erythromycin (Eryc, Eryctte, E-mycin, Ilotycin, AK-Mycin, A/T/S, T-stat)

^[1]^[2]^[3]^[4]^[5]^[6]^[7]^[8]^[9]^[10]^[11]^[12]^[13]^[14]^[15]^[16]

Introduction

Tradename: Eryc, E-mycin, Erycette (topical), Ilotycin, AK-Mycin (ophthalmic)

Indications

treatment of non life threatening bacterial infections
- skin or soft tissue infection
  - ecthyma, erysipeloid, erysepelas, erythrasma
  - moderate-severe inflammatory acne^[6]
- respiratory tract infection
  - pertussis
  - pneumonia
- gastrointestinal infection
  - proctitis
- urogenital infection
  - urethritis
  - syphilis, trachoma, gonorrhea, chancroid, lymphogranuloma venereum, donovanosis
- acute otitis media
- rheumatic fever
- Lyme disease, borreliosis
anthrax, cutaneous anthrax, inhalation anthrax^[15]
listeriosis, diptheria, actinomycosis, Legionnaire's disease,
prophylaxis before bowel surgery, upper GI endoscopy
stimulate intestinal motility
- GERD, gastroparesis, bowel preparation
topical: treatment of acne, rosacea^[10]:
eye infections

Contraindications

Caution: avoid in infants < 2 weeks of age^[8]^[9]

pregnancy category = b

safety in lactation = +

Dosage

systemic
- 250-500 mg PO QID.
- 333 mg PO TID.
- 500 mg PO BID.
- 10-20 mg/kg/day IV divided every 6 hours, max 4 g/day.
- Legionella dose: 1 g IV every 6 hours
topical: apply BID after cleansing
ophthalmic
- apply BID-QID
- Chlamydia: 1 strip BID for 2 months, or BID for the 1st 5 days of the month for 6 months

Tabs: 250, 333, 500 mg.

Injection: IV form: erythromycin lactobionate.

Solution: 60 mL

Ointment: 0.5%

Dosage adjustment in renal failure

Table

creatinine clearance	dosage
10-50 mL/min	100%
< 10 mL/min	50-75% dosing
hemodialysis	no post-hemodialysis dosing

Pharmacokinetics

oral dose absorbed primarily in the duodenum
oral bioavailability 18-45%
well distributed to most tissues
- does not penetrate CSF well
- crosses placenta
protein-binding 75-90%
metabolized by demethylation in the liver by cyt P450 3A4
eliminated in the bile
1/2life is 1-2 hours (5-6 hours ESRD)

elimination via liver

1/2life = 1-2 hours

protein binding = 75-90 %

Antimicrobial activity

Actinomyces
Clostridium species (+/-)

Adverse effects

common & less common (> 1%)
- nausea/vomiting
- diarrhea, cramps*
- increased aspartate transaminase (AST)
- cholestatic jaundice
- phlebitis at injection site & thrombophlebitis
- oral candidiasis
uncommon (< 1%)
- hypertrophic pyloric stenosis#, ventricular arrhythmias, fever, skin rash, diarrhea, eosinophilia, hypersensitivity reaction (rare)
other
- increased PT & INR
- ototoxicity (tinnitus, transient deafness)
  - high doses IV, i.e. 4 g/day
  - generally reversible
- QT prolongation, torsades de pointes
as topical agent
- local dryness
- erythema
- tenderness
- burning
- irritation
- hypersensitivity (rare)

* GI intolerance due to hepatic reduction to ketal analogous to motilin.

# Incidence of hypertrophic pyloric stenosis 1-2.6% in infants given erythromycin within 1st 2 weeks of life^[8]^[9]

drug adverse effects of macrolide(s)

Drug interactions

QT prolongation associated with concurrent administration of cyt P450 3A4 inhibitors:^[11]^[12]
erythromycin inhibits metabolism of:
do NOT administer in combination with clindamycin
any drug that inhibits cyt P450 3A4 may increase levels of erythromycin
any drug that induces cyt P450 3A4 may diminish levels of erythromycin
erythromycin inhibits cyt P450 1A2 & cyt P450 3A4
- inhibits its own metabolism & metabolism of other cyt P450 3A4 substrates
- inhibits metabolism of cyt P450 1A2 substrates
inhibits P-glycoprotein
- increases intracellular concentration of drugs pumped out of cells by P-glycoprotein^[13]
erythromycin in combination with calcium channel blocker may increase risk of hypotension & acute renal failure^[16]

Mechanism of action

bacteriostatic
binds to 50S ribosomal subunits
inhibits bacterial protein synthesis
may have anti-inflammatory properties^[14]
enhances GI motility, peristalsis

More general terms

macrolide (macrolide antibiotic)

More specific terms

Additional terms

Component of

benzoyl peroxide/erythromycin (Benzamycin)

References

↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
↑ Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 164
↑ Sanford Guide to antimicrobial therapy 1997
↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
↑ ^{Jump up to: 6.0} ^6.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2017.
↑ Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^{Jump up to: 8.0} ^8.1 ^8.2 Journal Watch 21(21):170, 2001 Mahon et al, J Pediatr 139:380, 2001
↑ ^{Jump up to: 9.0} ^9.1 ^9.2 Journal Watch 22(16):128, 2002 Cooper WO et al Arch Pedatr Adolesc Med 156:647, 2002
↑ ^{Jump up to: 10.0} ^10.1 Prescriber's Letter 10(4):22 2003
↑ ^{Jump up to: 11.0} ^11.1 Prescriber's Letter 11(11): 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=201115&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^{Jump up to: 12.0} ^12.1 Journal Watch 24(20):150, 2004 Ray WA, Murray KT, Meredith S, Narasimhulu SS, Hall K, Stein CM. Oral erythromycin and the risk of sudden death from cardiac causes. N Engl J Med. 2004 Sep 9;351(11):1089-96. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15356306
↑ ^{Jump up to: 13.0} ^13.1 Prescriber's Letter 12(9): 2005 Fatal Interaction Between Clarithromycin and Colchicine Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211004&pb=PRL (subscription needed) http://www.prescribersletter.com
↑ ^{Jump up to: 14.0} ^14.1 Kunisaki KM and Niewoehner DE Antibiotic prophylaxis for chronic obstructive pulmonary disease: resurrecting an old idea. Am J Respir Crit Care Med. 2008 Dec 1;178(11):1098-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19023036
↑ ^{Jump up to: 15.0} ^15.1 ^15.2 ^15.3 ^15.4 Deprecated Reference
↑ ^{Jump up to: 16.0} ^16.1 Paauw DS Dangerous and Deadly Drug Combinations Medscape. June 30, 2016 http://www.medscape.com/features/slideshow/dangerous-drug-combinations

Database

[ref1-1] The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996

[ref2-2] Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 164

[ref3-3] Sanford Guide to antimicrobial therapy 1997

[ref4-4] Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998

[ref5-5] Kaiser Permanente Northern California Regional Drug Formulary, 1998

[ref6-6] {Jump up to: 6.0} ^6.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2017.

[ref7-7] Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220233&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref8-8] {Jump up to: 8.0} ^8.1 ^8.2 Journal Watch 21(21):170, 2001 Mahon et al, J Pediatr 139:380, 2001

[ref9-9] {Jump up to: 9.0} ^9.1 ^9.2 Journal Watch 22(16):128, 2002 Cooper WO et al Arch Pedatr Adolesc Med 156:647, 2002

[ref10-10] {Jump up to: 10.0} ^10.1 Prescriber's Letter 10(4):22 2003

[ref11-11] {Jump up to: 11.0} ^11.1 Prescriber's Letter 11(11): 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=201115&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref12-12] {Jump up to: 12.0} ^12.1 Journal Watch 24(20):150, 2004 Ray WA, Murray KT, Meredith S, Narasimhulu SS, Hall K, Stein CM. Oral erythromycin and the risk of sudden death from cardiac causes. N Engl J Med. 2004 Sep 9;351(11):1089-96. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15356306

[ref13-13] {Jump up to: 13.0} ^13.1 Prescriber's Letter 12(9): 2005 Fatal Interaction Between Clarithromycin and Colchicine Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=211004&pb=PRL (subscription needed) http://www.prescribersletter.com

[ref14-14] {Jump up to: 14.0} ^14.1 Kunisaki KM and Niewoehner DE Antibiotic prophylaxis for chronic obstructive pulmonary disease: resurrecting an old idea. Am J Respir Crit Care Med. 2008 Dec 1;178(11):1098-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19023036

[ref15-15] {Jump up to: 15.0} ^15.1 ^15.2 ^15.3 ^15.4 Deprecated Reference

[ref16-16] {Jump up to: 16.0} ^16.1 Paauw DS Dangerous and Deadly Drug Combinations Medscape. June 30, 2016 http://www.medscape.com/features/slideshow/dangerous-drug-combinations

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erythromycin (Eryc, Eryctte, E-mycin, Ilotycin, AK-Mycin, A/T/S, T-stat)

Contents

Introduction

Indications

Contraindications

Dosage

Dosage adjustment in renal failure

Pharmacokinetics

Antimicrobial activity

Adverse effects

Drug interactions

Mechanism of action

More general terms

More specific terms

Additional terms

Component of

References

Database

Navigation menu

erythromycin (Eryc, Eryctte, E-mycin, Ilotycin, AK-Mycin, A/T/S, T-stat)

Introduction

Indications

Contraindications

Dosage

Dosage adjustment in renal failure

Pharmacokinetics

Antimicrobial activity

Adverse effects

Drug interactions

Mechanism of action

More general terms

More specific terms

Additional terms

Component of

References

Database

Navigation menu

Search