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Drug Interactions between erythromycin and TheraCys

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

erythromycin BCG

Applies to: erythromycin and TheraCys (bcg)

GENERALLY AVOID: Antibiotics may interfere with the anti-tumor activity of intravesical BCG, which contains a live, attenuated strain of Mycobacterium bovis. Some researchers have suggested that antibiotic therapy prior to or concurrently with BCG therapy may affect therapeutic efficacy via changes in the urinary microbiome. It is considered contraindicated to use intravesical BCG in patients with concurrent febrile illness, active tuberculosis, and/or urinary tract infections. Intravesical BCG is sensitive to most antibiotics, particularly those that are routinely used in the treatment of tuberculosis such as streptomycin, para-aminosalicylic acid (PAS), isoniazid (INH), rifampin, and ethambutol. It is reportedly not sensitive to pyrazinamide or cycloserine. Regardless of clinical susceptibility data, however, most antibacterials may still interfere with BCG in the bladder due to their high urinary recovery. One retrospective study in 276 high-risk non-muscle invasive bladder cancer patients receiving intravesical BCG reported a significantly higher 5-year recurrence-free survival rate in patients who did not receive antibiotic therapy than in those treated with long-course (>=7 days) antibiotics (ciprofloxacin, levofloxacin, cefaclor, cefpodoxime, or cefixime).

MANAGEMENT: Intravesical BCG should not be used in individuals with concurrent infections. For patients being treated with antibiotics, intravesical instillations of BCG should generally be postponed until completion of antibiotic therapy. If a bacterial urinary tract infection (UTI) occurs, therapy with intravesical BCG should be postponed or interrupted until complete resolution of the infection (e.g., negative urine culture and completion of antibiotic(s) and/or urinary antiseptic(s)), not only because antimicrobial administration may diminish the anti-tumor efficacy of BCG, but also because the combination of a UTI and BCG-induced cystitis may lead to more severe adverse effects in the genitourinary tract. There are no data to suggest that the acute, local urinary tract toxicity common with intravesical administration of BCG is due to mycobacterial infection, thus antituberculosis drugs should not be used to prevent or treat the local, irritative toxicities of intravesical BCG.

References

  1. Durek C, Rusch-Gerdes S, Jocham D, Bohle A (1999) "Interference of modern antibacterials with bacillus Calmette-Guerin viability." J Urol, 162, p. 1959-62
  2. (2021) "Product Information. OncoTICE (BCG)." Merck Sharp & Dohme (UK) Ltd
  3. (2022) "Product Information. Tice BCG Live (for intravesical use) (BCG)." Merck Sharp & Dohme LLC
  4. (2019) "Product Information. OncoTICE (BCG)." Organon
  5. (2021) "Product Information. Verity-BCG (BCG)." Verity Pharmaceuticals Inc.
  6. Pak S, Kim SY, kim sh, et al. (2023) Association between antibiotic treatment and the efficacy of intravesical BCG therapy in patients with high-risk non-muscle invasive bladder cancer. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051584/
View all 6 references

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Drug and food interactions

Moderate

erythromycin food

Applies to: erythromycin

ADJUST DOSING INTERVAL: Food may variably affect the bioavailability of different oral formulations and salt forms of erythromycin. The individual product package labeling should be consulted regarding the appropriate time of administration in relation to food ingestion. Grapefruit juice may increase the plasma concentrations of orally administered erythromycin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In an open-label, crossover study consisting of six healthy subjects, the coadministration with double-strength grapefruit juice increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single dose of erythromycin (400 mg) by 52% and 49%, respectively, compared to water. The half-life was not affected. The clinical significance of this potential interaction is unknown.

MANAGEMENT: In general, optimal serum levels are achieved when erythromycin is taken in the fasting state, one-half to two hours before meals. However, some erythromycin products may be taken without regard to meals.

References

  1. Welling PG, Huang H, Hewitt PF, Lyons LL (1978) "Bioavailability of erythromycin stearate: influence of food and fluid volume." J Pharm Sci, 67, p. 764-6
  2. Welling PG, Elliott RL, Pitterle ME, et al. (1979) "Plasma levels following single and repeated doses of erythromycin estolate and erythromycin stearate." J Pharm Sci, 68, p. 150-5
  3. Welling PG (1977) "Influence of food and diet on gastrointestinal drug absorption: a review." J Pharmacokinet Biopharm, 5, p. 291-334
  4. Coyne TC, Shum S, Chun AH, Jeansonne L, Shirkey HC (1978) "Bioavailability of erythromycin ethylsuccinate in pediatric patients." J Clin Pharmacol, 18, p. 194-202
  5. Malmborg AS (1979) "Effect of food on absorption of erythromycin. A study of two derivatives, the stearate and the base." J Antimicrob Chemother, 5, p. 591-9
  6. Randinitis EJ, Sedman AJ, Welling PG, Kinkel AW (1989) "Effect of a high-fat meal on the bioavailability of a polymer-coated erythromycin particle tablet formulation." J Clin Pharmacol, 29, p. 79-84
  7. Kanazawa S, Ohkubo T, Sugawara K (2001) "The effects of grapefruit juice on the pharmacokinetics of erythromycin." Eur J Clin Pharmacol, 56, p. 799-803
View all 7 references

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Minor

erythromycin food

Applies to: erythromycin

Ethanol, when combined with erythromycin, may delay absorption and therefore the clinical effects of the antibiotic. The mechanism appears to be due to slowed gastric emptying by ethanol. Data is available only for erythromycin ethylsuccinate. Patients should be advised to avoid ethanol while taking erythromycin salts.

References

  1. Morasso MI, Chavez J, Gai MN, Arancibia A (1990) "Influence of alcohol consumption on erythromycin ethylsuccinate kinetics." Int J Clin Pharmacol, 28, p. 426-9

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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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

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