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Erythromycin

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Erythromycin, Erythromycin Base

  • See Also
  1. Macrolide
  2. Erythromycin Ethyl Succinate (EES)
  3. Erythromycin Lactobionate
  • Indications
  1. Major indications for Erythromycin
    1. Chlamydia pneumoniae
    2. Chlamydia trachomatis
      1. Pneumoniae or Conjunctivitis
      2. Pelvic infection in pregnancy
    3. Legionella pneumophila
    4. Mycoplasma pneumoniae
    5. Bordetella pertussis
    6. Corynebacterium diphtheriae
    7. Campylobacter jejuni
  2. Other organisms covered
    1. Ureaplasma urealyticum
    2. Treponema pallidum (Syphilis)
    3. Staphylococcus
    4. Streptococcus
    5. Bacillus anthracis
    6. Clostridium species
  • Mechanism
  1. See Macrolide
  • Adverse Effects
  1. Gastrointestinal upset
  2. Nausea
  3. Cholestatic Jaundice
  4. Multiple Drug Interactions
  5. Candida Vaginitis infection
  6. Gram Negative Folliculitis
  7. Myasthenia Gravis exacerbation
  8. Hypertrophic Pyloric Stenosis (age <45 days)
  9. QT Prolongation
    1. Class effect with Macrolides
    2. Three fold increased risk of Sudden Cardiac Death while on Azithromycin
    3. Higher risk with known QTc Prolongation, Hypokalemia, Hypomagnesemia, Class IA or III Antiarrhythmics
    4. Ray (2013) N Engl J Med 366(20): 1881-90 [PubMed]
  • Drug Interactions
  1. See Macrolide
  2. Strong CYP3A4 Inhibitor
    1. Numerous Drug Interactions
  3. Warfarin
    1. May increase INR
  • Pharmacokinetics
  1. Half life: 1.5 hours
  • Dosing
  1. See Erythromycin Ethyl Succinate (EES)
  2. See Erythromycin Lactobionate
  3. See Pertussis
  4. Erythromycin Oral Preparations (Take with food to reduce GI Upset)
    1. Erythromycin Base
      1. Adult: Take 250 to 500 mg orally four times daily OR 333 mg orally three times daily
      2. Child: Take 30 to 50 mg/kg/day divided four times daily
    2. Erythromycin Ethyl Succinate (EES)
      1. Adult: 400 mg orally four times daily
      2. Child: 30-50 mg/kg/day divided orally four times daily
  5. Erythromycin Parenteral Preparation: Erythromycin Lactobionate
    1. Dose: 15 to 20 mg/kg/day IV divided every 6 hours
    2. Maximum: 4 grams
  • Safety
  1. Pregnancy Category B
  2. Considered safe in Lactation
  • Adverse Effects
  1. Myasthenia Gravis exacerbation
  2. Hypertrophic Pyloric Stenosis (age <45 days)
  3. Strong CYP3A4 Inhibitor
    1. Numerous Drug Interactions
    2. Serious interactions resulting in death have occurred
  4. Warfarin
    1. May increase INR
  5. QT Prolongation
    1. Class effect with Macrolides
    2. Three fold increased risk of Sudden Cardiac Death while on Azithromycin
    3. Higher risk with known QTc Prolongation, Hypokalemia, Hypomagnesemia, Class IA or III Antiarrhythmics
    4. Ray (2013) N Engl J Med 366(20): 1881-90 [PubMed]
  • Resources
  1. Erythromycin Base (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=ca1326d6-c5c6-4572-96b6-e56cd944799c