erythromycin

Drug Name

Generic Name :  erythromycin, erythromycin base , erythromycin estolate, erythromycin ethylsuccinate , erythromycin gluceptate , erythromycin lactobionate ,erythromycin stearate

Brand Name:

  • Oral, ophthalmic ointment, topical dermatologic solution for acne, topical dermatologic ointment: Akne-mycin, A/T/S, Apo-Erythro (CAN), Apo-Erythro E-C (CAN), Diomycin (CAN), E-Mycin, Erybid (CAN), Eryc, EryDerm, Erymax, Ery-Tab, Erythromycin Film-tabs, Ilotycin, PCE Dispertab Apo-Erythro ES (CAN), E.E.S. 200, E.E.S., 400, E.E.S. Granules, EryPed, EryPed 200, EryPed 400, EryPed Drops
  • Parenteral, IV: Ilotycin Gluceptate , Erythrocin I.V. (CAN), Erythrocin Lactobionate , Apo-Erythro-S (CAN), Nu-Erythromycin-S (CAN)

Classification: Macrolide antibiotic

Pregnancy Category B

Dosage & Route
Systemic administration
  • Oral preparations of the different erythromycin salts differ in pharmacokinetics: 400 mg erythromycin ethylsuccinate produces the same free erythromycin serum levels as 250 mg of erythromycin base, stearate, or estolate.

ADULTS

  • 15–20 mg/kg/day in continuous IV infusion or up to 4 g/day in divided doses q 6 hr; 250 mg (400 mg of ethylsuccinate) q 6 hr PO or 500 mg q 12 hr PO or 333 mg q 8 hr PO, up to 4 g/day, depending on the severity of the infection.
    • Streptococcal infections: 20–50 mg/kg/day PO in divided doses (for group A beta-hemolytic streptococcal infections, continue therapy for at least 10 days).
    • Legionnaire’s disease: 1–4 g/day PO or IV in divided doses for 10–21 days (ethylsuccinate 1.6 g/day; optimal doses not established).
    • Dysenteric amebiasis: 250 mg (400 mg of ethylsuccinate) PO qid or 333 mg q 8 hr for 10–14 days.
    • Acute PID (N. gonorrhoeae): 500 mg of lactobionate or gluceptate IV q 6 hr for 3 days and then 250 mg stearate or base PO q 6 hr or 333 mg q 8 hr for 7 days.
    • Prophylaxis against bacterial endocarditis before dental or upper respiratory procedures: 1 g (1.6 g of ethylsuccinate) 2 hr before procedure and 500 mg (800 mg ethylsuccinate) 6 hr later.
    • Chlamydial infections: Urogenital infections during pregnancy: 500 mg PO qid or 666 mg q 8 hr for at least 7 days, one-half this dose q 8 hr for at least 14 days if intolerant to first regimen. Urethritis in males: 800 mg of ethylsuccinate PO tid for 7 days.
    • Primary syphilis: 30–40 g (48–64 g of ethylsuccinate) in divided doses over 10–15 days.
    • CDC recommendations for STDs: 500 mg PO qid for 7–30 days, depending on the infection.

PEDIATRIC PATIENTS

  • 30–50 mg/kg/day PO in divided doses. Specific dosage determined by severity of infection, age, and weight.
    • Dysenteric amebiasis: 30–50 mg/kg/day in divided doses for 10–14 days.
    • Pertussis: 1 g PO daily in divided doses for 14 days.
    • Prophylaxis against bacterial endocarditis: 20 mg/kg before procedure and then 10 mg/kg 6 hr later.
    • Chlamydial infections: 50 mg/kg/day PO in divided doses, for at least 2 (conjunctivitis of newborn) or 3 (pneumonia of infancy) wk.
Ophthalmic ointment

ADULTS AND PEDIATRIC PATIENTS

  • One-half–inch ribbon instilled into conjunctival sac of affected eye two to six times per day, depending on severity of infection.
Topical

ADULTS AND PEDIATRIC PATIENTS

  • Dermatologic solution for acne: Apply to affected areas morning and evening.
  • Topical dermatologic ointment: Apply to affected area one to five times per day.
Therapeutic actions
  • Erythromycin inhibits protein synthesis by irreversibly binding to the 50S ribosomal subunit thus blocking the transpeptidation or translocation reactions of susceptible organisms resulting in stunted cell growth.
Indications
Systemic administration
  • Acute infections caused by sensitive strains of Streptococcus pneumoniae, Mycoplasma pneumoniae, Listeria monocytogenes, Legionella pneumophila
  • URIs, lower respiratory tract infections, skin and soft-tissue infections caused by group A beta-hemolytic streptococci when oral treatment is preferred to injectable benzathine penicillin
  • PID caused by N. gonorrhoeae in patients allergic to penicillin
  • In conjunction with sulfonamides in URIs caused by Haemophilus influenzae
  • As an adjunct to antitoxin in infections caused by Corynebacterium diphtheriae and Corynebacterium minutissimum
  • Prophylaxis against alpha-hemolytic streptococcal endocarditis before dental or other procedures in patients allergic to penicillin who have valvular heart disease
  • Oral erythromycin: Treatment of intestinal amebiasis caused by Entamoeba histolytica; infections in the newborn and in pregnancy that are caused by Chlamydia trachomatis and in adult chlamydial infections when tetracycline cannot be used; primary syphilis (Treponema pallidum) in penicillin-allergic patients; eliminating Bordetella pertussis organisms from the nasopharynx of infected individuals and as prophylaxis in exposed and susceptible individuals
  • Unlabeled uses: Erythromycin base is used with neomycin before colorectal surgery to reduce wound infection; treatment of severe diarrhea associated with Campylobacter enteritis or enterocolitis; treatment of genital, inguinal, or anorectal lymphogranuloma venereum infection; treatment of Haemophilus ducreyi (chancroid)
Ophthalmic ointment
  • Treatment of superficial ocular infections caused by susceptible strains of microorganisms; prophylaxis of ophthalmia neonatorum caused by N. gonorrhoeae or C. trachomatis
Topical dermatologic solutions for acne
  • Treatment of acne vulgaris
Topical dermatologic ointment
  • Prophylaxis against infection in minor skin abrasions
  • Treatment of skin infections caused by sensitive microorganisms
Adverse effects
  • Rash, urticaria; nausea, vomiting, GI discomfort; ototoxicity; central neurotoxicity; agranulocytosis; arrhythmias; pancreatitis.
  • Potentially Fatal: Hepatotoxicity, cholestatic jaundice; raised serum transaminases; eosinophilia.
Contraindications
  • Hypersensitivity; porphyria; hepatic impairment; pregnancy.
Nursing considerations
Assessment
  • History: Allergy to erythromycin, hepatic impairment, lactation; viral, fungal, mycobacterial infections of the eye (ophthalmologic), pregnancy
  • Physical: Site of infection; skin color, lesions; orientation, affect, hearing tests; R, adventitious sounds; GI output, bowel sounds, liver evaluation; culture and sensitivity tests of infection, urinalysis, LFTs
Interventions

Systemic administration

  • Culture site of infection before therapy.
  • Administer oral erythromycin base or stearate on an empty stomach, 1 hr before or 2–3 hr after meals, with a full glass of water (oral erythromycin estolate, ethylsuccinate, and certain enteric-coated tablets [see manufacturer’s instructions] may be given without regard to meals).
  • Administer around the clock to maximize effect; adjust schedule to minimize sleep disruption.
  • Monitor liver function in patients on prolonged therapy.
  • Give some preparations with meals, as directed, or substitute one of these preparations, if GI upset occurs with oral therapy.

Topical dermatologic solution for acne

  • Wash affected area, rinse well, and dry before application.

Ophthalmic and topical dermatologic preparation

  • Use topical products only when needed. Sensitization produced by the topical use of an antibiotic may preclude its later systemic use in serious infections. Topical antibiotic preparations not normally used systemically are best.
  • Culture site before beginning therapy.
  • Cover the affected area with a sterile bandage if needed (topical).
Teaching points

Systemic administration

  • Take oral drug on an empty stomach, 1 hour before or 2–3 hours after meals, with a full glass of water; some forms may be taken without regard to meals. Do not drink grapefruit juice while on this drug. The drug should be taken around the clock; schedule to minimize sleep disruption. Finish the full course of the drug therapy.
  • You may experience these side effects: Stomach cramping, discomfort (take the drug with meals, if appropriate); uncontrollable emotions, crying, laughing, abnormal thinking (reversible).
  • Report severe or watery diarrhea, severe nausea or vomiting, dark urine, yellowing of the skin or eyes, loss of hearing, rash or itching.

Ophthalmic ointment

  • Pull the lower eyelid down gently and squeeze a one-half–inch ribbon of the ointment into the sac, avoid touching the eye or lid. A mirror may be helpful. Gently close the eye, and roll the eyeball in all directions.
  • Drug may cause temporary blurring of vision, stinging, or itching.
  • Report stinging or itching that becomes pronounced.

Topical dermatologic solution for acne

  • Wash and rinse area, and pat it dry before applying solution.
  • Use fingertips or an applicator to apply; wash hands thoroughly after application.