Erythromycin

Indications
 Oral
Susceptible infections
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Severe campylobacter enteritis
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Pertussis
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Trench fever
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Chanroid
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Chlamydial infections
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Diphtheria
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Legionnaire's disease
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Pneumonia
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Sinusitis
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Bronchitis
Adult: 1-2 g daily, 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, increased to twice the usual dose in severe cases; 2-8 yr: 1 g daily in divided doses; <2 yr: 500 mg daily in divided doses.
Renal impairment: Severe impairment: Max: 1.5 g daily.
Oral
Acne
Adult: Maintenance: 250 mg daily. Severe cases may require up to 500 mg bid.
Child: Maintenance dose: 250 mg daily, up to 500 mg bid may be used in those >12 yr. For infants with acne, 250 mg daily in 1 or 2 divided doses may be used.
Renal impairment: Severe impairment: Max dose of 1.5 g daily.
Oral
Prophylaxis against pneumococcal infections
Adult: For patients who are unable to take penicillins or sulfonamides: 250 mg bid.
Child: For patients who are unable to take penicillins or sulfonamides: 1 mth-2 yr: 125 mg bid; for older children: 250 mg bid.
Renal impairment: Adult: Severe impairment: Max: 1.5 g daily.
Oral
Prophylaxis of streptococcal infections in patients with evidence of rheumatic fever or heart disease
Adult: For patients who are unable to take penicillins or sulfonamides: 250 mg bid.
Child: For patients who are unable to take penicillins or sulfonamides: 1 mth-2 yr: 125 mg bid; for older children: 250 mg bid.
Renal impairment: Adult: Severe impairment: Max: 1.5 g daily.
Intravenous
Susceptible infections
Adult: As lactobionate: 15-20 mg/kg/day, up to 4 g/kg/day in severe infections. May be given as a continuous or 6-hrly intermittent infusion over 20-60 minutes. Replace with oral erythromycin as soon as possible.
Renal impairment: Adult: Severe impairment: Max: 1.5 g daily.
Ophthalmic
Treatment and prophylaxis of ophthalmic infections
Adult: As 0.5% ophthalmic ointment: Apply to the affected eye(s) up to 6 times daily.
Ophthalmic
Treatment and prophylaxis of neonatal conjunctivitis
Child: and neonate: As 0.5% ophthalamic ointment: Apply approximately 1 cm in length into each of the lower conjunctival sac, up to 2-6 times daily depending on the severity of the infection.
Topical/Cutaneous
Acne
Adult: As 2% gel/solution: Apply onto affected areas 1-2 times daily. Discontinue treatment if condition worsens or if there is no improvement after 6-8 wk of continuous usage.

Special Populations: Max dose in patients with renal impairment: 1.5 g daily.
Contraindications
 Hypersensitivity; porphyria; hepatic impairment; pregnancy.
Warnings / Precautions
 Increased risk of cholestatic hepatitis when treatment is >10 days or in patients with previous history of erythromycin usage. History of hepatic disorders; arrhythmias; prolonged QT interval; lactation. Monitor liver function. Avoid estolate in liver impairment. Caution when using lactobionate in patients with severe renal impairment. May aggravate muscle weakness in patients with myasthenia gravis.
Adverse Reactions
 Rash, urticaria; nausea, vomiting, GI discomfort; ototoxicity; central neurotoxicity; agranulocytosis; arrhythmias; pancreatitis.
Potentially Fatal: Hepatotoxicity, cholestatic jaundice; raised serum transaminases; eosinophilia.
Overdose Reactions
 Treatment is supportive. Erythromycin is not removed by peritoneal dialysis or haemodialysis.
Drug Interactions
 May antagonise therapeutic effects lincomycin and clindamycin. Concurrent usage may lead to increased absorption of alcohol.
Potentially Fatal: May potentiate actions of neuromuscular blockers, oral anticoagulants, ciclosporin, theophylline. Terfenadine, astemizole, cisapride toxicity increased.
See Below for More erythromycin Drug Interactions
Lab Interactions
 False-positive urinary catecholamines. Falsely elevated serum-aspartate aminotransferase values.
Food Interactions
 Increased absorption when taken with meals.
Mechanism of Actions
 Erythromycin inhibits protein synthesis by irreversibly binding to the 50S ribosomal subunit thus blocking the transpeptidation or translocation reactions of susceptible organisms resulting in stunted cell growth.
Absorption: Variable and unreliable due to instability in GI environment; may be reduced in the presence of food (as the stearate or base). Peak plasma concentrations after 1-4 hr.
Distribution: Widely distributed into body tissues and fluids, liver and spleen (high concentrations), polymorphonuclear lymphocytes and macrophages; crosses the placenta (5-20% foetal plasma concentrations) and enters the breast milk. Protein-binding: 70-75% (as the base), 95% (as the propionate ester).
Metabolism: Hepatic (demethylation).
Excretion: Via the urine (2-5% of the oral dose, 12-15% of the IV dose); 1.5-2.5 hr (elimination half-life).
Administration
 Erythromycin base: Should be taken on an empty stomach. (Best taken on an empty stomach at least ½ hr & preferably 2 hr before meals.)
Storage Conditions
 Intravenous: Store at 15-25°C. Oral susp: Refrigerate at 2-8°C. Topical/Cutaneous: Store at 15-25°C. Oral susp: Refrigerate at 2-8°C.
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.
Storage
 Intravenous: Store at 15-25°C. Oral susp: Refrigerate at 2-8°C. Topical/Cutaneous: Store at 15-25°C. Oral susp: Refrigerate at 2-8°C.
Available As
  • Erythromycin 0.1% w/w
  • Erythromycin 1% w/w
  • Erythromycin Base IP 100 mg
  • Erythromycin 100 mg
  • Erythromycin Estolate 100 mg
  • Erythromycin Estolate IP 125 mg
  • Erythromycin 125 mg
  • Erythromycin Estolate 125 mg
  • Erythromycin 2%
  • Erythromycin 2% w/v
  • Erythromycin 2% w/w
  • Erythromycin 250 mg
  • Erythromycin Stearate 250 mg
  • Erythromycin Estolate 250 mg
  • Erythromycin Estolate IP 250 mg
  • Erythromycin 3%
  • Erythromycin 3% w/w
  • Erythromycin 333 mg
  • Erythromycin 4%
  • Erythromycin 4% w/v
  • Erythromycin 4% w/w
  • Erythromycin 40 mg
  • Erythromycin 400 mg
  • Erythromycin 500 mg

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