Category:

• Antibiotic

Description:

• Macrolide

Indications:

• Upper respiratory tract infections (S. pyogenes, S. pneumoniae, H. inlfuenzae)

• Lower respiratory tract infections (S. pyogenes, S. pneumoniae)

• Respiratory tract infections (Mycoplasma pneumoniae)

• Skin infections (S. aureus, S. pyogenes)

• Pertussis (Bordetella pertussis)

• Diphtheria (Corynebacterium diphtheriae)

• Erythasma (C. minutissimum)

• Intestinal amebiasis (Entamoeba histolytica)

• Pelvic inflammatory disease (N. gonorrhoeae)

• Conjunctivitis (Chlamydia trachomatis)

• Uncomplicated urethral, endocervical or rectal infections (Chlamydia trachomatis)

• Nongonococcal urethritis (Ureaplasma urealyticum)

• Primary syphilis (Treponema pallidum)

• Legionnaire’s disease (Legionella pneumonphila)

• Rheumatic fever

• Bacterial endocarditis

• Listeria monocytogenes infections

• Unlabled uses: Treponema pallidum, Campylobacter jejuni, Lymphogranuloma vernereum, Calymmatobacterium granulomatis, Haemophilus ducreyi (chanchroid)

Contraindications:

• None

Precautions:

• Pregnancy category B

• Counsel patient to finish all medication to prevent development of resistance

• Do not use with cisapride (ventricular arrythmias w/macrolides)

• Optimal serum levels are achieved if taken in fasting state or immediately before meals (base and stearate formulations).  Ehtylsuccinate,estolate and enteric-coated erythromycin formulations may be administered without regard for meals.

• Urine alkalinization (pH 8.5) increases gram-negative antibacterial activity.  If needed, administer with sodium bicarbonate or other alkalinizing agent

• Dosages are expressed in the form of erythromycin base:

  • Erythromycin Ethylsuccinate 400mg = 250mg of erythromycin base

Adverse Reactions (Side Effects):

• Hypersensitivity

• Gastrointestinal: abdominal pain (7.5%), nausea, vomiting, diarrhea (7.3%)

• Headache (8.2%)

• Decreased platelet count (4.8%)

• Vaginitis

Dosage:

• Administered orally (tablets, oral suspension)

• Adult:

  • 250mg four times a day, 500mg twice a day or 333mg three times a day for 10-14 days

• Legionnaire’s disease: 

  • 1-4 grams per day in four equal does for 10-14 days

• Child:

  • 30-50mg/kg/day divided into four equal doses

  • For oral suspension:  empty stomach, refrigerate, shake well, good for 14 days only