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Erythromycin Disease Interactions

There are 5 disease interactions with erythromycin.

Major

Antibiotics (applies to erythromycin) colitis

Major Potential Hazard, Moderate plausibility. Applicable conditions: Colitis/Enteritis (Noninfectious)

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

References

  1. "Product Information. Omnipen (ampicillin)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Ceftin (cefuroxime)." Glaxo Wellcome (2002):
  3. "Product Information. Zinacef (cefuroxime)." Glaxo Wellcome (2002):
  4. "Product Information. Cleocin (clindamycin)." Pharmacia and Upjohn (2002):
  5. "Product Information. Macrobid (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  6. "Product Information. Macrodantin (nitrofurantoin)." Procter and Gamble Pharmaceuticals (2002):
  7. "Product Information. Amoxil (amoxicillin)." SmithKline Beecham (2001):
  8. "Product Information. Merrem (meropenem)." Astra-Zeneca Pharmaceuticals (2001):
  9. "Product Information. Coly-Mycin M Parenteral (colistimethate)." Parke-Davis (2001):
  10. "Product Information. Lincocin (lincomycin)." Pharmacia and Upjohn (2001):
  11. "Product Information. Cubicin (daptomycin)." Cubist Pharmaceuticals Inc (2003):
  12. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):
  13. "Product Information. Doribax (doripenem)." Ortho McNeil Pharmaceutical (2007):
  14. "Product Information. Penicillin G Procaine (procaine penicillin)." Monarch Pharmaceuticals Inc (2009):
  15. "Product Information. Vibativ (telavancin)." Theravance Inc (2009):
  16. "Product Information. Teflaro (ceftaroline)." Forest Pharmaceuticals (2010):
  17. "Product Information. Penicillin G Sodium (penicillin G sodium)." Sandoz Inc (2022):
  18. "Product Information. Dalvance (dalbavancin)." Durata Therapeutics, Inc. (2014):
  19. "Product Information. Orbactiv (oritavancin)." The Medicines Company (2014):
  20. "Product Information. Bicillin C-R (benzathine penicillin-procaine penicillin)." A-S Medication Solutions (2017):
  21. "Product Information. Baxdela (delafloxacin)." Melinta Therapeutics, Inc. (2017):
  22. "Product Information. Polymyxin B Sulfate (polymyxin B sulfate)." AuroMedics Pharma LLC (2022):
  23. "Product Information. Zemdri (plazomicin)." Achaogen (2018):
  24. "Product Information. Seysara (sarecycline)." Allergan Inc (2018):
  25. "Product Information. Nuzyra (omadacycline)." Paratek Pharmaceuticals, Inc. (2018):
  26. "Product Information. Aemcolo (rifamycin)." Aries Pharmaceuticals, Inc. (2018):
  27. "Product Information. Fetroja (cefiderocol)." Shionogi USA Inc (2019):
  28. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  29. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  30. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
View all 30 references
Major

Erythromycin (applies to erythromycin) liver disease

Major Potential Hazard, Moderate plausibility. Applicable conditions: Biliary Obstruction

The use of oral erythromycin, especially erythromycin estolate and erythromycin ethylsuccinate, has been associated with occasional cases of hepatic dysfunction, including elevated liver enzymes and hepatocellular and/or cholestatic hepatitis. Therapy with oral erythromycin should be administered cautiously in patients with liver disease. Additionally, erythromycin is primarily excreted by the liver into the bile. The effect of liver and/or biliary disease on erythromycin clearance is unknown. Empiric dosage adjustments may be appropriate in patients with impaired hepatic or biliary function.

References

  1. Sullivan D, Csuka ME, Blanchard B "Erythromycin ethylsuccinate hepatotoxicity." JAMA 243 (1980): 1074
  2. Keeffe EB, Reis TC, Berland JE "Hepatotoxicity to both erythromycin estolate and erythromycin ethylsuccinate." Dig Dis Sci 27 (1982): 701-4
  3. Bachman BA, Boyd WP Jr, Brady PG "Erythromycin ethylsuccinate-induced cholestasis." Am J Gastroenterol 77 (1982): 397-400
  4. Inman WH, Rawson NS "Erythromycin estolate and jaundice." Br Med J 286 (1983): 1954-5
  5. Diehl AM, Latham P, Boitnott JK, et al. "Cholestatic hepatitis from erythromycin ethylsuccinate." Am J Med 76 (1984): 931-4
  6. Gholson CF, Warren GH "Fulminant hepatic failure associated with intravenous erythromycin lactobionate." Arch Intern Med 150 (1990): 215-6
  7. Hall KW, Nightingale CH, Gibaldi M, et al. "Pharmacokinetics of erythromycin in normal and alcoholic liver disease subjects." J Clin Pharmacol 22 (1982): 321-5
  8. Kroboth PD, Brown A, Lyon JA, et al. "Pharmacokinetics of single-dose erythromycin in normal and alcoholic liver disease subjects." Antimicrob Agents Chemother 21 (1982): 135-40
  9. Barre J, Mallat A, Rosenbaum J, et al. "Pharmacokinetics of erythromycin in patients with severe cirrhosis: respective influence of decreased serum binding and impaired liver metabolic capacity." Br J Clin Pharmacol 23 (1987): 753-7
  10. "Product Information. Eryc (erythromycin)." Parke-Davis
  11. Howe E, Benn RA "Hepatotoxicity due to erythromycin ethylsuccinate." Med J Aust 158 (1993): 142-4
  12. Gomezlechon MJ, Carrasquer J, Berenguer J, Castell JV "Evidence of antibodies to erythromycin in serum of a patient following an episode of acute drug-induced hepatitis." Clin Exp Allergy 26 (1996): 590-6
View all 12 references
Major

MDVs (applies to erythromycin) prematurity

Major Potential Hazard, Moderate plausibility. Applicable conditions: Prematurity/Underweight in Infancy

Parenteral medications formulated in multidose vials often contain benzyl alcohol as a preservative. Their use is considered by drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. When used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, benzyl alcohol has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. Thus, single-dose formulations should always be used in infants whenever possible. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. However, the administration of high dosages of these medications must take into account the total amount of benzyl alcohol administered. The level at which toxicity may occur is unknown.

References

  1. "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn (2001):
  2. "Product Information. Mesnex (mesna)." Bristol-Myers Squibb (2001):
  3. "Product Information. Mivacron (mivacurium)." Glaxo Wellcome (2001):
  4. "Product Information. Nuromax (doxacurium)." Glaxo Wellcome (2001):
  5. "Product Information. Tracrium (atracurium)." Glaxo Wellcome (2001):
  6. ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
View all 6 references
Moderate

Macrolide antibiotics (applies to erythromycin) myasthenia gravis

Moderate Potential Hazard, Moderate plausibility.

The use of macrolide antibiotics has been reported to exacerbate symptoms of myasthenia gravis and trigger new onset of symptoms of myasthenic syndrome. Therapy with these agents should be administered cautiously in patients with a history of myasthenia gravis.

References

  1. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  2. "Product Information. Zithromax IV (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2022):
  3. "Product Information. Zithromax (azithromycin)." Pfizer U.S. Pharmaceuticals Group (2021):
  4. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):
View all 4 references
Moderate

Macrolide antibiotics (applies to erythromycin) QT prolongation

Moderate Potential Hazard, High plausibility. Applicable conditions: Hypokalemia, Magnesium Imbalance, Arrhythmias

Macrolides have been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Clarithromycin and erythromycin should be avoided in: patients with known prolongation of the QT interval, ventricular cardiac arrhythmia, including torsades de pointes; patients with proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or receiving other drugs that prolong the QT interval.

References

  1. "Product Information. Biaxin (clarithromycin)." AbbVie US LLC (2019):
  2. "Product Information. E.E.S.-400 Filmtab (erythromycin)." Arbor Pharmaceuticals (2018):

Erythromycin drug interactions

There are 613 drug interactions with erythromycin.

Erythromycin alcohol/food interactions

There are 2 alcohol/food interactions with erythromycin.


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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.