IV PO Infections caused by susceptible organisms including:
Upper and lower respiratory tract infections,
Otitis media (with sulfonamides),
Skin and skin structure infections,
Pertussis,
Diphtheria,
Erythrasma,
Intestinal amebiasis,
Pelvic inflammatory disease,
Nongonococcal urethritis,
Syphilis,
Legionnaires' disease,
Rheumatic fever.
Useful when penicillin is the most appropriate drug but cannot be used because of hypersensitivity, including:
Streptococcal infections,
Treatment of syphilis or gonorrhea.
Topical Treatment of acne.
Action
Suppresses protein synthesis at the level of the 50S bacterial ribosome.
Therapeutic Effect(s):
Bacteriostatic action against susceptible bacteria.
Spectrum:
Active against many gram-positive cocci, including:
Streptococci,
Staphylococci.
Gram-positive bacilli, including:
Clostridioides,
Corynebacterium.
Several gram-negative pathogens, notably:
Neisseria,
Legionella pneumophila.
Mycoplasma and Chlamydia are also usually susceptible.
Pharmacokinetics
Absorption: Variable absorption from the duodenum after oral administration (dependent on salt form). Absorption of enteric-coated products is delayed. Minimal absorption may follow topical or ophthalmic use.
* CAPITALS indicate life-threatening. Underline indicate most frequent.
Interactions
Drug-Drug
Concurrent use with pimozide may ↑ levels and the risk for serious arrhythmias (concurrent use contraindicated); similar effects may occur with diltiazem, verapamil, ketoconazole, itraconazole, nefazodone, and protease inhibitors ; avoid concurrent use.
250 mg of erythromycin base or stearate = 400 mg of erythromycin ethylsuccinate
Most Infections
PO (Adults): Base, stearate– 250 mg every 6 hr, or 333 mg every 8 hr, or 500 mg every 12 hr. Ethylsuccinate– 400 mg every 6 hr or 800 mg every 12 hr.
PO (Children >1 mo): Base and ethylsuccinate– 30–50 mg/kg/day divided every 6–8 hr (max = 2 g/day as base or 3.2 g/day as ethylsuccinate). Stearate– 30–50 mg/kg/day divided every 6 hr (max = 2 g/day).
PO (Neonates ): Ethylsuccinate– 20–50 mg/kg/day divided every 6–12 hr.
IV (Adults): 250–500 mg (up to 1 g) every 6 hr.
IV (Children >1 mo): 15–50 mg/kg/day divided every 6 hr (max = 4 g/day).
Acne
Topical (Adults and Children >12 yr): 2% gel, solution, or pledgets twice daily.
Availability (generic available)
Erythromycin Base
Delayed-release capsules: 250 mg , 333 mg
Delayed–release tablets: 250 mg, 333 mg, 500 mg
Erythromycin Ethylsuccinate
Oral suspension (fruit, cherry, orange, or banana flavor): 200 mg/5 mL, 400 mg/5 mL
Tablets: 400 mg
Erythromycin Lactobionate
Powder for injection (requires reconstitution and dilution): 500 mg/vial, 1 g
Erythromycin Stearate
Film-coated tablets: 250 mg
Erythromycin Topical Preparations
Gel: 2%
Pledgets: 2%
Solution: 2%
In Combination with: benzoyl peroxide (Benzamycin). See combination drugs.
Assessment
Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.
Lab Test Considerations: Monitor liver function tests periodically on patients receiving high-dose, long-term therapy.
May cause ↑ serum bilirubin, AST, ALT, and alkaline phosphatase concentrations.
PO Administer around the clock. Erythromycin film-coated tablets (base and stearate) are absorbed better on an empty stomach, at least 1 hr before or 2 hr after meals; may be taken with food if GI irritation occurs. Enteric-coated erythromycin (base) may be taken without regard to meals. Erythromycin ethylsuccinate is best absorbed when taken with meals. Take each dose with a full glass of water.
Use calibrated measuring device for liquid preparations. Shake well before using.
Do not crush or chew delayed-release capsules or tablets; swallow whole. Erythromycin base delayed-release capsules may be opened and sprinkled on applesauce, jelly, or ice cream immediately before ingestion. Entire contents of the capsule should be taken.
Topical Cleanse area before application. Wear gloves during application.
IV Administration
IV Add 10 mL of sterile water for injection without preservatives to 250- or 500-mg vials and 20 mL to 1-g vial. Solution is stable for 7 days after reconstitution if refrigerated.
Intermittent Infusion: Diluent: Dilute in 0.9% NaCl or D5W. Concentration: 1–5 mg/mL.
Rate: Administer slowly over 20–60 min to avoid phlebitis. Assess for pain along vein; slow rate if pain occurs; apply ice and notify health care professional if unable to relieve pain.
Continuous Infusion: May also be administered as an infusion over 4 hr. Diluent: 0.9% NaCl, D5W, or LR. Concentration: 1 g/L.
Y-Site Incompatibility
amphotericin B deoxycholate
amphotericin B lipid complex
amphotericin B liposome
ascorbic acid
aztreonam
cefazolin
cefepime
cefotetan
cefoxitin
dantrolene
diazepam
diazoxide
doxycycline
furosemide
ganciclovir
indomethacin
ketorolac
metaraminol
nitroprusside
pemetrexed
pentobarbital
phenytoin
trimethoprim/sulfamethoxazole
Erythromycin Lactobionate
Y-Site Compatibility
acyclovir
alemtuzumab
alfentanil
amikacin
aminocaproic acid
aminophylline
amiodarone
anidulafungin
argatroban
atropine
azathioprine
benztropine
bivalirudin
bleomycin
bumetanide
buprenorphine
butorphanol
calcium chloride
calcium gluconate
cangrelor
carboplatin
carmustine
caspofungin
cefotaxime
ceftriaxone
cefuroxime
chlorpromazine
cisplatin
cyanocobalamin
cyclophosphamide
cyclosporine
cytarabine
dacarbazine
dactinomycin
daptomycin
daunorubicin hydrochloride
dexmedetomidine
dexrazoxane
digoxin
diltiazem
diphenhydramine
dobutamine
docetaxel
dolasetron
dopamine
doxorubicin
doxorubicin liposomal
enalaprilat
ephedrine
epinephrine
epirubicin
epoetin alfa
eptifibatide
ertapenem
esmolol
etoposide
etoposide phosphate
famotidine
fenoldopam
fentanyl
fluconazole
fludarabine
fluorouracil
folic acid
foscarnet
fosphenytoin
gemcitabine
gentamicin
glycopyrrolate
granisetron
hetastarch
hydrocortisone
hydromorphone
idarubicin
ifosfamide
imipenem/cilastatin
insulin
irinotecan
isoproterenol
labetalol
leucovorin
levofloxacin
lidocaine
lorazepam
mannitol
meperidine
mesna
methotrexate
methyldopate
methylprednisolone
metoclopramide
metoprolol
metronidazole
midazolam
milrinone
mitoxantrone
morphine
multivitamins
mycophenolate
nafcillin
nalbuphine
naloxone
nicardipine
nitroglycerin
norepinephrine
octreotide
ondansetron
oxacillin
oxaliplatin
oxytocin
paclitaxel
palonosetron
pamidronate
pancuronium
papaverine
pentamidine
perphenazine
phenylephrine
phytonadione
piperacillin/tazobactam
potassium acetate
potassium chloride
procainamide
prochlorperazine
promethazine
propranolol
protamine
pyridoxine
sodium acetate
sodium bicarbonate
streptokinase
succinylcholine
sufentanil
tacrolimus
theophylline
thiamine
thiotepa
tigecycline
tirofiban
tobramycin
topotecan
vancomycin
vasopressin
vecuronium
verapamil
vinblastine
vincristine
vinorelbine
vitamin B complex with C
voriconazole
zidovudine
zoledronic acid
Y-Site Incompatibility
amphotericin B deoxycholate
amphotericin B lipid complex
amphotericin B liposome
ascorbic acid
aztreonam
cefazolin
cefepime
cefotetan
cefoxitin
dantrolene
diazepam
diazoxide
doxycycline
furosemide
ganciclovir
indomethacin
ketorolac
metaraminol
nitroprusside
pemetrexed
pentobarbital
phenytoin
trimethoprim/sulfamethoxazole
Patient/Family Teaching
Instruct patient to take medication around the clock and to finish the drug completely as directed, even if feeling better. Take missed doses as soon as remembered, with remaining doses evenly spaced throughout day. Advise patient that sharing of this medication may be dangerous.
May cause nausea, vomiting, diarrhea, or stomach cramps; notify health care professional if these effects persist or if severe abdominal pain, yellow discoloration of the skin or eyes, darkened urine, pale stools, or unusual tiredness develops. May cause infantile hypertrophic pyloric stenosis in infants; notify health care professional if vomiting and irritability occur.
Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several wk after discontinuation of medication.
Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools).
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
Instruct patient to notify health care professional if symptoms do not improve.
Evaluation/Desired Outcomes
Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
Improvement of acne lesions.
ERYTHROMYCIN† is a sample topic from the Davis's Drug Guide.
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