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Erythromycin topical

Pronunciation

Class: Antibacterials
VA Class: DE101
Chemical Name: (3R*,4S*,5S*,6R*,7R*,9R*,11R*,12R*,13S*,14R*) - 4 - [(2,6 - dideoxy - 3 - C - methyl - 3 - O - methyl - α - l - ribo - hexopyranosyl)oxy] - 14 - ethyl - 7,12,13 - trihydroxy - 3,5,7,9,11,13 - hexamethyl - 6 - [[3,4,6 - trideoxy - 3 - (dimethylamino) - β - d - xylo - hexopyranosyl]oxy]oxacyclotetradecane - 2,10 - dione
CAS Number: 114-07-8
Brands: Akne-Mycin, Benzamycin, Erygel, Erythro-Rx, Erythra-Derm

Introduction

Antibacterial; macrolide antibiotic.b

Uses for Erythromycin

Acne Vulgaris

Treatment of acne vulgaris.a b c d e 110 111

Generally effective for the treatment of mild to moderate inflammatory acne.b 110 111 Main action is prevention of new lesions.110

May induce bacterial resistance when used as monotherapy;110 111 resistance associated with decreased clinical efficacy.110

Particularly useful when used in combination with benzoyl peroxide or topical retinoids;110 111 reduction in total lesion count of 50–70% reported when combination therapy used.110

Other Uses

Not indicated for the treatment of superficial skin infections (e.g., wound infections).b

Erythromycin Dosage and Administration

General

  • Apply to all areas of skin prone to acne.110

  • Maintenance therapy needed to prevent recurrence.110

Administration

Topical

Apply to the skin as a 2% solution, ointment, or gel or as a gel containing erythromycin 3% admixed with benzoyl peroxide 5%.a c d e

For external use only; do not use near eyes, nose, mouth, or other mucous membranes.a b c d e

Apply a thin film of solution, gel, or ointment to cleansed and dried affected area each morning and/or evening.a c d e

Apply the 2% gel to the skin lightly without rubbing.a

Rub pledget saturated with 2% solution over affected area.b d

Commercial preparation containing erythromycin and benzoyl peroxide is supplied in foil pouch with the 2 drugs in separate compartments.c Mix the contents of the 2 compartments in palm of hand, apply immediately, and then wash hands.c

Dosage

Pediatric Patients

Acne Vulgaris
Topical

Apply a thin film to affected area once or twice daily.b c e

Adults

Acne Vulgaris
Topical

Apply a thin film to affected area once or twice daily.a c d e

Cautions for Erythromycin

Contraindications

  • Known hypersensitivity to erythromycin or any ingredient in the formulation.a c d e

Warnings/Precautions

Warnings

Superinfection/Clostridium difficile-associated Colitis

Possible emergence and overgrowth of nonsusceptible bacteria or fungi.b c e Discontinue drug and institute appropriate therapy if superinfection occurs.b c e

Consider Clostridium difficile-associated diarrhea and colitis (antibiotic-associated pseudomembranous colitis) if diarrhea develops and manage accordingly.a d

Some mild cases of C. difficile-associated diarrhea and colitis may respond to discontinuance alone.a d Manage moderate to severe cases with fluid, electrolyte, and protein supplementation; appropriate anti-infective therapy (e.g., oral metronidazole or vancomycin) recommended if colitis is severe.105 106 107 108 a d

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Category B.a d

Category C (admixed preparation containing benzoyl peroxide).c

Lactation

Not known whether erythromycin is distributed into milk following topical application;a c d distributed into milk following systemic administration.a c d Caution if used in nursing women.a c d

Pediatric Use

Safety and efficacy of single-entity topical gel or solution not established in children.a d

Safety and efficacy of admixed preparation (erythromycin and benzoyl peroxide) not established in children <12 years of age.c

Common Adverse Effects

Local dryness, erythema, tenderness, stinging, burning, pruritus, oiliness, desquamation.a b c d e

Interactions for Erythromycin

Cosmetics

Alcohol-containing cosmetics (e.g., astringents, after-shave lotions): Cumulative irritant or drying effect; use with caution.b

Topical Acne Preparations

Medicated soaps or abrasive, peeling, or desquamating agents: Cumulative irritant or drying effect; use with caution.a b c d

Specific Drugs

Drug

Interaction

Comments

Clindamycin

In vitro antagonisma d

Concomitant use not recommendedb

Salicylic acid

Cumulative irritant or drying effecta b c d

Use with cautiona b c d

Sulfur

Cumulative irritant or drying effecta b c d

Use with cautiona b c d

Tretinoin

Cumulative irritant or drying effecta b c d

Use with cautiona b c d

Erythromycin Pharmacokinetics

Absorption

Bioavailability

Does not appear to be absorbed systemically following topical application as 2% solution in vehicle containing 77% alcohol and polyethylene glycol and acetone.b

Not known whether absorbed systemically following topical application as ointment.b

Not detectable in plasma in 15 of 16 patients following topical application of a single dose of admixed preparation (erythromycin 3% and benzoyl peroxide 5%).c

Distribution

Extent

Not known whether topically applied erythromycin is distributed into breast milk; systemically administered erythromycin crosses the placenta, but fetal plasma concentrations generally are low.a d

Stability

Storage

Topical

Gel

15–30°C; keep away from heat and open flames.b

Ointment

<27°C.e

Solution

15–30°C; keep away from heat and open flames.b

Actions and Spectrum

  • Usually bacteriostatic; may be bactericidal in high concentrations or against highly susceptible organisms.b

  • Inhibits protein synthesis in susceptible organisms by reversibly binding to 50S ribosomal subunits.a d

  • Erythromycin-resistant P. acnes develop during topical therapy when used as monotherapy.110 Partial cross-resistance occurs between erythromycin and clindamycin and lincomycin.b

Advice to Patients

  • Importance of not using near eyes, nose, mouth, or other mucous membranes.a c d

  • Use only for condition prescribed.a c d

  • Importance of reporting any local adverse reactions to clinician.a c d

  • If admixed preparation (erythromycin and benzoyl peroxide) is used, instruct patient on proper mixing procedure.c

  • Importance of keeping gel and solution formulations away from heat or open flames.a b c

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, particularly topical acne preparations.a c d

  • Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.b

  • Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Erythromycin

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

 

Erythro-Rx for Prescription Compounding

X-Gen

Topical

Gel

2%*

Erythromycin Gel

Erygel

Merz

Ointment

2%

Akne-Mycin

Healthpoint

Solution

2%*

Erythromycin Solution

Erythra-Derm

Paddock

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Erythromycin Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Gel

3% with Benzoyl Peroxide 5%*

Benzamycin

Dermik

Erythromycin and Benzoyl Peroxide Gel

AHFS DI Essentials. © Copyright, 2016, American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814. Review Date: September 06, 2016.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Fulton JE Jr, Pablo G. Topical antibacterial therapy for acne: study of the family of erythromycins. Arch Dermatol. 1974; 110:83-6. [PubMed 4278511]

101. Fisher AA. Erythromycin “free base”—a nonsensitizing topical antibiotic for infected dermatoses and acne vulgaris. Cutis. 1977 (Jul); 20:17,26,30,35.

102. Fisher AA. The safety of topical antibiotics in the treatment of acne vulgaris. Cutis. 1980 (May); 25:474,476,481.

103. Van Ketel WG. Immediate- and delayed-type allergy to erythromycin. Contact Dermatitis. 1976; 2:363-4. [PubMed 1032135]

104. Fisher AA. Is topical erythromycin base non-allergenic? Contact Dermatitis. 1983; 9:243. Letter.

105. Johnson S, Gerding DN. Clostridium difficile-associated diarrhea. Clin Infect Dis. 1998; 26:1027-36. [IDIS 407733] [PubMed 9597221]

106. Gerding DN, Johnson S, Peterson LR et al for the Society for Healthcare Epidemiology of America. Position paper on Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol. 1995; 16:459-77. [PubMed 7594392]

107. Fekety R for the American College of Gastroenterology Practice Parameters Committee. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol. 1997; 92:739-50. (IDIS 386628) [IDIS 386628] [PubMed 9149180]

108. American Society of Health-System Pharmacists Commission on Therapeutics. ASHP therapeutic position statement on the preferential use of metronidazole for the treatment of Clostridium difficile-associated disease. Am J Health-Syst Pharm. 1998; 55:1407-11. [IDIS 407213] [PubMed 9659970]

109. Wilcox MH. Treatment of Clostridium difficile infection. J Antimicrob Chemother. 1998; 41(Suppl C):41-6. [IDIS 407246] [PubMed 9630373]

110. James WD. Acne. N Engl J Med. 2005; 352:1463-72. [PubMed 15814882]

111. Strauss JS, Krowchuk DP, Leyden JJ et al. Guidelines of care for acne vulgaris management. J Am Acad Dematol. 2007; 56:651-63.

a. Merz Pharmaceuticals. Erygel (erythromycin) topical gel 2% for dermatologic use prescribing information. 2001 Oct. Greensboro, NC.

b. AHFS Drug Information. McEvoy GK, ed. Erythromycin. American Society of Health-System Pharmacists; 2007:3442-4.

c. Dermik Laboratories. Benzamycin Pak (erythromycin 3%-benzoyl peroxide 5%) topical gel for dermatologic use prescribing information. Bridgewater, NJ; 2006 Dec.

d. Fougera. Erythromycin solution prescribing information. Melville, NT; 2006 Aug.

e. Healthpoint. Akne-mycin (erythromycin 2%) ointment for topical use prescribing information. San Antonio, Texas.

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