccinate is administered with 150 mg/kg daily of sulfisoxazole. Maximum: Adult dosage, or 6 g daily for erythromycin ethylsuccinate. To treat lower respiratory tract infections caused by S. pneumoniae or S. pyogenes (group A beta-hemolytic streptococcus) , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults.250 to 500 mg (base) every 6 hr for 10 days. Children.250 to 500 mg (base) q.i.d. or 20 to 50 mg (base)/kg daily in divided doses for 10 days. Maximum: Adult dosage. To treat respiratory tract infections caused by Mycoplasma pneumoniae , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults.500 mg (base) every 6 hr for 5 to 10 days or up to 3 wk for severe infections. To treat mild to moderate skin and softtissue infections caused by S. pyogenes or Staphylococcus aureus , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults. 250 mg (base) every 6 hr or 500 mg (base) every 12 hr for 10 days. Maximum: 4 g (base) daily. Children. 250 to 500 mg (base) q.i.d. or 20 to 50 mg (base)/kg daily in divided doses for 10 days. Maximum: Adult dosage. To treat acne vulgaris DELAYED-RELEASE , DELAYED-RELEASE , Adults and adolescents. Initial: 250 mg (base) every 6 hr, 333 mg (base) every 8 hr, or 500 mg (base) every 12 hr for 4 wk. Maintenance: 333 to 500 mg (base) daily. To treat pertussis (whooping cough) caused by Bordetella pertussis , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV: Children.500 mg (base) q.i.d. or 40 to 50 mg (base)/kg daily in divided doses for 5 to 14 days. To treat diphtheria , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV: Adults and children.500 mg (base) every 6 hr for 10 days. To treat erythrasma , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV: Adults and children.250 mg (base) t.i.d. for 21 days. To treat intestinal amebiasis , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults.250 mg (base) every 6 hr for 10 to 14 days. Children. 30 to 50 mg (base)/kg daily in erythromycin 387 E F divided doses for 10 to 14 days To treat pelvic inflammatory disease caused by Neisseria gonorrhoeae , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults.500 mg (base) I.V. every 6 hr for 3 days and then 250 mg (base) P.O. or I.V. every 6 hr for 7 days. To treat conjunctivitis in newborns
IV: Neonates.50 mg (base)/kg daily in 4 divided doses for 14 days. To treat pneumonia in neonates
IV: Neonates.50 mg (base)/kg daily in divided doses for 21 days. To treat urogenital infections caused by Chlamydia trachomatis during pregnancy ,CHEWABLE ,DELAYED-RELEASE ,DELAYED-RELEASE , ORAL SUSPENSION,
Adults. 500 mg (base) on an empty stomach every 6 hr for 7 days; or 250 mg (base) on an empty stomach every 6 hr for at least 14 days. To treat nongonococcal urethritis or uncomplicated urethral, endocervical, or rectal infections caused by C. trachomatis , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,
Adults.500 mg (base) every 6 hr for 7 days. If patient can’t tolerate high doses, 250 mg (base) every 6 hr for 14 days. To treat primary syphilis ,CHEWABLE ,DELAYED-RELEASE ,DELAYED-RELEASE , ORAL SUSPENSION,
Adults. 20 to 40 g (base) in divided doses over 10 to 15 days. To treat Legionnaire’s disease , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults.1 to 4 g (base) daily in divided doses for 10 to 14 days. To treat rheumatic fever , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION, ,
IV
Adults.250 mg (base) every 12 hr. To prevent bacterial endocarditis in patients with penicillin allergy who plan dental or upper respiratory tract surgery , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION, ,
IV
Adults.1 g (base) given 1 to 2 hr before procedure and then 500 mg (base) 6 hr after initial dose. Children.20 mg (base)/kg given 2 hr before procedure and then 10 mg (base)/kg 6 hr after initial dose. To treat listeriosis , CHEWABLE , DELAYED-RELEASE , DELAYED-RELEASE , ORAL SUSPENSION,,
IV:
Adults.250 mg (base) every 6 hr or 500 mg (base) every 12 hr. Maximum: 4 g (base) daily.
Mechanism of Action
Binds with the 50S ribosomal subunit of the 70S ribosome in many types of aerobic, anaerobic, gram-positive, and gram-negative bacteria. This action inhibits RNAdependent protein synthesis in bacterial cells, causing them to die.
Contraindications
Astemizole, cisapride, pimozide, or terfenadine therapy; hypersensitivity to erythromycin, macrolide antibiotics, or their components; hepatic disease (erythromycin estolate)
Interactions
alfentanil: Decreased alfentanil clearance, prolonged alfentanil action astemizole, cisapride, terfenadine: Increased risk of cardiotoxicity, torsades de pointes, ventricular tachycardia, and death atorvastatin, lovastatin, pravastatin, simvastatin: Increased risk of rhabdomyolysis carbamazepine,
valproic acid: Possibly inhibited metabolism of these , increasing their blood levels and risk of toxicity chloramphenicol, lincomycins: Antagonized effects of these cyclosporine: Increased risk of nephrotoxicity digoxin: Increased serum digoxin level and risk of digitalis toxicity diltiazem, verapamil: Increased risk of lifethreatening cardiac events ergotamine: Decreased ergotamine metabolism, increased risk of vasospasm from erythromycin 388 ergotamine use hepatotoxic : Increased risk of hepatotoxicity midazolam, triazolam: Increased pharmacologic effects of these oral contraceptives: Failed contraception, hepatotoxicity ototoxic : Increased risk of ototoxicity if patient with impaired renal function receives high doses of erythromycin penicillins: Interference with bactericidal effects of penicillins
sildenafil: Increased effects of sildenafil
warfarin: Prolonged PT and risk of hemorrhage, especially in elderly patients xanthines (except dyphylline): Increased serum theophylline level and risk of theophylline toxicity
alcohol use: Increased alcohol level (by 40%) with I.V. erythromycin
Side Efect
CNS: Fatigue, fever, malaise, weakness
CV: Prolonged QT interval, torsades de pointes, ventricular arrhythmias
EENT: Hearing loss, oral candidiasis
GI: Abdominal cramps and pain, diarrhea, hepatotoxicity, nausea, pseudomembranous colitis, vomiting
GU: Vaginal candidiasis
MS: New or aggravated myasthenia gravis syndrome
SKIN: Erythema, jaundice, pruritus, rash
Other: Fluid overload (from I.V. infusion), injection site inflammation and phlebitis
Cautions
Use erythromycin cautiously in patients with impaired hepatic function because drug is metabolized by the liver. Use erythromycin cautiously in elderly patients, especially those with renal or hepatic dysfunction, because these patients are at increased risk of hearing loss and torsades de pointes. They’re also at increased risk of bleeding if taking an oral anticoagulant. Before giving first erythromycin dose, expect to obtain body fluid or tissue sample for culture and sensitivity testing. Reconstitute parenteral form before administration. Add at least 10 ml of preservative-free sterile water for injection to each 500-mg vial or at least 20 ml of diluent to each 1-g vial. For prolonged infusion, expect to infuse a buffered solution up to 24 hours after dilution. For intermittent infusion, dilute dose in 100 to 250 ml normal saline solution or D5W if needed; give slowly over 20 to 60 minutes. When giving I.V. erythromycin gluceptate, dilute the solution if needed to 1 g/L in normal saline solution or D5W injection for slow, continuous infusion. Diluted solution remains potent for 7 days if refrigerated. When giving I.V. erythromycin lactobionate, dilute the solution if needed to 1 to 5 mg/ml in normal saline solution, lactated Ringer’s solution, or other electrolyte solution for slow, continuous infusion. Diluted solution remains potent for 14 days if refrigerated and for 24 hours at room temperature. Be aware that infusions prepared in piggyback infusion bottles stay potent for 30 days if frozen, 24 hours if refrigerated, or 8 hours at room temperature. Don’t store infusions prepared in the ADDvantage system. Don’t use diluent with benzyl alcohol if parenteral erythromycin is for a neonate. It may cause a fatal toxic syndrome of CNS depression, hypotension, metabolic acidosis, renal failure, respiratory problems, and, possibly, seizures and intracranial hemorrhage. Periodically monitor liver function test results to detect hepatotoxicity, which is most common with erythromycin estolate. Signs typically appear within 2 weeks after continuous therapy starts and resolve when it stops. Assess hearing regularly, especially in elderly patients and those who receive 4 g or more daily or have hepatic or renal disease. Hearing impairment begins 36 hours to 8 days after treatment starts and usually begins to improve 1 to 14 days after it stops. During I.V. therapy, watch for evidence of fluid overload, such as acute dyspnea and crackles. Monitor infants for vomiting or irritability with feeding because infantile hypertrophic pyloric stenosis has been reported. erythromycin 389 E F Assess myasthenia gravis patients for weakness because drug may aggravate it. Keep in mind that myasthenic syndrome may arise in patients previously undiagnosed with myasthenia gravis. Watch closely for signs and symptoms of superinfection. If they occur, notify prescriber and expect to stop drug and provide appropriate therapy. Monitor patient for diarrhea during and for at least 2 months after erythromycin therapy; diarrhea may signal pseudomembranous colitis caused by Clostridium difficile. If diarrhea occurs, notify prescriber and expect to withhold drug and treat with fluids, electrolytes, protein, and an antibiotic effective against C. difficile. If patient receives an order for urine catecholamine analysis, notify prescriber because erythromycin interferes with fluorometric measurement of urine catecholamines. PATIENT SAFTY
Urge patient to complete prescribed therapy, even if he feels better before it’s finished. Tell patient to notify prescriber if symptoms worsen or don’t improve after a few days. Teach patient how to administer prescribed form of erythromycin. Instruct him to swallow capsules or tablets whole. For an oral suspension, teach him to use the calibrated measuring device provided to ensure accurate doses. Remind him to shake the suspension before measuring a dose. Advise patient to take oral form of erythromycin with a full glass of water on an empty stomach (except erythromycin ethylsuccinate, which is better absorbed with food). If GI distress occurs, instruct patient to take oral form with food. Instruct patient to promptly notify prescriber if he develops allergic reactions, hearing changes, or signs of hepatic dysfunction. Urge patient to tell prescriber about diarrhea that’s severe or lasts longer than 3 days. Remind patient that watery or bloody stools can occur 2 or more months after antibiotic therapy and can be serious, requiring prompt treatment.
Trade Name & Company Name
effect of Erythromycin in Pregnancy, Fetal Health
and Breast feeding
Pregnancy
. The routine use of macrolide antibiotics prolongs the latency interval and reduces infectious morbidity in women with PPROM, but offers no such prolongation in women with preterm labor and intact membranes, and may even increase the risk of neurodevelopmental compromise. Prolongation of the latency interval is not synonymous with irradication of inflammation. In one study, the administration of both erythromycin and ampicillin rarely eradicated intra-amniotic infection in patients with PPROM. In addition, intra-amniotic inflammation developed in1=3 of women who did not have inflammation on admission despite antibiotic therapy. However, there was a subgroup of women with documented inflammation who demonstrated a decrease in the intensity of the inflammatory process after antibiotic administration. This group likely accounts for the beneficial effects of erythromycin on the latency interval. Erythromycin reduces the frequency of preterm delivery in women with either asymptomatic bacteriuria or symptomatic lower genital tract infections. However, the practice of routine screening for BV in asymptomatic women who are at low risk for preterm delivery cannot be supported based on evidence from the literature. The frequency of GBS resistance renders it a poor selection for prophylaxis. Erythromycin is an effective alternative therapy for the treatment of chlamydial infection. Partner treatment is, overall, cost-effective among women ages 15-29. Though an alternative for the treatment of syphilis in penicillin- allergic patients, placental transport is low (<5%). Thus, erythromycin is not recommended for the treatment of syphilis during pregnancy. Penicillin-allergic women should be desensitized. Recently, a relationship between oral erythromycin and sudden cardiac death was reported in patients also receiving strong inhibitors of CYP3A such as nitroimidazole antifungal agents, diltiazem, verapamil, and troleandomycin; each doubles, at least, the AUC for a CYP3A substrate. The potential implication for obstetrics is real with the growing use of nifedipine as a tocolytic agent in women who may also be treated with antibiotics for preterm PROM. Although not included in the referenced study, nifedipine is also a substrate for CYP3A, suggesting the likelihood for some interaction is high. Fetal Health
There are no adequate reports or well-controlled studies in human fetuses. Erythromycin crosses the human placenta, achieving an F:M concentration ratio of 0.3. Breastfeeding
There are no adequate reports or well-controlled studies in nursing women. Erythromycin is excreted into human breast milk, achieving an M:P ratio approximating unity. Rodent studies are reassuring, revealing no evidence of teratogenicity or IUGR despite the use of doses higher than those used clinically. 359
the follwing drugs will increse Erythromycin by inhepiting cyp450
the follwing drugs will decrease Erythromycin by inhancing cyp450
trad drugs based on Erythromycin
| Gen name | Trade name | Catagory name |
| benzoyl peroxide / erythromycin | Aktipak | Topical acne agents |
| benzoyl peroxide / erythromycin | Benzamycin | Topical acne agents |
| benzoyl peroxide / erythromycin | Benzamycin Pak | Topical acne agents |
| erythromycin | A/T/S | Topical acne agents |
| erythromycin | A/T/S | Topical anti-rosacea agents |
| erythromycin | Akne-Mycin | Topical acne agents |
| erythromycin | Akne-Mycin | Topical anti-rosacea agents |
| erythromycin | E.E.S. Granules | Macrolides |
| erythromycin | Emcin Clear | Topical acne agents |
| erythromycin | Emcin Clear | Topical anti-rosacea agents |
| erythromycin | Emgel | Topical acne agents |
| erythromycin | Emgel | Topical anti-rosacea agents |
| erythromycin | Ery Pads | Topical acne agents |
| erythromycin | Ery Pads | Topical anti-rosacea agents |
| erythromycin | Ery-Tab | Macrolides |
| erythromycin | Eryc | Macrolides |
| erythromycin | Erycette | Topical acne agents |
| erythromycin | Erycette | Topical anti-rosacea agents |
| erythromycin | Eryderm | Topical acne agents |
| erythromycin | Eryderm | Topical anti-rosacea agents |
| erythromycin | Erygel | Topical acne agents |
| erythromycin | Erygel | Topical anti-rosacea agents |
| erythromycin | EryPed | Macrolides |
| erythromycin | Erythra-Derm | Topical acne agents |
| erythromycin | Erythra-Derm | Topical anti-rosacea agents |
| erythromycin | Erythrocin | Macrolides |
| erythromycin | Erythrocin Lactobionate | Macrolides |
| erythromycin | Eyemycin | Ophthalmic anti-infectives |
| erythromycin | Ilosone | Macrolides |
| erythromycin | Ilotycin | Ophthalmic anti-infectives |
| erythromycin | PCE Dispertab | Macrolides |
| erythromycin | Roymicin | Ophthalmic anti-infectives |
| erythromycin | Spotex | Topical acne agents |
| erythromycin | Spotex | Topical anti-rosacea agents |
| erythromycin | Staticin | Topical acne agents |
| erythromycin | Staticin | Topical anti-rosacea agents |
| erythromycin | T-Stat | Topical acne agents |
| erythromycin | T-Stat | Topical anti-rosacea agents |
| erythromycin | Theramycin Z | Topical acne agents |
| erythromycin | Theramycin Z | Topical anti-rosacea agents |
| erythromycin / sulfisoxazole | Eryzole | Miscellaneous antibiotics |
| erythromycin / sulfisoxazole | Pediazole | Miscellaneous antibiotics |
| Erythromycin | ERYSOL 2% TOPICAL LOTION | |
| Erythromycin | ERYTHROCIN IV 500MG VIAL | |
| Erythromycin | ERYTHROCIN PCE 333MG TAB | |
| Erythromycin | ERYTHROCIN TAB.?250 MG. | |
| Erythromycin | ERYTHROCIN TAB.?500mg. | |
| Erythromycin | ERYTHRODAR | |
| Erythromycin | ERYTHRODAR 400MG FORT TAB | |
| Erythromycin | ERYTHROMIL 250MG TAB | |
| Erythromycin | ERYTHROMIL FORTE 400MG-5MLSUSP. | |
| Erythromycin | OFTALMOLOSA 0.5% | |
| Erythromycin | OMATHROCIN ORAL DROPS 100 MG- 2.5 ML | |
| Erythromycin | RYTHINATE SUSP.?200MG-5ML | |
other drugs from same cataogory