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Erythromycins (Systemic)

This monograph includes information on the following:

1) Erythromycin Base
2) Erythromycin Estolate
3) Erythromycin Ethylsuccinate
4) Erythromycin Gluceptate
5) Erythromycin Lactobionate
6) Erythromycin Stearate

BAN:
Erythromycin ethylsuccinate—Erythromycin ethyl succinate

VA CLASSIFICATION
Erythromycin Base
Primary: AM200
Secondary: DE751

Erythromycin Estolate
Primary: AM200
Secondary: DE751

Erythromycin Ethylsuccinate
Primary: AM200
Secondary: DE751

Erythromycin Gluceptate
Primary: AM200

Erythromycin Lactobionate
Primary: AM200

Erythromycin Stearate
Primary: AM200
Secondary: DE751


Commonly used brand name(s): Apo-Erythro1; Apo-Erythro E-C1; Apo-Erythro-ES3; Apo-Erythro-S6; E-Base1; E-Mycin1; E.E.S.3; ERYC1; ERYC-2501; ERYC-3331; Ery-Tab1; EryPed3; Erybid1; Erythro3; Erythrocin5; Erythrocot6; Erythromid1; Ilosone2; Ilotycin1; My-E6; Novo-Rythro3; Novo-rythro2; Novo-rythro Encap1; PCE1; Wintrocin6.

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).



Category:


Antibacterial (systemic)—Erythromycin Base; Erythromycin Estolate; Erythromycin Ethylsuccinate; Erythromycin Gluceptate; Erythromycin Lactobionate; Erythromycin Stearate;

Antiacne agent—Erythromycin Base; Erythromycin Estolate; Erythromycin Ethylsuccinate; Erythromycin Stearate;

Bowel preparation (preoperative) adjunct—Erythromycin Base;

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

General considerations
Erythromycin is a broad-spectrum antibiotic with activity against gram-positive and gram-negative bacteria, and other infectious agents, including Chlamydia trachomatis , mycoplasmas (Mycoplasma pneumoniae and Ureaplasma urealyticum), and spirochetes(Treponema pallidum and Borrelia species).

Erythromycin has good activity against Streptococcus pneumoniae , S. pyogenes (group A beta-hemolytic streptococci), and Staphylococcus aureus . Resistant strains of both streptococci have been encountered, especially in populations recently exposed to erythromycin. {139} The incidence of resistance to group A streptococci has ranged from 1 to 18% in small studies to up to 60% in a population that had been widely treated with erythromycin for respiratory infections. {135} {136} {139} Most strains of S. aureus are currently sensitive to erythromycin. However, the incidence of resistance is increasing. Resistance may develop to erythromycin alone, or may be the result of cross-resistance to other macrolides. {139}

Erythromycin also has good activity against certain gram-negative bacteria, including Legionella pneumophila , Campylobacter jejuni , and Bordetella pertussis , and somewhat lower activity against Haemophilus influenzae . There is activity against some gram-negative anaerobes, but most strains of Bacteroides fragilis are resistant. Enterobacteriaceae are usually resistant. {139}

Accepted

Bowel preparation, preoperative—Enteric-coated erythromycin base is indicated concurrently with oral-local neomycin as part of an adjunctive regimen for the suppression of normal bacterial flora in the preoperative preparation of the bowel. {17} {21} {26} {133} {134}

Bronchitis, bacterial exacerbations (treatment)
Otitis media, acute (treatment) or
Sinusitis (treatment)—Erythromycins are indicated in the treatment of bacterial exacerbations of bronchitis and in the treatment of sinusitis caused by susceptible organisms. Erythromycins are indicated concurrently with sulfonamides in the treatment of acute otitis media caused by susceptible organisms. {64} {79}

Chlamydial infections, endocervical and urethral (treatment)—Erythromycins are indicated in the treatment of endocervical and urethral chlamydial infections caused by Chlamydia trachomatis . {63} {79} Erythromycins are recommended for the treatment of chlamydia in pregnant women. {23} {128} However, erythromycin estolate is contraindicated in pregnancy because of drug-related hepatotoxicity. {23}

Conjunctivitis, chlamydial (treatment) or
Pneumonia, chlamydial (treatment)—Erythromycins are indicated in the treatment of conjunctivitis in newborns and pneumonia in infants caused by Chlamydia trachomatis . {63} {79} The efficacy of erythromycin treatment for these uses is approximately 80%; a second course of therapy may be required. {23}

Diphtheria (prophylaxis and treatment)—Erythromycins are indicated as an adjunct to antitoxin, to prevent establishment of chronic carriers and to eradicate the organsim in carriers of diphtheria caused by Corynebacterium diphtheriae . {35} {64}

Endocarditis, bacterial (prophylaxis)—Erythromycins are indicated in the prophylaxis of bacterial endocarditis in penicillin-allergic patients who have congenital heart disease, rheumatic or other acquired valvular heart disease, prosthetic heart valves, previous bacterial endocarditis, hypertrophic cardiomyopathy, mitral valve prolapse with valvular regurgitation, and who undergo certain dental or surgical procedures. {09} {14} {63}

Erythrasma (treatment)—Erythromycins are indicated in the treatment of erythrasma caused by Corynebacterium minutissimum . {08} {63}

Gonorrhea, endocervical (treatment) or
Gonorrhea, urethral (treatment)—Erythromycins are indicated in the treatment of gonorrhea caused by Neisseria gonorrhoeae {63}; cephalosporins and fluoroquinolones are recommended for first-line treatment. {23}

Legionnaires' disease (treatment)— Erythromycins are indicated in the treatment of Legionnaires" disease caused by Legionella pneumophila . {63} {125}

Listeriosis (treatment)—Erythromycins are indicated in the treatment of listeriosis caused by Listeria monocytogenes . {63} {139}

Pertussis (treatment)—Erythromycins are indicated in the treatment of pertussis (whooping cough) caused by Bordetella pertussis . {63} {129}

Pharyngitis, streptococcal (treatment)—Erythromycins are indicated in the treatment of pharyngitis caused by Streptococcus pyogenes (group A beta-hemolytic streptococci) in patients allergic to penicillin. {64} {139}

Pneumonia, mycoplasmal (treatment) or
Pneumonia, pneumococcal (treatment)—Erythromycins are indicated in the treatment of pneumonia caused by Mycoplasma pneumoniae and Streptococcus pneumoniae . {27} {79} {80}

Rheumatic fever (prophylaxis)—Erythromycins are indicated as an alternative to penicillin in the long-term prophylaxis of rheumatic fever. {06} {34}

Skin and soft tissue infections (treatment)—Erythromycins are indicated in the treatment of skin and soft tissue infections, including burn wound infections, caused by S. pyogenes (group A beta-hemolytic streptococci). {06} {63}

Syphilis (treatment)—Erythromycins are indicated in the treatment of syphilis caused by Treponema pallidum in penicillin-allergic patients. {68} {79} {86} However, erythromycin is less effective than other recommended regimens {23}, and its use in pregnancy has failed to prevent congenital syphilis. {126}

Urethritis, nongonococcal (treatment)—Erythromycins are indicated in the treatment of nongonococcal urethritis caused by Chlamydia trachomatis and Ureaplasma urealyticum {23} {81} {127}.

[Acne vulgaris (treatment)]—Oral erythromycins are used in the treatment of acne vulgaris. {31} {122}

[Actinomycosis (treatment)]1; {27} {139}
[Anthrax (treatment)]1; {27} {139}
[Chancroid (treatment)]1; {23} {123} {124}
[Lymphogranuloma venereum (treatment) ]1; {23} {79} or
[Relapsing fever (treatment)]1 {28} {139}—Erythromycins are used in the treatment of actinomycosis, anthrax, chancroid, lymphogranuloma venereum, and relapsing fever caused by Borrelia species.

[Enteritis, Campylobacter (treatment)]1—Erythromycins are used in the treatment of enteritis caused by Campylobacter jejuni . {27} Erythromycin therapy shortened the excretion of C. jejuni in the feces, but had no effect on the clinical course of the disease. {130} {131} {132}

[Gastroparesis (treatment)]1—Erythromycins are used in the treatment of gastroparesis, including severe diabetic gastroparesis, gastroparesis associated with progressive systemic sclerosis, and postvagotomy gastroparesis. {101} {102} {103} {104} {105} Intravenous erythromycin appears to be more effective than oral erythromycin at increasing gastric emptying. {84} {89} {93}

[Lyme disease (treatment)]1—Erythromycins are used in the treatment of early stage Lyme disease in patients who are allergic to penicillin and in children under 9 years of age; however, erythromycins may be less effective than amoxicillin or doxycycline, possibly due to erratic absorption. {40} {120} {121}

—Not all species or strains of a particular organism may be susceptible to erythromycins.

1 Not included in Canadian product labeling.



Pharmacology/Pharmacokinetics

Physicochemical characteristics:
Molecular weight—
    Erythromycin base: 733.94 {59}
    Erythromycin estolate: 1056.39 {59}
    Erythromycin ethylsuccinate: 862.06 {59}
    Erythromycin gluceptate: 960.12 {59}
    Erythromycin lactobionate: 1092.23 {59}
    Erythromycin stearate: 1018.42 {59}

Mechanism of action/Effect:

Antibacterial—Erythromycin is a bacteriostatic macrolide antibiotic. However, it may be bactericidal in high concentrations or when used against highly susceptible organisms. {100} {139} It is thought to penetrate the bacterial cell membrane and to reversibly bind to the 50 S subunit of bacterial ribosomes {100}; it does not directly inhibit peptide formation, but rather inhibits the translocation of peptides from the acceptor site on the ribosome to the donor site, inhibiting subsequent protein synthesis. {68} Erythromycin is effective only against actively dividing organisms. {100}

Gastroparesis—Erythromycin is thought to bind to motilin receptors and to act as an agonist. {84} {93} {94} Erythromycin administration accelerates gastric emptying by increasing the amplitude of antral contractions and improving antroduodenal coordination. The effect appears to be dose-related. {84} {93} In patients with diabetic gastroparesis, low intravenous doses (40 mg) induce phase 3 of the migrating motor complex in the antrum of the stomach; and higher doses (200 mg) elicit prolonged periods of strong antral contractions. {84} Faster emptying from the proximal stomach contributes to more rapid gastric emptying. {93}

Absorption:

Bioavailability varies between 30 and 65%, depending on the salt. {138} Erythromycin film-coated tablets (base and stearate) are subject to gastric acid inactivation and are best absorbed on an empty stomach. {02} {52} {81} However, enteric-coated erythromycin base and erythromycin estolate are acid-stable and may be taken without regard to meals {34} {81}, and erythromycin ethylsuccinate is better absorbed when taken with meals. {39}

Distribution:

Widely distributed to most tissues and fluids, including middle ear exudate, prostatic fluid, and semen. {13} Highest concentrations are found in the liver, bile, and spleen. {02} Low concentrations are found in the cerebrospinal fluid (CSF); however, penetration into CSF increases with meningeal inflammation. {76} {81}

Vol D—0.9 L per kg. {138}

Protein binding:

High (70 to 90%). {13} {81} {100}

Biotransformation:

Hepatic; > 90% is hepatically metabolized {138}, partially to inactive metabolites; may accumulate in patients with severe hepatic disease. {81}

Erythromycin estolate (lauryl sulfate salt of the propanoate ester)—Propanoate ester is partially hydrolyzed in the gastrointestinal tract, then hydrolyzed in the blood to produce 20 to 40% of the dose as base in the serum. {34} {144}

Erythromycin ethylsuccinate—Absorbed into the blood as the ethylsuccinate salt and hydrolyzed to erythromycin base in the gastrointestinal tract and in the blood to produce 56 to 69% of the dose as base in the serum. {99} {144} Also, despite the high rate of biotransformation of erythromycin ethylsuccinate to active base, the area-under-the-curve (AUC) of active base generated from the ethylsuccinate salt was 1.6 times lower than that generated from a comparable dose of erythromycin estolate. {144}

Erythromycin stearate—Dissociated to erythromycin base in the duodenum. {99}

Half-life:

Normal renal function—1.4 to 2 hours. {69} {138}

Anuric patients—Approximately 5 hours. {69}

Time to peak concentration:

2 to 4 hours, depending on the specific product (see Peak serum concentration ). {68} {81}

Peak serum concentration:


Erythromycin base:

Delayed-release capsules: Single dose of 250 mg—1.1 to 1.7 mcg per mL (mcg/mL) at 3 hours. {81}

Delayed-release tablets: Single dose of 250 mg—Approximately 0.9 mcg/mL at 4 hours. {99}

Delayed-release tablets: Multiple doses of 250 mg—Approximately 2.8 mcg/mL at 2 hours. {142}



Erythromycin estolate:

Single dose of 250 mg: Approximately 0.8 to 1.2 mcg/mL at 2 to 4 hours. {34} {99}



Erythromycin ethylsuccinate:

Single dose of 400 mg: Approximately 0.8 mcg/mL at 1 hour. {99}

Multiple doses (400 mg twice a day), fasting: Approximately 1.4 mcg/mL. {99}

Multiple doses (400 mg twice a day), with food: Approximately 3 mcg/mL. {99}



Erythromycin gluceptate:

Single dose of 200 mg: 3 to 4 mcg/mL. {06} {48}



Erythromycin lactobionate:

Single dose of 500 mg: Approximately 10 mcg/mL. {07}



Erythromycin stearate:

Single dose of 250 mg: Approximately 0.8 mcg/mL at 3 hours. {143}


Elimination:
    Biliary; primarily excreted into the bile. {02}
    Renal, by glomerular filtration; 2 to 5% excreted unchanged following oral administration; 12 to 15% excreted unchanged following intravenous administration. {02} {06} {07} {68}
    Erythromycins are not removed by hemodialysis or peritoneal dialysis. {90}


Precautions to Consider

Cross-sensitivity and/or related problems

Patients intolerant of one erythromycin or other macrolides may be intolerant of other erythromycins also. {67}

Tumorigenicity

Tumorigenicity/Mutagenicity

Long-term (20 month) oral studies done in rats did not demonstrate erythromycin base to be tumorigenic. Mutagenicity studies have not been conducted. {81}

Pregnancy/Reproduction
Fertility—
Adequate and well-controlled studies in humans have not been done.

Studies in rats fed erythromycin base at concentrations up to 0.25% of their diet found no apparent effect on male or female fertility. {81}

Pregnancy—
Erythromycins cross the placenta, resulting in low fetal plasma concentrations (5 to 20% of maternal plasma concentrations). {137} Erythromycin estolate has been associated with an increased risk of reversible, subclinical hepatotoxicity in approximately 10% of pregnant women; its use during pregnancy is not recommended. {23} However, problems with other erythromycins have not been documented. {67} {90}

There was no evidence of teratogenicity or any other adverse effect on reproduction in female rats fed erythromycin base (up to 0.25% of their diet) prior to and during mating, during gestation, and through weaning of 2 successive litters. {21}

FDA Pregnancy Category B. {21}

Breast-feeding

Erythromycins are distributed into breast milk. However, problems in humans have not been documented. {21} {67} {81}

Pediatrics

Studies performed to date have not demonstrated pediatrics-specific problems that would limit the usefulness of erythromycin in children.


Geriatrics


Studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of erythromycin in the elderly. However, elderly patients may be at increased risk of hearing loss if they also have decreased renal or hepatic function associated with aging and are receiving high doses of erythromycin.


Dental

Systemic erythromycins may lead to oral candidiasis in patients undergoing long-term therapy. {63}

Drug interactions and/or related problems
The following drug interactions and/or related problems have been selected on the basis of their potential clinical significance (possible mechanism in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):


Note: Combinations containing any of the following medications, depending on the amount present, may also interact with this medication.

Alcohol{93}    (concurrent use with intravenous erythromycin was found to increase the peak blood alcohol concentration by 40%; erythromycin is not known to affect alcohol metabolism directly, but is thought to be related to more rapid gastric emptying; less exposure to alcohol dehydrogenase in the gastric mucosa and slower small intestine transit time may also favor the increase of alcohol absorption; there may be less of an effect with oral erythromycin)


» Alfentanil{31}{111}    (chronic preoperative or perioperative use of erythromycins, which are hepatic enzyme inhibitors, may decrease the plasma clearance and prolong the duration of action of alfentanil)


» Astemizole or
» Terfenadine{02}{34}{70}{110}    (concurrent use of astemizole or terfenadine with erythromycins is contraindicated; concurrent use may increase the risk of cardiotoxicity, such as torsades de pointes and ventricular tachycardia, and death)


» Carbamazepine or
Valproic acid{31}{74}{113}{114}    (erythromycins may inhibit carbamazepine and valproic acid metabolism, resulting in increased anticonvulsant plasma concentrations and toxicity; it is recommended that erythromycins be used with caution if at all in patients receiving carbamazepine or valproic acid)


» Chloramphenicol or
» Lincomycins{34}{39}{71}    (erythromycins may displace these medications from, or prevent them from binding to, 50 S subunits of bacterial ribosomes, thus antagonizing the effects of chloramphenicol and lincomycins; concurrent use is not recommended)


» Cyclosporine{04}{67}{95}    (erythromycin has been reported to increase cyclosporine plasma concentrations and may increase the risk of nephrotoxicity)


Digoxin{77}{78}{91}{146}{147}{148}    (although no clinical cases of toxicity have been reported, concurrent use of oral antibiotics may increase serum digoxin concentrations in some individuals; in these individuals, alteration of the gut flora by antibiotics may diminish digoxin conversion to inactive metabolites, resulting in increased serum digoxin concentrations; although limited data are available, this interaction has been reported with oral use of erythromycins, neomycin, and tetracyclines)


Ergotamine{63}{77}    (erythromycin inhibits the metabolism of ergotamine and has been reported to increase the vasospasm associated with ergotamines)


» Hepatotoxic medications, other (see Appendix II ){67}    (concurrent use of other hepatotoxic medications with erythromycins may increase the potential for hepatotoxicity)


Lovastatin{108}{109}    (concurrent use of lovastatin with erythromycin may increase the risk of rhabdomyolysis, which typically occurs after the completion of erythromycin therapy; this is thought to be due to erythromycin's inhibition of lovastatin metabolism, which increases lovastatin serum concentrations; simultaneous administration of erythromycin and lovastatin should be used with caution)


Midazolam or
Triazolam{01}{21}{31}{34}{73}{100}    (concurrent use with erythromycin may decrease the clearance of these medications, increasing the pharmacological effect of midazolam or triazolam)


Ototoxic medications, other (see Appendix II ){67}    (concurrent use of other ototoxic medications with high-dose erythromycin in patients with renal function impairment may increase the potential for ototoxicity)


Penicillins{72}    (since bacteriostatic drugs may interfere with the bactericidal effect of penicillins in the treatment of meningitis or in other situations where a rapid bactericidal effect is necessary, it is best to avoid concurrent therapy)


» Warfarin{02}{115}{116}    (use of erythromycins in patients receiving chronic warfarin therapy may result in excessive prolongation of prothrombin time and increased risk of hemorrhage, especially in elderly patients, because of possible decreased warfarin metabolism and clearance; warfarin dosage adjustments may be necessary during and after therapy with erythromycins, and prothrombin times should be monitored closely)


» Xanthines, such as:
Aminophylline
Caffeine
Oxtriphylline
Theophylline{02}{34}{82}{112}    (concurrent use of the xanthines [except dyphylline] with erythromycins may decrease hepatic clearance of theophylline, resulting in increased serum theophylline concentrations and/or toxicity; this effect may be more likely to occur after 6 days of concurrent therapy because the magnitude of theophylline clearance reduction is proportional to the peak serum erythromycin concentrations; dosage adjustment of the xanthines may be necessary during and after therapy with erythromycins)



Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With diagnostic test results
Aspartate aminotransferase (AST [SGOT]){21}    (use of erythromycin may interfere with AST [SGOT] determinations if azonefast violet B or diphenylhydrazine colorimetric tests are used)


Catecholamines, urinary{39}{52}{81}    (erythromycin may produce false elevations of urinary catecholamines because of interference with the fluorometric determination)

With physiology/laboratory test values
Alanine aminotransferase (ALT [SGPT]) and
Alkaline phosphatase and
Aspartate aminotransferase (AST [SGOT]) and
Bilirubin, serum{67}{81}    (values may be increased by all erythromycins, but more commonly by erythromycin estolate)


Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).


Risk-benefit should be considered when the following medical problems exist
» Cardiac arrhythmias, history of, or QT prolongation{63}{67}{98}    (patients with a history of cardiac arrhythmias or QT prolongation may be at risk for arrhythmias or torsades de pointes while receiving high doses of erythromycin)


» Hepatic function impairment, especially with erythromycin estolate{63}{67}    (erythromycins, especially erythromycin estolate, may be hepatotoxic on rare occasion)


Hypersensitivity to erythromycins
Loss of hearing{02}{06}{07}{63}{67}    (patients with a history of hearing loss may be at increased risk of further hearing loss, especially if the patient has renal or hepatic function impairment, is elderly, and is receiving high doses of erythromycin)



Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Electrocardiogram{96}{97}{98}    (monitoring of QT interval recommended, especially in patients receiving high doses of parenteral erythromycin)


» Hepatic function determinations{09}{67}{83}    (may be required periodically if signs of hepatic dysfunction occur with any of the erythromycins; erythromycins should be discontinued promptly if signs of hepatic dysfunction occur)




Side/Adverse Effects

Note: Hepatotoxicity has been associated, rarely, with all erythromycin salts, but more frequently with erythromycin estolate. {54} Reports suggest that a hypersensitivity mechanism may be involved. Symptoms include malaise, nausea, vomiting, abdominal cramps, skin rash, and fever. Jaundice may or may not be present. Liver function tests often indicate cholestasis. Symptoms typically appear within a few days to 1 or 2 weeks after the start of continuous therapy, and are reversible when erythromycin is discontinued. {34} {54} {55} However, hepatotoxicity reappears promptly on readministration to sensitive patients. {34}
Hearing loss is more likely to occur with administration of high doses (³ 4 grams per day) in patients with renal or hepatic disease and/or in elderly patients. {69} {117} It appears to be related to high peak plasma concentrations, usually exceeding 12 mcg per mL. {69} Hearing loss is usually reversible, although irreversible deafness has occurred. It occurs from 36 hours to 8 days after treatment is started, and begins to recover within 1 to 14 days after erythromycin is discontinued. {69}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating need for medical attention
Incidence less frequent
    
Hepatotoxicity (fever; nausea; skin rash; stomach pain, severe; unusual tiredness or weakness; yellow eyes or skin; vomiting){34}{54}{55}{67}
    
hypersensitivity (skin rash, redness, or itching){02}{43}

Incidence less frequent
—parenteral erythromycins only    
Inflammation or phlebitis at the injection site{47}{49}{119}

Incidence rare
    
Cardiac toxicity, especially QT prolongation and torsades de pointes (irregular or slow heart rate; recurrent fainting; sudden death){66}{96}{97}{98}{106}{107}
    
loss of hearing, usually reversible{02}{06}{07}{67}
    
pancreatitis (severe abdominal pain, nausea, and vomiting){65}{100}{118}



Those indicating need for medical attention only if they continue or are bothersome
Incidence more frequent
    
Gastrointestinal disturbances (abdominal or stomach cramping and discomfort; diarrhea, nausea or vomiting){02}{43}

Incidence less frequent
    
Oral candidiasis (sore mouth or tongue ; white patches in mouth and/or on tongue){02}{67}
    
vaginal candidiasis (vaginal itching and discharge){01}{08}{34}{43}





Overdose
For specific information on the agents used in the management of erythromycin overdose, see:
   • Epinephrine (Systemic) monograph;
   • Corticosteroids (Inhalation-Local) monograph; and/or
   • Antihistamines (Systemic) monograph.
For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Treatment of overdose
Recommended treatment consists of the following: {09} {63} {67}

To decrease absorption—Evacuating the stomach to eliminate unabsorbed drug.

Specific treatment—Administering epinephrine, corticosteroids, and antihistamines for allergic reactions.

Supportive care—Using supportive measures as needed. Patients in whom intentional overdose is known or suspected should be referred for psychiatic consultation.


Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Erythromycins (Systemic).

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Hypersensitivity to erythromycins or other macrolides

Pregnancy—Erythromycins cross the placenta; erythromycin estolate has been associated with an increased risk of reversible, subclinical hepatotoxicity in pregnant women





Breast-feeding—Erythromycins are distributed into breast milk





Dental—Oral candidiasis may occur with long-term therapy
Other medications, especially alfentanil, astemizole, carbamazepine, chloramphenicol, cyclosporine, other hepatotoxic medications, lincomycins, terfenadine, warfarin, and xanthines
Other medical problems, especially a history of cardiac arrhythmias or QT prolongation or hepatic function impairment

Proper use of this medication
Taking with a full glass of water, on an empty stomach; may be taken with food if stomach upset occurs

Proper administration technique for oral liquids and/or pediatric drops, chewable tablets, delayed-release capsules and tablets

Not using oral liquids and/or pediatric drops after expiration date

» Compliance with full course of therapy, especially in streptococcal infections

» Importance of not missing doses and taking at evenly spaced times

» Proper dosing
Missed dose: Taking as soon as possible; not taking if almost time for next dose; not doubling dose

» Proper storage

Precautions while using this medication
Checking with physician if no improvement within a few days


Side/adverse effects
Signs of potential side effects, especially, hepatotoxicity, hypersensitivity, inflammation or phlebitis at the injection site, cardiac toxicity, loss of hearing, or pancreatitis


General Dosing Information
Therapy should be continued for at least 10 days in group A beta-hemolytic streptococcal infections to help prevent the occurrence of acute rheumatic fever.

For oral dosage forms only
Doses greater than 1 gram per dose are not recommended with twice-a-day dosing. {02} {34} {81}

Erythromycin film-coated tablets (base and stearate) are best absorbed on an empty stomach; however, if gastrointestinal irritation occurs, they may be taken with food. {02} {52} {81} Enteric-coated erythromycin base and erythromycin estolate may be taken without regard to meals {34} {81}; and erythromycin ethylsuccinate is better absorbed when taken with meals. {39}

ERYTHROMYCIN BASE


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

ERYTHROMYCIN DELAYED-RELEASE CAPSULES USP

Usual adult and adolescent dose
Antibacterial
Oral, 250 mg (base) every six hours; 333 mg every eight hours; or 500 mg every twelve hours if twice-a-day dosage is desired. {31} {81}

Note: Acne vulgaris—Oral, 250 mg (base) every six hours; 333 mg every eight hours; or 500 mg every twelve hours for four weeks. This dose may be reduced to 333 to 500 mg once a day for a maintenance dose. {31} {122}
Bowel preparation (preoperative) adjunct—Oral, 1 gram (base) administered at nineteen hours, eighteen hours, and nine hours (total of 3 grams) before the start of surgery. {21} {30} {133} {134}
Chlamydial infections, endocervical and urethral—Oral, 333 mg (base) every eight hours, or 500 mg every six hours for seven days; or 250 mg every six hours for fourteen days. Erythromycin base may be used in pregnant women. {23} {24} {30} {81}
[Chancroid]1—Oral, 500 mg (base) every six hours for seven days. {23} {123} {124}
Endocarditis prophylaxis—Oral, 1 gram (base) two hours prior to the procedure, and 500 mg six hours after the initial dose. {14} {81}
[Enteritis, Campylobacter]1—Oral, 250 mg (base) four times a day for five days. {130}
[Gastroparesis]1—Oral, 250 mg (base) taken thirty minutes before meals, three times a day. {101} {102} {104}
Legionnaires' disease—Oral, 500 mg (base) to 1 gram every six hours. {31} {81} {125}
[Lyme disease]1—Oral, 250 mg (base) four times a day for ten to twenty-one days. {121}
[Lymphogranuloma venereum]1—Oral, 500 mg (base) every six hours for twenty-one days. {23}
Pelvic inflammatory disease, caused by Neisseria gonorrhoeae —Oral, 250 mg (base) every six hours for seven days, after intravenous administration of erythromycin 500 mg every six hours for three days. {81}
[Relapsing fever]1—Oral, 10 mg (base) per kg of body weight every six hours for ten days. {28}
Streptococcal prophylaxis—Continuous prophylaxis of streptococcal infections in patients with a history of rheumatic heart disease: Oral, 250 mg (base) every twelve hours. {31} {81}
Syphilis, primary—Oral, 30 to 40 grams (base) over a ten- to fifteen-day period. {31} {32} {81}
Urethritis, nongonococcal, caused by Ureaplasma urealyticum —Oral, 500 mg (base) every six hours for seven days {23} {81}; or 250 mg every six hours for fourteen days. {23}



Usual adult prescribing limits
Antibacterial
Up to 4 grams (base) a day. {81}


Usual pediatric dose
Antibacterial
Oral, 7.5 to 12.5 mg (base) per kg of body weight every six hours; or 15 to 25 mg per kg of body weight every twelve hours. {31} {81}

Severe infections, 15 to 25 mg (base) per kg of body weight every six hours. {81}

Note: Chlamydial infections, endocervical and urethral {23} {31}
Children up to 45 kg of body weight: Oral, 10 mg (base) per kg of body weight every six hours for ten to fourteen days.
Children 45 kg of body weight and over but less than 8 years of age: See Usual adult and adolescent dose .
Conjunctivitis, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for at least ten to fourteen days. {15} {23}
Diphtheria—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {35}
Endocarditis prophylaxis—Oral, 20 mg (base) per kg of body weight two hours prior to the procedure, and 10 mg per kg of body weight six hours after the initial dose. {14} {81}
[Enteritis, Campylobacter]1—Oral, 10 mg (base) per kg of body weight every six hours for five days. {130} {131} {132}
[Lyme disease]1—Oral, 7.5 mg (base) per kg of body weight every six hours for ten to twenty-one days. {40}
Pertussis—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {16} {31} {75}
Pneumonia, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for two weeks. {15} {23} {75}
[Relapsing fever]1—Oral, 10 mg (base) per kg of body weight every six hours for ten days. {28}
Streptococcal pharyngitis—Oral, 5 to 7.5 mg (base) per kg of body weight every six hours; or 10 to 15 mg per kg of body weight every twelve hours for at least ten days. {19}



Strength(s) usually available
U.S.—


250 mg (base) (Rx) [ERYC][Generic]

Canada—


250 mg (base) (Rx) [Apo-Erythro E-C] [ERYC-250] [Novo-rythro Encap]


333 mg (base) (Rx) [Apo-Erythro E-C] [ERYC-333]

Packaging and storage:
Store below 40 °C (l04 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. {81}

Auxiliary labeling:
   • Continue medicine for full time of treatment.
   • Swallow capsules whole.

Note: Erythromycin delayed-release capsules contain enteric-coated pellets. The entire contents of a capsule may be sprinkled on applesauce, jelly, or ice cream immediately prior to ingestion. Subdividing the contents of the capsule is not recommended. {31}



ERYTHROMYCIN TABLETS USP

Usual adult and adolescent dose
See Erythromycin Delayed-release Capsules USP .

Usual adult prescribing limits
See Erythromycin Delayed-release Capsules USP .

Usual pediatric dose
See Erythromycin Delayed-release Capsules USP .

Strength(s) usually available
U.S.—


250 mg (base) (Rx)[Generic]


500 mg (base) (Rx)[Generic]

Canada—


250 mg (base) (Rx) [Apo-Erythro] [Erythromid]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Continue medicine for full time of treatment.


ERYTHROMYCIN DELAYED-RELEASE TABLETS USP

Usual adult and adolescent dose
See Erythromycin Delayed-release Capsules USP .

Note: Endocarditis prophylaxis—The manufacturer of E-Mycin recommends taking 1 gram three to four hours prior to the procedure because of the pharmacokinetics of their enteric-coated product. {21} {30}


Usual adult prescribing limits
See Erythromycin Delayed-release Capsules USP .

Usual pediatric dose
See Erythromycin Delayed-release Capsules USP .

Note: Endocarditis prophylaxis—The manufacturer of E-Mycin recommends taking 1 gram three to four hours prior to the procedure because of the pharmacokinetics of their enteric-coated product. {21}


Strength(s) usually available
U.S.—


250 mg (base) (Rx) [E-Mycin] [Ery-Tab] [Ilotycin][Generic]


333 mg (base) (Rx) [E-Base] [E-Mycin] [Ery-Tab] [PCE][Generic]


500 mg (base) (Rx) [E-Base] [Ery-Tab] [PCE]

Canada—


250 mg (base) (Rx) [E-Mycin][Generic]


333 mg (base) (Rx) [PCE]


500 mg (base) (Rx) [Erybid]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Continue medicine for full time of treatment.
   • Swallow tablets whole.


ERYTHROMYCIN ESTOLATE

Summary of Differences


Precautions:
Pregnancy—Associated with increased risk of reversible, subclinical hepatotoxicity.

Laboratory value alterations—Serum alkaline phosphatase, bilirubin, AST (SGOT), and ALT (SGPT) concentrations may be increased more frequently than with other erythromycins.



Side/adverse effects:
May also cause cholestatic jaundice less frequently (rare with other erythromycins).



Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

Note: The dosing and strengths of the dosage forms available are expressed in terms of erythromycin base (not the estolate salt).


ERYTHROMYCIN ESTOLATE CAPSULES USP

Usual adult and adolescent dose
Antibacterial
Oral, 250 mg (base) every six hours; or 500 mg every twelve hours if twice-a-day dosage is desired. {34}

Note: Chlamydial infections, endocervical and urethral—Oral, 500 mg (base) every six hours for seven days; or 250 mg every six hours for fourteen days. Erythromycin estolate is not recommended for use in pregnant women. {34}
Endocarditis prophylaxis—Oral, 1 gram (base) two hours prior to the procedure, and 500 mg six hours after the initial dose. {14} {34}
[Gastroparesis]1—Oral, 250 mg (base) taken thirty minutes before meals, three times a day. {101} {102} {104}
Legionnaires' disease—Oral, 500 mg (base) to 1 gram every six hours. {34}
Streptococcal prophylaxis—Continuous prophylaxis of streptococcal infections in patients with a history of rheumatic heart disease: Oral, 250 mg (base) every twelve hours. {34}
Syphilis, primary—Oral, 20 to 30 grams (base) over a ten-day period. {34} {37}



Usual adult prescribing limits
Antibacterial
Up to 4 grams (base) daily. {34}


Usual pediatric dose
Antibacterial
Oral, 7.5 to 12.5 mg (base) per kg of body weight every six hours; or 15 to 25 mg per kg of body weight every twelve hours. {34}

Severe infections, 15 to 25 mg (base) per kg of body weight every six hours. {34}

Note: Conjunctivitis, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for at least two weeks. {10} {15} {34}
Diphtheria—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {35}
Endocarditis prophylaxis—Oral, 20 mg (base) per kg of body weight two hours prior to the procedure, and 10 mg per kg of body weight six hours after the initial dose. {14} {34}
Pertussis—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {16} {34} {75}
Pneumonia, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for two weeks. {15} {34} {75}
Streptococcal pharyngitis—Oral, 5 to 7.5 mg (base) per kg of body weight every six hours; or 10 to 15 mg per kg of body weight every twelve hours for at least ten days. {19} {34}



Strength(s) usually available
U.S.—


250 mg (base) (Rx) [Ilosone][Generic]

Canada—


250 mg (base) (Rx) [Ilosone] [Novo-rythro]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Continue medicine for full time of treatment.


ERYTHROMYCIN ESTOLATE ORAL SUSPENSION USP

Usual adult and adolescent dose
See Erythromycin Estolate Capsules USP .

Usual adult prescribing limits
See Erythromycin Estolate Capsules USP .

Usual pediatric dose
See Erythromycin Estolate Capsules USP .

Strength(s) usually available
U.S.—


125 mg (base) per 5 mL (Rx) [Ilosone (methylparaben) (propylparaben)][Generic]


250 mg (base) per 5 mL (Rx) [Ilosone (methylparaben) (propylparaben)][Generic]

Canada—


125 mg (base) per 5 mL (Rx) [Ilosone] [Novo-rythro]


250 mg (base) per 5 mL (Rx) [Ilosone] [Novo-rythro]

Packaging and storage:
Store between 2 and 8 °C (36 and 46 °F). Store in a tight container.

Auxiliary labeling:
   • Refrigerate.
   • Shake well.
   • Continue medicine for full time of treatment.
   • Take by mouth only (pediatric drops).

Note: Explain administration technique for pediatric drops (100 mg per mL).
When dispensing, include a calibrated liquid-measuring device.



ERYTHROMYCIN ESTOLATE TABLETS USP

Usual adult and adolescent dose
See Erythromycin Estolate Capsules USP .

Usual adult prescribing limits
See Erythromycin Estolate Capsules USP .

Usual pediatric dose
See Erythromycin Estolate Capsules USP .

Strength(s) usually available
U.S.—


250 mg (base) (Rx)[Generic]


500 mg (base) (Rx) [Ilosone]

Canada—


500 mg (base) (Rx) [Ilosone]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Continue medicine for full time of treatment.


ERYTHROMYCIN ETHYLSUCCINATE

Summary of Differences
1.6 grams of erythromycin ethylsuccinate produce approximately the same blood levels as 1 gram erythromycin base. {39}

In pediatric patients, equivalent doses of erythromycin ethylsuccinate and erythromycin base produce comparable blood levels. {87}


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

Note: The dosing and dosage forms available are expressed in terms of ethylsuccinate salt. 400 mg of erythromycin ethylsuccinate produces approximately the same blood levels as 250 mg erythromycin base. {87}


ERYTHROMYCIN ETHYLSUCCINATE ORAL SUSPENSION USP

Usual adult and adolescent dose
Antibacterial
Oral, 400 mg every six hours; or 800 mg every twelve hours if twice-a-day dosing is desired. {39}

Note: Chlamydial infections, endocervical and urethral—Oral, 800 mg (base) every six hours for seven days, or 400 mg every six hours for fourteen days. Erythromycin ethylsuccinate may be used in pregnant women. {23}
Endocarditis prophylaxis—Oral, 1.6 grams {39} two hours prior to the procedure, and 800 mg {39} six hours after the initial dose. {14}
[Gastroparesis]1—Oral, 400 mg taken thirty minutes before meals, three times a day. {101} {102} {104}
Legionnaires' disease—Oral, 400 mg to 1 gram every six hours. {39}
Streptococcal prophylaxis—Continuous prophylaxis of streptococcal infections in patients with a history of rheumatic heart disease: Oral, 400 mg every twelve hours. {39}
Syphilis, primary—Oral, 48 to 64 grams (base) over a ten- to fifteen-day period. {39}
Urethritis, nongonococcal, caused by Ureaplasma urealyticum —Oral, 800 mg every eight hours for seven days; or 400 mg every six hours for fourteen days. {23} {39}



Usual adult prescribing limits
Antibacterial
Up to 4 grams daily. {39}


Usual pediatric dose
Antibacterial
Oral, 7.5 to 12.5 mg per kg of body weight every six hours; or 15 to 25 mg per kg of body weight every twelve hours. {39}

Severe infections, 15 to 25 mg per kg body weight every six hours. {39}

Note: Conjunctivitis, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for ten to fourteen days. {12} {15} {23}
Diphtheria—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {35}
Endocarditis prophylaxis—Oral, 20 mg per kg of body weight two hours prior to the procedure, and 10 mg per kg of body weight six hours after the initial dose. {14} {39}
[Enteritis, Campylobacter]1—Oral, 10 mg (base) per kg of body weight every six hours for five days. {130} {131} {132}
Pertussis—Oral, 10 to 12.5 mg per kg of body weight every six hours for fourteen days. {16} {39}
Pneumonia, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for ten to fourteen days. {12} {15} {23}



Strength(s) usually available
U.S.—


200 mg per 5 mL (Rx) [E.E.S. (methylparaben) (propylparaben)] [Erythro][Generic]


400 mg per 5 mL (Rx) [E.E.S. (methylparaben) (propylparaben)] [Erythro][Generic]

Canada—
Not commercially available.

Packaging and storage:
Store between 2 and 8 °C (36 and 46 °F). Store in a tight container. {39}

Note: After dispensing, suspensions do not require refrigeration if used within 14 days. Some manufacturers recommend storage in light-resistant containers to prevent discoloration. {39}


Auxiliary labeling:
   • Shake well.
   • Continue medicine for full time of treatment.
   • Beyond-use date.

Note: When dispensing, include a calibrated liquid-measuring device.



ERYTHROMYCIN ETHYLSUCCINATE FOR ORAL SUSPENSION USP

Usual adult and adolescent dose
See Erythromycin Ethylsuccinate Oral Suspension USP .

Usual adult prescribing limits
See Erythromycin Ethylsuccinate Oral Suspension USP .

Usual pediatric dose
See Erythromycin Ethylsuccinate Oral Suspension USP .

Strength(s) usually available
U.S.—


200 mg per 5 mL (when reconstituted according to manufacturer's instructions) (Rx) [E.E.S.] [EryPed][Generic]


400 mg per 5 mL (when reconstituted according to manufacturer's instructions) (Rx) [EryPed][Generic]

Canada—


100 mg per 5 mL (when reconstituted according to manufacturer's instructions) (Rx) [Novo-Rythro]


200 mg per 5 mL (when reconstituted according to manufacturer's instructions) (Rx) [E.E.S.] [Novo-Rythro]


400 mg per 5 mL (when reconstituted according to manufacturer's instructions) (Rx) [E.E.S.]

Packaging and storage:
Prior to reconstitution, store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Note: After reconstitution, depending on manufacturer or specific product, suspensions do not require refrigeration if used within 14 days. {39} {41}


Auxiliary labeling:
   • Shake well.
   • Continue medicine for full time of treatment.
   • Beyond-use date.
   • Take by mouth only (pediatric drops).

Note: Explain administration technique for pediatric drops.
When dispensing, include a calibrated liquid-measuring device.



ERYTHROMYCIN ETHYLSUCCINATE TABLETS USP

Usual adult and adolescent dose
See Erythromycin Ethylsuccinate Oral Suspension USP .

Usual adult prescribing limits
See Erythromycin Ethylsuccinate Oral Suspension USP .

Usual pediatric dose
See Erythromycin Ethylsuccinate Oral Suspension USP .

Strength(s) usually available
U.S.—


400 mg (Rx) [E.E.S.][Generic]

Canada—


600 mg (Rx) [Apo-Erythro-ES] [E.E.S.]

Packaging and storage:
Store below 40 °C (104 °F), preferably beween 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Continue medicine for full time of treatment.


ERYTHROMYCIN ETHYLSUCCINATE TABLETS (CHEWABLE) USP

Usual adult and adolescent dose
See Erythromycin Ethylsuccinate Oral Suspension USP .

Usual adult prescribing limits
See Erythromycin Ethylsuccinate Oral Suspension USP .

Usual pediatric dose
See Erythromycin Ethylsuccinate Oral Suspension USP .

Strength(s) usually available
U.S.—


200 mg (Rx) [EryPed]


400 mg (Rx) [Erythro]

Canada—


200 mg (Rx) [E.E.S. (scored)] [EryPed]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Chew or crush tablets before swallowing.
   • Continue medicine for full time of treatment.


ERYTHROMYCIN GLUCEPTATE

Summary of Differences
Category: Indicated only as an antibacterial.


Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

Note: The dosing and strengths of the dosage forms available are expressed in terms of erythromycin base (not the gluceptate salt).


ERYTHROMYCIN GLUCEPTATE STERILE USP

Usual adult and adolescent dose
Antibacterial
Intravenous infusion, 250 to 500 mg (base) every six hours; or 3.75 to 5 mg per kg of body weight every six hours. {06} {47}

Note: [Gastroparesis]1—Oral, 200 mg taken thirty minutes before meals, three times a day. {89} {93} {101} {105}
Legionnaires' disease—Intravenous infusion, 1 gram (base) every six hours. {06} {48} {125}
Pelvic inflammatory disease, caused by Neisseria gonorrhoeae —Intravenous infusion, 500 mg (base) every six hours for three days, then oral administration of erythromycin 250 mg every six hours for seven days. {06} {48}



Usual adult prescribing limits
Up to 4 grams (base) daily. {06} {47}

Usual pediatric dose
Antibacterial
Intravenous infusion, 3.75 to 5 mg (base) per kg of body weight every six hours. {06} {47}

Note: Diphtheria—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {35}



Size(s) usually available:
U.S.—


1 gram (base) (Rx) [Ilotycin]

Canada—


500 mg (base) (Rx) [Ilotycin]


1 gram (base) (Rx) [Ilotycin]

Packaging and storage:
Prior to reconstitution, store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Preparation of dosage form:
To prepare initial dilution, add at least 10 mL of sterile water for injection (without preservatives) to each 500-mg vial and at least 20 mL of diluent to each 1-gram vial. {47}

After initial dilution, solution may be further diluted to a concentration of 1 gram per liter in 0.9% sodium chloride injection or 5% dextrose injection for slow, continuous infusion. {47}

Stability:
After reconstitution, initial dilutions (25 to 50 mg per mL) retain their potency for 7 days if refrigerated. {47}

Additional information:
Infusions with a pH below 5.5 tend to lose potency rapidly and should be administered completely within 4 hours after dilution. {47}

If administration time is prolonged, infusions should be buffered to neutrality with a suitable buffer and administered completely within 24 hours after dilution. {47}

If administered by intermittent infusion, dose may be diluted in 100 to 250 mL of 0.9% sodium chloride injection or 5% dextrose injection and administered slowly over a 20- to 60-minute period. {06} {85}


ERYTHROMYCIN LACTOBIONATE

Summary of Differences
Category: Indicated only as an antibacterial.


Parenteral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

Note: The dosing and strengths of the dosage forms available are expressed in terms of erythromcyin base (not the lactobionate salt).


ERYTHROMYCIN LACTOBIONATE FOR INJECTION USP

Usual adult and adolescent dose
Antibacterial
Intravenous infusion, 250 to 500 mg (base) every six hours; or 3.75 to 5 mg per kg of body weight every six hours. {07} {49}

Note: [Gastroparesis]1—Oral, 200 mg administered thirty minutes before meals, three times a day. {89} {93} {101} {105}
Legionnaires' disease—Intravenous infusion, 1 gram (base) every six hours. {07} {51} {125}
Pelvic inflammatory disease, caused by Neisseria gonorrhoeae —Intravenous infusion, 500 mg (base) every six hours for three days, then oral administration of erythromycin 250 mg every six hours for seven days. {07}



Usual adult prescribing limits
Up to 4 grams (base) daily. {07} {49}

Usual pediatric dose
Antibacterial
Intravenous infusion, 3.75 to 5 mg (base) per kg of body weight every six hours. {07} {49} {51} This product should be used with caution in neonates since it contains benzyl alcohol. {51}

Note: Diphtheria—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {35}



Size(s) usually available:
U.S.—


500 mg (base) (Rx) [Erythrocin (may contain benzyl alcohol 90 mg per 500 mg vial)][Generic]


1 gram (base) (Rx) [Erythrocin (may contain benzyl alcohol 180 mg per 1 gram vial)][Generic]

Canada—


500 mg (base) (Rx) [Erythrocin (may contain benzyl alcohol 0.9% per vial)]


1 gram (base) (Rx) [Erythrocin (may contain benzyl alcohol 0.9% per vial)]

Packaging and storage:
Prior to reconstitution, store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Preparation of dosage form:
To prepare initial dilution, add 10 mL of sterile water for injection (without preservatives) to each 500-mg vial and 20 mL of diluent to each 1-gram vial. {07}

After initial dilution, solution may be further diluted to a concentration of 1 to 5 mg per mL in 0.9% sodium chloride injection, lactated Ringer's injection, or other electrolyte solutions (see manufacturer's package insert) for slow, continuous infusion. Dextrose-containing solutions may also be used if suitably buffered by adding 1 mL of 4% sodium bicarbonate per 100 mL of solution. {07} {49}

For reconstitution of piggyback infusion bottles, see manufacturer's labeling for instructions. {07}

Caution: Use of diluents containing benzyl alcohol is not recommended for preparation of medications for use in neonates. A fatal toxic syndrome consisting of metabolic acidosis, CNS depression, respiratory problems, renal failure, hypotension, and possibly seizures and intracranial hemorrhages has been associated with this use. {51}

Stability:
After reconstitution, initial dilutions (50 mg per mL) retain their potency for 14 days if refrigerated, or for 24 hours at room temperature. {49}

Infusions prepared in piggyback infusion bottles retain their potency for 8 hours at room temperature, for 24 hours if refrigerated, or for 30 days if frozen. {49}

Infusions prepared in the ADD-vantage system should not be stored. {145}

Additional information:
Acidic infusions are unstable and lose potency rapidly. A pH of at least 5.5 is recommended for final dilutions, which should be administered completely within 8 hours after dilution. {49}

If administered by intermittent infusion, dose may be diluted to a maximum concentration of 5 mg per mL with specified diluent and administered slowly over a 20- to 60-minute period. {85}


ERYTHROMYCIN STEARATE


Oral Dosage Forms

Note: Bracketed uses in the Dosage Forms section refer to categories of use and/or indications that are not included in U.S. product labeling.

Note: The dosing and strengths of the dosage forms available are expressed in terms of erythromycin base (not the stearate salt).


ERYTHROMYCIN STEARATE ORAL SUSPENSION

Usual adult and adolescent dose
Antibacterial
Oral, 250 mg (base) every six hours; or 500 mg every twelve hours if twice a day dosage is desired. {52}

Note: Chlamydial infections, endocervical and urethral—Oral, 500 mg (base) every six hours for seven days; or 250 mg every six hours for fourteen days. Erythromycin stearate may be used in pregnant women. {23} {52} {60}
Endocarditis prophylaxis—Oral, 1 gram (base) two hours prior to the procedure, and 500 mg six hours after the initial dose. {14} {52}
Legionnaires' disease—Oral, 500 mg (base) to 1 gram every six hours. {52} {60} {125}
Pelvic inflammatory disease, caused by Neisseria gonorrhoeae —Oral, 250 mg (base) every six hours for seven days, after intravenous administration of erythromycin 500 mg (base) every six hours for three days. {52}
Streptococcal prophylaxis—Continuous prophylaxis of streptococcal infections in patients with a history of rheumatic heart disease: Oral, 250 mg (base) every twelve hours. {52}
Syphilis, primary—Oral, 30 to 40 grams (base) over a ten- to fifteen-day period. {52} {60}
[Gastroparesis]1—Oral, 150 to 250 mg (base) taken thirty minutes before meals, three times a day. {101} {102} {104}



Usual adult prescribing limits
Antibacterial
Up to 4 grams (base) daily. {52} {60}


Usual pediatric dose
Antibacterial
Oral, 7.5 to 12.5 mg (base) per kg of body weight every six hours; or 15 to 25 mg per kg of body weight every twelve hours. {52} {60}

Severe infections, 15 to 25 mg (base) per kg of body weight every six hours. {52} {60}

Note: Conjunctivitis, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for at least two weeks. {15} {52}
Endocarditis prophylaxis—Oral, 20 mg (base) per kg of body weight two hours prior to the procedure, and 10 mg per kg of body weight six hours after the initial dose. {14} {60}
Pertussis—Oral, 10 to 12.5 mg (base) per kg of body weight every six hours for fourteen days. {16} {52}
Pneumonia, chlamydial1—Oral, 12.5 mg (base) per kg of body weight every six hours for two weeks. {15} {52}
Streptococcal pharyngitis—Oral, 5 to 7.5 mg (base) per kg of body weight every six hours; or 10 to 15 mg per kg of body weight every twelve hours for at least ten days. {19} {60}



Strength(s) usually available
U.S.—
Not commercially available.

Canada—


125 mg per 5 mL (base) (Rx) [Erythrocin (parabens)] [Novo-rythro]


250 mg per 5 mL (base) (Rx) [Erythrocin (parabens)] [Novo-rythro]

Packaging and storage:
Prior to reconstitution, store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Auxiliary labeling:
   • Refrigerate.
   • Shake well.
   • Continue medicine for full time of treatment.
   • Beyond-use date.

Note: When dispensing, include a calibrated liquid-measuring device.



ERYTHROMYCIN STEARATE TABLETS USP

Usual adult and adolescent dose
See Erythromycin Stearate Oral Suspension .

Usual adult prescribing limits
See Erythromycin Stearate Oral Suspension .

Usual pediatric dose
See Erythromycin Stearate Oral Suspension .

Strength(s) usually available
U.S.—


250 mg (base) (Rx) [Erythrocin] [Erythrocot] [My-E] [Wintrocin][Generic]


500 mg (base) (Rx) [Erythrocin][Generic]

Canada—


250 mg (base) (Rx) [Apo-Erythro-S] [Erythrocin] [Novo-rythro]


500 mg (base) (Rx) [Apo-Erythro-S] [Erythrocin]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container.

Note: Some manufacturers recommend storage in light-resistant containers to prevent discoloration.


Auxiliary labeling:
   • Continue medicine for full time of treatment.



Revised: 08/14/1997



References
  1. Erythromycin base package insert (Ilotycin, Dista—US), Rev 9/89, Rec 6/93.
  1. Erythromycin base package insert (E-Base, Barr—US), Rev 1/93, Rec 5/93.
  1. Erythromycin delayed-release capsules (Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 424-6.
  1. Kohan DE. Possible interaction between cyclosporine and erythromycin. New Engl J Med 1986; 314: 448.
  1. Erythromycin delayed-release tablets (generic). Red book 1993. Montvale, NJ: Medical Economics Data Production Company, 1993: 236.
  1. Erythromycin gluceptate package insert (Ilotycin, Dista—US), Rev 5/93, Rec 10/93.
  1. Erythromycin lactobionate package insert (Elkin-Sinn—US), Rev 8/91, Rec 5/92.
  1. Erythromycin stearate package insert (Zenith—US), Rev 5/93, Rec 8/93.
  1. Erythromycin base (E-Mycin, Upjohn). In: PDR Physicians' desk reference. 42nd ed. 1988. Oradell, NJ: Medical Economics Company, 1988: 2125-6.
  1. Erythromycin estolate (Ilosone, Dista). In: PDR Physicians' desk reference. 42nd ed. 1988. Oradell, NJ: Medical Economics Company, 1988: 907-8.
  1. Erythromycin base (Apo-Erythro E-C, Apotex). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 84.
  1. Erythromycin ethylsuccinate (EryPed, Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 432-3.
  1. Erythromycin drug information. In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 435-6.
  1. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1990; 264(12): 2919-22.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 169.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 359-60.
  1. Mycifradin package insert (Upjohn—US), Rev 8/87, Rec 9/87.
  1. USP DI 1989, VA Medication Classification System: 2472.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 442-4.
  1. Erythromycin base (Novo-rythro Encap, Novopharm). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 844.
  1. Erythromycin base (E-Mycin, Boots). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 625-6.
  1. Erythromycin filmtab (Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 423-4.
  1. Centers for Disease Control. 1993 Sexually Transmitted Diseases Treatment Guidelines. MMWR 1993; 42(RR-14): 1-102.
  1. Erythromycin base (PCE, Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 446-8.
  1. Robimycin (AHR). Red book 1993. Montvale, NJ: Medical Economics Data, 1993: 488.
  1. Tan E, Hart LL. Metronidazole/neomycin as preoperative bowel preparation. Ann Pharmacother 1993; 27: 1064-5.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 131, 139, 160, 334.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 154-6.
  1. Erythromycin base (Apo-Erythro base, Apotex). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 84.
  1. Erythromycin base (E-Mycin, Upjohn). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 412.
  1. Erythromycin base (ERYC, PD). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 431-2.
  1. Erythromycin base (Erythromid, Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 434-5.
  1. Erythromycin (generic). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 436.
  1. Erythromycin estolate package insert (Ilosone, Dista—US). Rev 6/93, Rec 11/93.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 191-5.
  1. Erythromycin estolate (generic). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 237.
  1. Erythromycin estolate (Ilosone, Lilly). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 566.
  1. Erythromycin estolate (Novo-rythro, Novopharm). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 23rd ed. Ottawa: Canadian Pharmaceutical Association, 1988: 640.
  1. Erythromycin ethylsuccinate (E.E.S., Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 420-2.
  1. American Association of Pediatrics. Report of the committee of infectious diseases (The red book). 22nd ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 1991: 298.
  1. Erythromycin ethylsuccinate (EryPed, Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 418-9.
  1. Erythro (Balan). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 236.
  1. Tanis AA, Baggen MGA, Wiggers RH, Ouwendijk RJT. Side-effects of oral erythromycin for treatment of diabetic gastroparesis. Lancet 1993; 342: 1431.
  1. Erythromycin ethylsuccinate (generic). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 237-8.
  1. Erythromycin ethylsuccinate (Apo-Erytho-ES, Apotex). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 84.
  1. Erythromycin ethylsuccinate (E.E.S., Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 402-3.
  1. Erythromycin gluceptate (Ilotycin, Dista). In: PDR Physicians' desk reference. 43rd ed. 1989. Oradell, NJ: Medical Economics Company, 1989: 890.
  1. Erythromycin gluceptate (Ilotycin, Lilly). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 566-7.
  1. Erythromycin lactobionate (Erythrocin, Abbott). Red book 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 236.
  1. Erythomycin lactobionate (generic). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 238.
  1. Erythomycin lactobionate (Erythrocin, Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 433-4.
  1. Erythromycin stearate (Erythrocin, Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 422-3.
  1. Erythrocot (Truxton). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 236.
  1. Carson JL, Strom BL, Duff A, et al. Acute liver disease associated with erythromycins, sulfonamides, and tetracyclines. Ann Intern Med 1993; 119(7 part 1): 576-83.
  1. Shirin H, Schapiro JM, Arber N, Pinkhas J, Sidi Y, Salomon F. Erythromycin base-induced rash and liver function disturbances. Ann Pharmacother 1992; 26: 1522-3.
  1. My-E (Seneca). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 386.
  1. Wintrocin (Hauck). Red book 1994. Montvale, NJ: Medical Economics Data, 1994: 603.
  1. Erythromycin stearate (Wyamycin-S, Wyeth). In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 2623.
  1. Reynolds JEF, editor. Martindale, the extra pharmacopeia. 30th ed. London: The Pharmaceutical Press, 1993: 161.
  1. Erythromycin stearate (Erythrocin, Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 433-4.
  1. Erythromycin stearate (Apo-Erythro-S, Apotex). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 84.
  1. Erythromycin stearate (Novo-rythro, Novopharm). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 23rd ed. Ottawa: Canadian Pharmaceutical Association, 1988: 640.
  1. Erythromycin base (Ery-Tab, Abbott). In: PDR Physicians' desk reference. 48th ed. 1994. Montvale, NJ: Medical Economics Data Production Company, 1994: 419-20.
  1. Erythromycin gluceptate package insert (Ilotycin, Dista—US), Rev 5/88, Rec 2/89.
  1. Berger TM, Cook WJ, O'Marcaigh AS, Zimmerman D. Acute pancreatitis in a 12-year-old girl after an erythromycin overdose. Pediatrics 1992; 90(4): 624-6.
  1. Farrar HC, Walsh-Sukys MC, Kyllonen K, Blumer JL. Cardiac toxicity associated with intravenous erythromycin lactobionate: two case reports and a review of the literature. Pediatr Infect Dis J 1993; 12: 688-91.
  1. Erythromycin estolate package insert (Ilosone, Dista—US), Rev 2/89, Rec 5/89.
  1. Gilman AG, Rall TW, Nies AS, Taylor P, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 8th ed. New York: Pergamon Press, 1990: 1130-4.
  1. Sacristán JA, Soto JA, de Cos MA. Erythromycin-induced hypoacusis: 11 new cases and literature review. Ann Pharmacother 1993; 27: 950-5.
  1. Honig PK, Woosley RL, Zamani K, Conner D, Cantilena LR. Changes in the pharmacokinetics and electrocardiographic pharmacodynamics of terfenadine with concomitant administration of erythromycin. Clin Pharmacol Ther 1992; 52(8): 231-8.
  1. Shinn AF, Shrewsbury RP. EDI, Evaluation of drug interactions. 3rd ed. St Louis: Mosby, l985: 379.
  1. Tatro DS, editor. Drug interaction facts. St Louis: Facts and Comparisons, 1983: 376.
  1. Olkkola KT, Aranko K, Luurila H, et al. A potentially hazardous interaction between erythromycin and midazolam. Clin Pharmacol Ther 1993; 53(3): 298-305.
  1. Redington K, Wells C, Petito F. Erythromycin and valproate interaction. Ann Intern Med 1992; 116(10): 877-8.
  1. Panel comment, 8/19/88.
  1. Reynolds JEF, editor. Martindale, the extra pharmacopeia. 29th ed. London: The Pharmaceutical Press, 1989: 222-30.
  1. Ludden TM. Pharmacokinetic interactions of the macrolide antibiotics. Clinical Pharamcokinet 1985; 10: 63-79.
  1. Maxwell DL, Gilmour-White SK, Hall MR. Digoxin toxicity due to interaction of digoxin with erythromycin. Br Med J 1989; 298: 572.
  1. Washington JA, Wilson WR. Erythromycin: a microbial and clinical perspective after 30 years of clinical use (second of two parts). Mayo Clin Proc 1985; 60: 271-8.
  1. Wyngaarden JB, Smith LH, editors. Cecil textbook of medicine. Philadelphia: W.B. Saunders Company, 1988: 1559.
  1. Erythromycin base (ERYC, PD). In: PDR Physicians' desk reference. 48th ed. 1994. Oradell, NJ: Medical Economics Data Production Company, 1994: 1739-41.
  1. Periti P, Mazzei T, Mini E, Novelli A. Pharmacokinetic drug interactions of macrolides. Clin Pharmacokinet 1992; 23(2): 106-31.
  1. Alcalay J, Halevy S, Theodor E, Sandbank M. Asymptomatic liver injury due to erythromycin stearate. Drug Intell Clin Pharm 1986; 20: 601-2.
  1. Drenth JPH, Engels LGJB. Diabetic gastroparesis. A critical reappraisal of new treatment strategies. Drugs 1992; 44(4): 537-53.
  1. Trissel LA. ASHP handbook on injectable drugs. 5th ed. Bethesda MD: American Society of Hospital Pharmacists, 1988: 280.
  1. Yoshikawa TT, Chow AW, Guze LB, editors. Infectious disease. Boston: Houghton Mifflin Professional Publications, 1980: 181.
  1. Personal communication, Abbott, 7/5/89.
  1. Erythromycin base (PCE, Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 910-1.
  1. Fraser R, Shearer T, Fuller J, Horowitz M, Dent J. Intravenous erythromycin overcomes small intestinal feedback on antral, pyloric, and duodenal motility. Gastroenterology 1992; 103(1): 114-9.
  1. Mandell GL, Douglas RG, Bennett JE, editors. Principles and practice of infectious diseases. 3rd ed. New York: Churchill Livingstone, 1990: 308-12.
  1. Morton MR, Cooper JW. Erythromycin-induced digoxin toxicity. Drug Intell Clin Pharm 1989; 23: 668-70.
  1. Erythromycin ethylsuccinate (EryPed, Abbott). In: PDR Physicians' desk reference. 45th ed. 1991. Oradell, NJ: Medical Economics Data, 1991: 518-9.
  1. Edelbroek MAL, Horowitz M, Wishart JM, Akkermans LMA. Effects of erythromycin on gastric emptying, alcohol absorption and small intestinal transit in normal subjects. J Nucl Med 1993; 34(4): 582-8.
  1. Kawamura O, Sekiguchi T, Kusano M, Nishioka T, Itoh Z. Effect of erythromycin on interdigestive gastrointestinal contractile activity and plasma motilin concentration in humans. Dig Dis Sci 1993; 38(5): 870-6.
  1. Ignoffo RJ, Kim LE. Erythromycin and cyclosporine drug interaction. DICP Ann Pharmacother 1991; 25: 30-1.
  1. Lindsay J, Smith MA, Light JA. Torsades de pointes associated with antimicrobial therapy for pneumonia. Chest 1990; 98: 222-3.
  1. Schownenberger RA, Haefeli WE, Weiss P, Ritz RF. Association of intravenous erythromycin and potentially fatal ventricular tachycardia with Q-T prolongation (torsades de pointes). Br Med J 1990; 300: 1375-6.
  1. Nattel S, Ranger S, Talajic M, Lemery R, Roy D. Erythromycin-induced long QT syndrome: concordance with quinidine and underlying cellular electrophysiologic mechanism. Am J Med 1990; 89: 235-8.
  1. Fraser DG. Selection of an oral erythromycin product. Am J Hosp Pharm 1980; 37: 1199-1205.
  1. Erythromycin base (Erybid, Abbott). In: Krogh CME, editor. CPS Compendium of pharmaceuticals and specialties. 28th ed. Ottawa: Canadian Pharmaceutical Association, 1993: 430.
  1. Janssens J, Peeters TL, Vantrappen G, et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. N Engl J Med 1990; 322(15): 1028-31.
  1. Dull JS, Raufman J-P, Zakai MD, Strashun A. Successful treatment of gastroparesis with erythromycin in a patient with progressive systemic sclerosis. Am J Med 1990; 89: 528-30.
  1. Wadhwa NK, Atkins H, Cabralda T. Intraperitoneal erythromycin for gastroparesis. Ann Intern Med 1991; 114(10): 912.
  1. Mozwecz H, Pavel D, Pitrak D, et al. Erythromycin stearate as prokinetic agent in postvagotomy gastroparesis. Dig Dis Sci 1990; 35(7): 902-5.
  1. Urbain JLC, Vantrappen G, Janssens J, Van Cutsem E, Peeters T, De Roo M. Intravenous erythromycin dramatically accelerates gastric emptying in gastroparesis diabeticorum and normals and abolishes the emptying discrimination between solids and liquids. J Nucl Med 1990; 31(9): 1490-3.
  1. McComb JM, Campbell NPS, Cleland J. Recurrent ventricular tachycardia associated with QT prolongation after mitral valve replacement and its association with intravenous administration of erythromycin. Am J Cardiol 1984; 54: 922-3.
  1. Guelon D, Bedock B, Chartier C, Haberer J-P. QT prolongation and recurrent ``torsades de pointes'' during erythromycin lactobionate infusion. Am J Cardiol 1986; 58: 666.
  1. Ayanian JZ, Fuchs CS, Stone RM. Lovastatin and rhabdomyolysis. Ann Intern Med 1988; 109(8): 682-3.
  1. Spach DH, Bauwens JE, Clark CD, Burke WG. Rhabdomyolysis associated with lovastatin and erythromycin use. West J Med 1991; 154(2): 213-5.
  1. Honig P, Wortham D, Zamani K, Cantilena L. Comparison of the effect of erythromycin, clarithromycin and azithromycin on terfenadine steady-state pharmacokinetics and electrocardiographic parameters. Drug Invest 1994; 7(3): 148-56.
  1. Bartkowski RR, Goldberg ME, Larijani GE, Boerner T. Inhibition of alfentanil metabolism by erythromycin. Clin Pharmacol Ther 1989; 46(1): 99-102.
  1. Stratton MA. Theophylline-erythromycin base interaction: case report and kinetic profile. Clin Pharm 1983; 2: 183-6.
  1. Wroblewski BA, Singer WD, Whyte J. Carbamazepine-erythromycin interaction. JAMA 1986; 225(9): 1165-7.
  1. Goulden KJ, Camfield P, Dooley JM, et al. Severe carbamazepine intoxication after coadministration of erythromycin. J Pediatr 1986; 109(1): 135-8.
  1. Sato RI, Gray DR, Brown SE. Warfarin interaction with erythromycin. Arch Intern Med 1984; 144: 2413-4.
  1. Weibert RT, McQuade Lorentz S, Townsend RJ, Cook CE, Klauber MR, Jagger PI. Effect of erythromycin in patients receiving long-term warfarin therapy. Clin Pharm 1989; 8: 210-4.
  1. Méry J-P, Kanfer A. Ototoxicity of erythromycin in patients with renal insufficiency. N Engl J Med 1979; 301: 944.
  1. Gumaste VV. Erythromycin-induced pancreatitis. Am J Med 1989; 86: 725.
  1. Holt R, Gaskins J. Phlebitis with intravenous erythromycin. Clin Pharm 1986; 5: 787.
  1. Zemel LS. Lyme disease—a pediatric perspective. J Rheumatol 1992; 19(suppl 34): 1-13.
  1. Rahn DW, Malawista SE. Lyme disease: recommendations for diagnosis and treatment. Ann Intern Med 1991; 114(6): 472-81.
  1. Gammon WR, Meyer C, Lantis S, Shensfelt P, Reizner G, Cripps DJ. Comparative efficacy of oral erythromycin versus oral tetracycline in the treatment of acne vulgaris. J Am Acad Dermatol 1986; 14(2 part 1): 183-6.
  1. Duncan MO, Bilgeri YR, Fehler HG, Ballard RC. Treatment of chancroid with erythromycin. Br J Vener Dis 1983; 59: 265-8.
  1. Plummer FA, D'Costa LJ, Nsanze H, et al. Antimicrobial therapy of chancroid: effectiveness of erythromycin. J Infect Dis 1983; 148(4): 726-31.
  1. Edelstein PH, Meyer RD. Legionnaires' disease. A review. Chest 1984; 85(1): 114-20.
  1. Hook EW, Marra CM. Acquired syphilis in adults. N Engl J Med 1992; 326(16): 1060-9.
  1. Hooton TM, Wong ES, Barnes RC, Roberts PL, Stamm WE. Erythromycin for persistent or recurrent nongonococcal urethritis. Ann Intern Med 1990; 113(1): 21-6.
  1. Schachter J, Sweet RL, Grossman M, Landers D, Robbie M, Bishop E. Experience with the routine use of erythromycin for chlamydial infections in pregnancy. New Engl J Med 1986; 314(5): 276-9.
  1. Hoppe JE, and the Erythromycin Study Group. Comparison of erythromycin estolate and erythromycin ethylsuccinate for treatment of pertussis. Pediatr Infect Dis J 1992; 11(3): 189-93.
  1. Anders BJ, Paisley JW, Lauer BA, Reller LB. Double-blind placebo controlled trial of erythromycin for treatment of campylobacter enteritis. Lancet 1982; 1: 131-2.
  1. Robins-Browne RM, Mackenjee MKR, Bodasing MN, Coovadia HM. Treatment of Campylobacter-associated enteritis with erythromycin. Am J Dis Child 1983; 137: 282-5.
  1. Pai CH, Gillis F, Tuomanen E, Marks MI. Erythromycin in treatment of Campylobacter enteritis in children. Am J Dis Child 1983; 137: 286-8.
  1. Edmondson HT, Rissing JP. Prophylactic antibiotics in colon surgery. Cephaloridine v erythromycin and neomycin. Arch Surg 1983; 118: 227-31.
  1. DiPiro JT, Patrias JM, Townsend RJ, et al. Oral neomycin sulfate and erythromycin base before colon surgery: a comparison of serum and tissue concentrations. Pharmacother 1985; 5(2): 91-4.
  1. Seppälä H, Nissinen A, Järvinen H, et al. Resistance to erythromycin in group A streptococci. N Engl J Med 1992; 326(5): 292-7.
  1. Kelley R, Langley G, Bates L. Erythromycin. Still a good choice for strep throat. Clin Pediatr 1993: 744-5.
  1. Washington JA, Wilson WR. Erythromycin: a microbial and clinical perspective after 30 years of clinical use (first of two parts). Mayo Clin Proc 1985; 60: 189-203.
  1. Koda-Kimble MA, Young LY, editors. Applied therapeutics. The clinical use of drugs. 5th ed. Vancouver WA: Applied Therapeutics, Inc., 1992: 26-5, 34-3.
  1. Mandell GL, Douglas RG, Bennett JE, editors. Principles and practice of infectious diseases. 3rd ed. New York: Churchill Livingstone, 1990: 308-12, 800, 1594, 1818, 1940.
  1. Fleeger CA, editor. USAN 1993. USAN and the USP dictionary of drug names. Rockville, MD: The United States Pharmacopeial Convention, Inc., 1992: 245.
  1. Canadian Drug Identification Code. 19th ed. Ottawa, Canada: Canada Communication Group, 1993: III-110.
  1. Erythromycin base filmtab, 250 mg bioavailability study abstract PT-65, Abbott Laboratories.
  1. Erythromycin stearate filmtab, 250 mg bioavailability study abstract 75-140, Abbott Laboratories.
  1. Croteau D, Bergeron MG, LeBel M. Pharmacokinetic advantages of erythromycin estolate over ethylsuccinate as determined by high-pressure liquid chromatography. Antimicrob Agents Chemother 1988; 32(4): 561-5.
  1. Panel comment, 6/94.
  1. Lindenbaum J, Tse-Eng D, Butler VP, et al. Urinary excretion of reduced metabolites of digoxin. Am J Med 1981; 71: 67-74.
  1. Lindenbaum J, Rund DG, Butler VP, et al. Inactivation of digoxin by the gut flora: reversal by antibiotic therapy. N Engl J Med 1981; 305(14): 789-94.
  1. Norregaard-Hansen K, Klitgaard NA, Pedersen KE. The significance of the enterohepatic circulation on the metabolism of digoxin in patients with the ability of intestinal conversion of the drug. Acta Med Scand 1986; 220: 89-92.
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