Erythromycin


Full Generic Medicine Info
Dosage/Direction for Use

Oral
Prophylaxis of surgical infections
Adult: 1-2 g daily in 2-4 divided doses; may be increased up to 4 g daily for severe infections. Doses >1 g should be given in more than 2 divided doses.
Child: 30-50 mg/kg daily in 2-4 divided doses; may be doubled in severe infections.
Reconstitution: Oral: Add enough water to make 100 mL susp, shake vigorously.

Oral
Respiratory tract infections
Adult: 1-2 g daily in 2-4 divided doses; may be increased up to 4 g daily for severe infections. Doses >1 g should be given in more than 2 divided doses.
Child: 30-50 mg/kg daily in 2-4 divided doses; may be doubled in severe infections.
Reconstitution: Oral: Add enough water to make 100 mL susp, shake vigorously.

Oral
Skin and soft tissue infections
Adult: 1-2 g daily in 2-4 divided doses; may be increased up to 4 g daily for severe infections. Doses >1 g should be given in more than 2 divided doses.
Child: 30-50 mg/kg daily in 2-4 divided doses; may be doubled in severe infections.
Reconstitution: Oral: Add enough water to make 100 mL susp, shake vigorously.

Oral
Susceptible Gram-positive infections
Adult: 1-2 g daily in 2-4 divided doses; may be increased up to 4 g daily for severe infections. Doses >1 g should be given in more than 2 divided doses.
Child: 30-50 mg/kg daily in 2-4 divided doses; may be doubled in severe infections.
Reconstitution: Oral: Add enough water to make 100 mL susp, shake vigorously.

Oral
Susceptible Gram-negative infections
Adult: 1-2 g daily in 2-4 divided doses; may be increased up to 4 g daily for severe infections. Doses >1 g should be given in more than 2 divided doses.
Child: 30-50 mg/kg daily in 2-4 divided doses; may be doubled in severe infections.
Reconstitution: Oral: Add enough water to make 100 mL susp, shake vigorously.

Intravenous
Susceptible Gram-negative infections
Adult: As erythromycin lactobionate: 1-2 g daily equivalent to 25 mg/kg daily given in 2-4 divided doses, up to 4 g daily equivalent to 50 mg/kg daily in severe infections. Doses may be given as continuous or via intermittent infusion over 20-60 minutes every 6 hours. Replace with oral erythromycin after 2-7 days.
Child: 15-20 mg/kg daily divided every 6 hours. Max: 4 g daily.
Reconstitution: IV: Add 20 mL sterile water for inj to a vial labelled as containing 1 g to prepare a concentration of 50 mg/mL; further dilute with ≥100 mL of suitable diluent to a final concentration of 1-5 mg/mL.

Intravenous
Susceptible Gram-positive infections
Adult: As erythromycin lactobionate: 1-2 g daily equivalent to 25 mg/kg daily given in 2-4 divided doses, up to 4 g daily equivalent to 50 mg/kg daily in severe infections. Doses may be given as continuous or via intermittent infusion over 20-60 minutes every 6 hours. Replace with oral erythromycin after 2-7 days.
Child: 15-20 mg/kg daily divided every 6 hours. Max: 4 g daily.
Reconstitution: IV: Add 20 mL sterile water for inj to a vial labelled as containing 1 g to prepare a concentration of 50 mg/mL; further dilute with ≥100 mL of suitable diluent to a final concentration of 1-5 mg/mL.

Intravenous
Skin and soft tissue infections
Adult: As erythromycin lactobionate: 1-2 g daily equivalent to 25 mg/kg daily given in 2-4 divided doses, up to 4 g daily equivalent to 50 mg/kg daily in severe infections. Doses may be given as continuous or via intermittent infusion over 20-60 minutes every 6 hours. Replace with oral erythromycin after 2-7 days.
Child: 15-20 mg/kg daily divided every 6 hours. Max: 4 g daily.
Reconstitution: IV: Add 20 mL sterile water for inj to a vial labelled as containing 1 g to prepare a concentration of 50 mg/mL; further dilute with ≥100 mL of suitable diluent to a final concentration of 1-5 mg/mL.

Intravenous
Respiratory tract infections
Adult: As erythromycin lactobionate: 1-2 g daily equivalent to 25 mg/kg daily given in 2-4 divided doses, up to 4 g daily equivalent to 50 mg/kg daily in severe infections. Doses may be given as continuous or via intermittent infusion over 20-60 minutes every 6 hours. Replace with oral erythromycin after 2-7 days.
Child: 15-20 mg/kg daily divided every 6 hours. Max: 4 g daily.
Reconstitution: IV: Add 20 mL sterile water for inj to a vial labelled as containing 1 g to prepare a concentration of 50 mg/mL; further dilute with ≥100 mL of suitable diluent to a final concentration of 1-5 mg/mL.

Intravenous
Prophylaxis of surgical infections
Adult: As erythromycin lactobionate: 1-2 g daily equivalent to 25 mg/kg daily given in 2-4 divided doses, up to 4 g daily equivalent to 50 mg/kg daily in severe infections. Doses may be given as continuous or via intermittent infusion over 20-60 minutes every 6 hours. Replace with oral erythromycin after 2-7 days.
Child: 15-20 mg/kg daily divided every 6 hours. Max: 4 g daily.
Reconstitution: IV: Add 20 mL sterile water for inj to a vial labelled as containing 1 g to prepare a concentration of 50 mg/mL; further dilute with ≥100 mL of suitable diluent to a final concentration of 1-5 mg/mL.

Ophthalmic
Superficial ocular infections
Adult: As 0.5% oint: Apply approx 1 cm length to the affected eye(s) up to 6 times daily depending on the severity of the infection.
Child: Same as adult dose.

Ophthalmic
Prophylaxis of neonatal conjunctivitis
Child: As 0.5% oint: Instill approx 1 cm in length into each of the lower conjunctival sac.

Topical/Cutaneous
Acne vulgaris
Adult: As 2 or 4% gel/pad/soln: Apply onto affected areas 1-2 times daily. Discontinue treatment if condition worsens or if there is no improvement after 6-8 weeks.
Administration
Erythromycin base: Should be taken on an empty stomach. Best taken on an empty stomach at least 30 min & preferably 2 hr before meals.
Contraindications
Hypersensitivity. Prolonged QT interval, uncorrected hypokalaemia or hypomagnesaemia, clinically significant bradycardia. Concomitant use with astemizole, terfenadine, cisapride, pimozide, tolterodine, mizolastine, amisulpride, ergotamine or dihydroergotamine, lovastatin, simvastatin, Class 1A or III antiarrhythmic agents.
Special Precautions
Patient with risk factors for prolonged cardiac repolarisation, coronary artery disease, myasthenia gravis. Hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Fungal or bacterial superinfection (e.g. C. difficile-associated diarrhoea [CDAD]); myasthenia gravis; infantile hypertrophic pyloric stenosis; hepatotoxicity. Blood and lymphatic system disorders: Eosinophilia. Cardiac disorders: Chest pain, palpitations. Ear and labyrinth disorders: Deafness, tinnitus. Eye disorders: Mitochondrial optic neuropathy. Gastrointestinal disorders: Nausea, vomiting, abdominal pain, diarrhoea, pancreatitis. General disorders and administration site conditions: Fever, malaise. Hepatobiliary disorders: Cholestatic hepatitis, jaundice, hepatic dysfunction, hepatomegaly, hepatic failure, hepatocellular hepatitis. Immune system disorders: Allergic reactions, anaphylaxis. Investigations: Increased liver enzymes. Metabolism and nutrition disorders: Anorexia. Nervous system disorders: Convulsions, vertigo. Psychiatric disorders: Hallucinations, confusion. Renal and urinary disorders: Interstitial nephritis. Skin and subcutaneous tissue disorders: Pruritus, urticaria, exanthema, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme. Topical: burning, peeling, drying, reddening, oiliness and pruritus at the application site. Vascular disorders: Hypotension.
Potentially Fatal: QT prolongation, ventricular arrhythmias including torsades de pointes, pseudomembranous colitis.
Drug Interactions
Increased risk of hypotension with Ca channel blockers that are metabolised by CYP3A4 (e.g. verapamil, amlodipine, diltiazem). May cause a significant increase in the plasma concentration of colchicine. Decreased serum concentration with CYP3A4 inducers (e.g. rifampicin, phenytoin). May decrease the effectiveness of contraceptives. May increase the effect of oral anticoagulants (e.g. warfarin). May increase plasma concentration of benzodiazepines (e.g. midazolam). May increase the pharmacodynamic effects of zopiclone. Increased plasma concentration with cimetidine.
Potentially Fatal: Increased risk of rhabdomyolysis with simvastatin and lovastatin. May increase serum concentration and enhance QT prolongation, ventricular tachycardia or fibrillation and torsades de pointes with Class IA (e.g. procainamide, quinidine) or Class III (e.g. amiodarone, sotalol, dofetilide) antiarrhythmics, cisapride. Increased risk of serious CV events with astemizole, terfenadine, pimozide, tolterodine, mizolastine, amisulpride. Increased risk of acute ergot toxicity with ergotamine or dihydroergotamine.
Food Interaction
Decreased serum concentration with St John's wort.
Lab Interference
May give a false-positive result for urinary catecholamines, 17-hydroxycorticosteroids and 17-ketosteroids. May interfere with colorimetric assays resulting in falsely elevated AST and ALT concentrations.
Action
Erythromycin inhibits protein synthesis by binding to the 50S ribosomal subunit of susceptible organisms resulting in blockage of transpeptidation.
Absorption: Variable and unreliable due to instability in gastric acid. Time to peak plasma concentration: 1-4 hours.
Distribution: Widely distributed throughout the body tissues and fluids; diffused into CSF (minimal). Crosses the placenta and enters breast milk. Volume of distribution: 0.64 L/kg. Plasma protein binding: 70-75% (as the base), 95% (as the propionate ester).
Metabolism: Partly metabolised in the liver via N-demethylation by CYP3A4 into inactive, unidentified metabolites.
Excretion: Mainly via faeces; urine (2-15% as unchanged drug). Elimination half-life: 1.5-2.5 hours.
Storage
Intravenous: Store between 20-25°C. Ophthalmic: Store between 20-25°C. Oral: Store between 20-25°C. Topical/Cutaneous: Store between 20-25°C.
CIMS Class
Acne Treatment Preparations / Eye Anti-Infectives & Antiseptics / Macrolides / Topical Antibiotics
ATC Classification
D10AF02 - erythromycin ; Belongs to the class of topical antiinfective preparations used in the treatment of acne.
J01FA01 - erythromycin ; Belongs to the class of macrolides. Used in the systemic treatment of infections.
S01AA17 - erythromycin ; Belongs to the class of antibiotics. Used in the treatment of eye infections.
Disclaimer: This information is independently developed by CIMS based on erythromycin from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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