Erythromycin Dosage

Usual Adult Dose for Campylobacter Gastroenteritis

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Chancroid

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Lymphogranuloma Venereum

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Mycoplasma Pneumonia

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Nongonococcal Urethritis

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Otitis Media

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Pharyngitis

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Pneumonia

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Skin or Soft Tissue Infection

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Syphilis - Early

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Upper Respiratory Tract Infection

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Bronchitis

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Chlamydia Infection

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Lyme Disease

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Legionella Pneumonia

Although the dosage has not been established, clinical trials have used 1 to 4 g/day orally or IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

1 g (stearate) or 800 mg (ethylsuccinate) orally two hours before procedure, then one-half the amount six hours after initial dose.

Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations. However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.

Usual Adult Dose for Bowel Preparation

1 g (base) orally at 1, 2, and 11 PM the day before surgery (assuming 8 a.m. surgery time); given with oral neomycin 1 g and bowel evacuants.

Usual Adult Dose for Rheumatic Fever Prophylaxis

250 mg orally twice a day.

Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and sulfonamides.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

20 mg/kg (ethylsuccinate or stearate) orally two hours before procedure, then one-half the amount six hours after initial dose.

Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations. However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.

Usual Pediatric Dose for Bowel Preparation

20 mg/kg (base) orally at 1, 2, and 11 PM the day before surgery (assuming 8 a.m. surgery time); given with oral neomycin and bowel evacuants.

Usual Pediatric Dose for Pneumonia

Neonatal chlamydial conjunctivitis and pneumonia: 50 mg/kg/day orally in divided doses every 6 hours for at least 2 weeks.

Usual Pediatric Dose for Chlamydia Infection

Neonatal chlamydial conjunctivitis and pneumonia: 50 mg/kg/day orally in divided doses every 6 hours for at least 2 weeks.

Usual Pediatric Dose for Rheumatic Fever Prophylaxis

250 mg orally twice a day.

Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and sulfonamides.

Usual Pediatric Dose for Pertussis

40-50 mg/kg/day, orally, divided every 6 hours for 14 days; maximum dose: 2 g/day (not preferred agent for infants less than 1 month of age).

Renal Dose Adjustments

No adjustment required.

Liver Dose Adjustments

Since erythromycin is primarily eliminated by the liver, caution is advised when it is administered to patients with impaired hepatic function.

Dose Adjustments

No adjustment required

Dialysis

Erythromycin is not significantly removed by hemodialysis or peritoneal dialysis.

Other Comments

The total daily dosage may also be administered as two or three equally divided doses every 8 or 12 hours. However, twice-a-day dosing is not recommended when erythromycin dosages exceed 1 g/day (base, estolate, stearate) or 1.6 g/day (ethylsuccinate).

The duration of therapy depends on the nature and severity of infection. Generally, upper respiratory infections should be treated for 7 to 10 days (streptococcal infections such as tonsillitis or pharyngitis at least 10 days); otitis media for 10 to 14 days; pertussis for 14 days; pneumonia for 10 to 21 days; skin or soft tissue infection for 7 to 10 days; urogenital infections for 7 to 14 days; acute pelvic inflammatory disease for 10 to 14 days; primary syphilis for 14 days; lymphogranuloma venereum for 21 days; Lyme disease for 14 to 21 days; and Campylobacter gastroenteritis for 3 to 5 days.

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