Erythromycin

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications:

• Upper respiratory tract infections (sinusitis, pharyngitis, otitis media) caused by Streptococcus pyogenes, Streptococcus pneumoniae, Corynebacterium diphtheriae, Haemophilus influenza
• Prophylaxis and treatment of Streptococcal pharyngitis and long term prophylaxis of rheumatic fever (when penicillin is contraindicated)
• Lower respiratory tract infections (bronchitis, pneumonia) caused by Streptococcus pneumoniae, Streptococcus pyogenes, Bordetella pertussis, Legionella pneumophila (Legionnaire's disease), Chlamydia pneumoniae, Chlamydia trachomatis in newborn infants of infected mothers, Listeria monocytogenes, Mycoplasma pneumoniae, Haemophilus influenza
• Gastrointestinal infections caused by Campylobacter jejuni
• Skin and soft tissue infections caused by Streptococcus pyogenes, methicillin-sensitive Staphylococcus aureus
• Acne vulgaris
• Actinomycosis
• Genitourinary infections caused by Chlamydia trachomatis, Haemophilus ducreyi, Lymphogranuloma venereum, Ureaplasma urealyticum, Treponema pallidum, Neisseria gonorrhoeae
  - Non-gonococcal urethritis in males
  - Pelvic infections in females
  - Alternative choice for treatment of early syphilis (in patients allergic to penicillins)
• Relapsing fever due to Borrelia species
• Lyme disease
• Listeriosis
• Second-line treatment of infections caused by Clostridium tetani, Clostridium perfringens
  - Tetanus
• Some atypical mycobacteria (M.scrofulaceum, M.kansasii, M.avium-intracellulare)
• Short term prophylaxis of bacterial endocarditis prior to dental or oral operative procedures (when penicillin is contraindicated, patients with a history of rheumatic fever or presence of congenital heart disease) (inj)
• Alternate treatment choice for bacteremia and arthritis caused by N.gonorrhoea (inj)
  - Acute pelvic inflammation
• Treatment of erythrasma caused by C. minitissimum

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Erythromycin is not considered first-line treatment for infections caused by Neisseria gonorrhoeae and Treponema pallidum (primary, secondary, early latent stage). Use of erythromycin in pregnancy for treatment of Treponema pallidum may not prevent congenital syphilis

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Hypersensitivity to other macrolide antibiotics
• Severe hepatic impairment (inj)
• Porphyria
• Congenital or acquired QT interval prolongation
• Ventricular cardiac arrhythmia
• Torsades de pointes
• Electrolyte disturbances
  - Hypokalaemia
  - Hypomagnesaemia
• Severe decompensated cardiac failure (NYHA IV) (inj)
• Coadministration with astemizole, terfenadine, disopyramide, cisapride, pimozide, tolterodine, mizolastine, amisulpride, ergot alkaloids (such as ergotamine and dihydroergotamine) simvastatin, atorvastatin or lovastatin
• Coadministration with lead to QT interval prolongation, such as antiarrhythmics classes IA and III, certain neuroleptics, tri- and tetracyclic antidepressants, arsenic trioxide, methadone and budipine, certain fluoroquinolones, imidazole and anti-malarial agents such as IV pentamidine

Cautions

• Pregnancy
• Breastfeeding
• Severe renal impairment (CrCl<10ml/min)
• Hepatic impairment
• Elderly
• Infants
• Infants born to women treated for syphilis during pregnancy (tab)
• Myasthenia gravis
• Risk factors for electrolyte disturbances:
  - Diuretic and laxative medication
  - Vomiting
  - Diarrhoea
  - Emergency use of insulin
  - Kidney disease
  - Anorexic conditions
• Prolonged use
• Streptococcus pneumoniae (use there than in patients with hypersensitivity to beta-lactams or when beta-lactams are not appropriate for other reasons)
• Coronary artery disease
• Severe cardiac insufficiency
• Conduction disturbances
• Clinically relevant bradycardia
• Administration of parenteral fluids, especially those containing sodium ions, to patients receiving corticosteroids or corticotrophins
• Coadministration with potentially hepatotoxic agents
• Fructose intolerance (sus)
• Glucose-galactose malabsorption (sus)
• Sucrase-isomaltase insufficiency (sus)
• Sodium-restricted diets (sus)

Forms avail. in SA and covered in this monograph: inj, sus, tab, cap

Adult dosages below include:

• General dosing range
• International manufacturer recommendations
• South African manufacturer recommendations

Infection caused by: Gram-positive bacteria such as Listeria monocytogenes, Corynebacterium diphtheriae (as an adjunct to antitoxin), Corynebacterium minutissimumStaphylococci spp, Streptococcus pyogenes, Streptococci spp (including Enterococci); Gram-negative bacteria such as Haemophilus influenzae, Neisseria meningitidis, Neisseria gonorrhoeae, Legionella pneumophila, Moraxella (Branhamella) catarrhalis, Bordetella pertussis, Campylobacter spp; Mycoplasma such as Mycoplasma pneumoniae, Ureaplasma urealyticum; and other organisms such as Treponema pallidum, Chlamydia spp, Chlamydia trachomatis; Chlamydia pneumoniae; Chlamydia psittaci, Clostridia spp, L-forms, the agents causing trachoma and lymphogranuloma venereum; Actinomyces sp.; Arcanobacter sp., Campylobacter jejuni, Haemophilus ducreyi, K. granulomatis, Legionella sp.

General dosing range

• Erythromycin base: Oral (tab, cap, sus): 250mg-500mg 6-12hrly
• Erythromycin ester: Oral (tab, cap, sus): 400-800mg, 6-12hrly
• IV: 15-20mg/kg/day, 6hrly in divided doses; Max: 4g/24hrs

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

International manufacturer recommendations

Conjunctivitis
Pneumonia caused by atypical agents
Whooping cough
Urogenital infections
Severe gastroenteritis
Diphtheria
Lymphogranuloma venereum
Infections in patients with hypersensitivity to beta-lactams or when beta-lactams are not appropriate for other reasons
- Otitis media in severe cases
- Community-acquired pneumoniaa
- Skin and soft tissue infections
- Acute bacterial exacerbation of chronic bronchitis

Usual dose

• IV: 25mg/kg/day, in 3-4 divided doses, as an infusion over 60mins; Dose range:1-2g/24hrs; Treatment duration: Continue for 2-3 days after symptoms have disappeared

Severe infections

• IV: 50mg/kg/day, as an infusion over 60mins; Max: 4g/24hrs; Treatment duration: Continue for 2-3 days after symptoms have disappeeared

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Erythromycin can be administered in continuous or intermittent infusion

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A longer period of infusion should be used in patients with risk factors or previous evidence of arrhythmias

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Intravenous therapy should be replaced by oral administration after 2-7 days

---

IV treatment to only be considered when oral administration is not possible or insufficient

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Upper respiratory tract infections:
- Tonsillitis
- Peritonsillar abscess
- Pharyngitis
- Laryngitis
- Sinusitis
- Secondary infections in influenza and common colds
Lower respiratory tract infections:
- Tracheitis
- Acute and chronic bronchitis
- Pneumonia (lobar pneumonia, bronchopneumonia, primary atypical pneumonia)
- Bronchiectasis
- Legionnaire's disease
Ear infections:
- Otitis media and otitis externa, mastoiditis
Eye infections:
- Blepharitis
- Chlamydial conjunctivitis
Oral infections:
- Gingivitis
- Vincent's angina
Skin and soft tissue infections:
- Boils and carbuncles, paronychia, abscesses, pustular acne, impetigo, cellulitis, erysipelas
Gastro-intestinal infections:
- Cholecystitis
- Staphylococcal enterocolitis
- Campylobacter infections
Prophylaxis in:
- Pre- and post-operative trauma
- Burns
- Rheumatic fever
Other infections:
- Osteomyelitis
- Urethritis
- Gonorrhoea
- Syphilis
- Lymphogranuloma venereum
- Diphtheria
- Prostatitis
- Scarlet fever
- Pertussis

Mild to moderate infections

Oral (tab, sus): 2g, dly in divided doses

Severe infections

• Oral (tab, sus): Max: 4g/24hrs, in divided doses

OR

• Oral (sus): 250-500mg, 6hrly OR 0.5-1g, 12hrly

Acne vulgaris

• Oral (sus): 250mg, 8hrly before meeals; Treatment duration: 1-4 weeks; Then; Maintenance: 250mg, 12hrly; Treatment duration: Until improvement occurs

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There have been reports suggesting erythromycin does not reach the foetus in adequate concentrations to prevent congenital syphilis. Infants born to women treated during pregnancy with oral erythromycin for early syphilis should be treated with an appropriate penicillin regimen

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South African manufacturer recommendations

Mild to moderate infection with susceptible organisms

• Oral (tab): 250mg, 6hrly; Treatment duration: Until 48hrs or more after symptoms have resolved and temperature has returned to normal

OR 

• Oral (tab): 500mg, 8hrly; Treatment duration: Until 48hrs or more after symptoms have resolved and temperature has returned to normal

OR

• Oral (cap): 1-2g, dly, usually given 6hrly, depending on the nature and severity of the infection

OR

• Oral (sus): 250-500mg, 6hrly, before meals

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See additional prescribing points for reconstitution directions

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Severe infections, or those caused by less susceptible organisms

• Oral (tab): 1000mg, 8hrly; Treatment duration: Until 48hrs or more after symptoms have resolved and temperature has returned to normal

OR

• Oral (cap): 2-4g, dly

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Capsule formulation: Twice daily dosing is not recommended when doses larger than 1g daily are administered. Should be taken with a full glass of water (240ml) on an empty stomach (either 1hr before or 3-4hrs after meals

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OR

• IV: 15-20mg/kg administered as an infusion, dly; Max: 4g/24hrs

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IV: Continuous infusion of erythromycin is preferable, however intermittent infusion at intervals not greater than 6hrly is also effective. IV erythromycin should be replaced by oral erythromycin as soon as possible

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IV: See additional prescribing points for infusion and administration directions

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Take capsule with 250ml of water on an empty stomach

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Unusually severe infections

• Oral (tab): 1000mg, 6hrly; Treatment duration: Until 48hrs or more after symptoms have resolved and temperature has returned to normal

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Streptococcal pharyngitis: Treatment duration should be continued for 10 days to prevent rheumatic fever or streptococcal glomerulonephritis

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Syphilis
- As an alternative for the treatment of early syphilis (primary, secondary or early latent - less than one year) in penicillin sensitivity

• Oral (tab): Cumulative dose of 30-40g, in divided doses over 15-20 days

OR

• Oral (cap): 2-4g, dly; Treatment duration: 10-15 days

- Late syphilis (late latent and tertiary)

• Oral (tab): 2g, as divided doses; Treatment duration: 30 days

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Patients need to be closely followed up by serology since erythromycin has not been adequately evaluated in these cases. In neurosyphilis, serial lumbar punctures to monitor efficacy of treatment are recommended

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Legionnaire's disease

• IV/Oral (tab): 1-4g, dly in divided doses

OR

• Oral (cap): 0.5-1g, 6hrly

Group A haemolytic streptococcal infections
- Glomerulonephritis
Prophylaxis of rheumatic fever

• Oral (cap): 250-500mg, 6hrly; Treatment duration: 10 days

Bacterial endocarditis
- Prophylaxis, following dental or oropharyngeal procedures

• Oral (cap): 1g, 90mins-2hrs before the procedure; Then: 500mg, 6hrly; Treatment duration: 48 hrs (8 doses)

Acute pelvic inflammatory disease caused by N. gonorrhoea

• IV: 500mg, 6hrly; Treatment duration: 3 days; Then: 250mg erythromycin base/stearate/ethyl-succinate, 6hrly; Treatment duration: 7 days

Forms avail. in SA and covered in this monograph: inj, sus, tab

Paed. dosages below include:

• General dosing range
• International manufacturer recommendations
• South African manufacturer recommendations

Infection caused by: Gram-positive bacteria such as Listeria monocytogenes, Corynebacterium diphtheriae (as an adjunct to antitoxin), Corynebacterium minutissimumStaphylococci spp, Streptococcus pyogenes, Streptococci spp (including Enterococci); Gram-negative bacteria such as Haemophilus influenzae, Neisseria meningitidis, Neisseria gonorrhoeae, Legionella pneumophila, Moraxella (Branhamella) catarrhalis, Bordetella pertussis, Campylobacter spp; Mycoplasma such as Mycoplasma pneumoniae, Ureaplasma urealyticum; and other organisms such as Treponema pallidum, Chlamydia spp, Chlamydia trachomatis; Chlamydia pneumoniae; Chlamydia psittaci, Clostridia spp, L-forms, the agents causing trachoma and lymphogranuloma venereum; Actinomyces sp.; Arcanobacter sp., Campylobacter jejuni, Haemophilus ducreyi, K. granulomatis, Legionella sp.

General dosing range

28 days and younger

• No information available

Older than 28 days

• IV/Oral (tab, sus): 40-50mg/kg/day, in divided doses, 6hrly

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

International manufacturer recommendations

Conjunctivitis
Pneumonia caused by atypical agents
Whooping cough
Urogenital infections
Severe gastroenteritis
Diphtheria
Lymphogranuloma venereum
Infections in patients with hypersensitivity to beta-lactams or when beta-lactams are not appropriate for other reasons
- Otitis media in severe cases
- Community-acquired pneumoniaa
- Skin and soft tissue infections
- Acute bacterial exacerbation of chronic bronchitis

Birth - 1 month

• IV: 10-15mg/kg/day, in 3 divided doses

1 month - 12 years (≤40kg)

• IV: 15-20mg/kg/day, as 3-4 divided doses; Dosage may be doubled depending on indication

Older than 12 years (>40kg)

• See adult dosage

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IV treatment to only be considered when oral administration is not possible or insufficient

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Intravenous therapy should be replaced by oral administration after 2-7 days. In the interest of sustaining successful treatment, erythromycin should be continued for a further 2-3 days after symptoms have disappeared

---

Upper respiratory tract infections:
- Tonsillitis
- Peritonsillar abscess
- Pharyngitis
- Laryngitis
- Sinusitis
- Secondary infections in influenza and common colds
Lower respiratory tract infections:
- Tracheitis
- Acute and chronic bronchitis
- Pneumonia (lobar pneumonia, bronchopneumonia, primary atypical pneumonia)
- Bronchiectasis
- Legionnaire's disease
Ear infections:
- Otitis media and otitis externa, mastoiditis
Eye infections:
- Blepharitis
- Chlamydial conjunctivitis
Oral infections:
- Gingivitis
- Vincent's angina
Skin and soft tissue infections:
- Boils and carbuncles, paronychia, abscesses, pustular acne, impetigo, cellulitis, erysipelas
Gastro-intestinal infections:
- Cholecystitis
- Staphylococcal enterocolitis
- Campylobacter infections
Prophylaxis in:
- Pre- and post-operative trauma
- Burns
- Rheumatic fever
Other infections:
- Osteomyelitis
- Urethritis
- Gonorrhoea
- Syphilis
- Lymphogranuloma venereum
- Diphtheria
- Prostatitis
- Scarlet fever
- Pertussis

Mild to moderate infections

Younger than 2 years (Infants and babies) 

• Oral (tab, sus): 500mg, dly in divided doses

OR

• Oral (sus): 125mg, 6hrlyOR 30mg/kg/day in divided doses

Between 2-8 years

• Oral (tab, sus): 1g, dly in divided doses

OR

• Oral (sus): 250mg, 6hrly OR 30mg/kg/day in divided doses

Older than 8 years

• See adult dosage

Severe infections

Younger than 8 years (Infants and babies) 

• Oral (tab): Double the recommended dosage for mild to moderate infections
• Oral (sus): Max: 50mg/kg/24hrs, in divided doses

Older than 8 years

• Oral (tab): Double the recommended dosage for mild to moderate infections
• Oral (sus): See adult dosage

Acne vulgaris

Younger than 8 years

• Oral (sus): No information available

Older than 8 years

• Oral (sus): See adult dosage

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Oral treatment to be taken before meals

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South African manufacturer recommendations

Mild to moderate infection with susceptible organisms

• Erythromycin base: Oral (tab): 7.5-12.5mg/kg, 6hrly before meals

OR

• Erythromycin base: Oral (tab): 15-25mg/kg, 12hrly before meals

OR

• Oral (sus): 30-50mg/kg, in divided doses 6hrly before meals

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See additional prescribing points for reconstitution directions 

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Oral (sus) may be doubled in severe infections

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Severe infections

• IV: 15-20mg/kg administered as an infusion, dly; Max: 4g/24hrs

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IV: See additional prescribing points for infusion and administration directions

Pregnancy

• Caution
• There are no animal reproductive toxicology studies with erythromycin available, but studies with other macrolides, similar to erythromycin that are potent hERG-channel blockers, have shown embryonic death and malformations (including cardiovascular defects and cleft palate). Mechanistic studies have shown that substances blocking the hERG-channel cause cardiovascular defects and embryonic death by inducing arrhythmia in the foetus
• There are no appropriately controlled studies in pregnant women
• Erythromycin should not be administered to pregnant women unless the benefits outweigh the potential risks. Observational studies in people reported cardiovascular abnormalities when pregnant women took agents containing erythromycin during early pregnancy
• Erythromycin crosses the placenta and gives rise to foetal plasma levels which are approximately 5-20% of maternal limits. However, the risks associated with this phenomenon have not been clearly established

Breastfeeding

• Caution
• Erythromycin is not recommended for breastfeeding mothers unless the expected benefits outweigh the potential risks
• In breastfeeding women, erythromycin is secreted into breast milk in quantities of between 0.5-6.2μg/ml. These quantities are not known to be harmful
• About 50% of the drug crosses into the mother's milk and can cause gastrointestinal disorders in the infant, but possibly also the formation of pyloric stenosis. Furthermore, sensitivity of infection with blastomycetes is also possible
• The benefits and risks of use during breastfeeding must be carefully considered

Fertility

• No data exists on the effect of erythromycin on fertility in human subjects. Animal studies showed that erythromycin has no teratogenic effects

Renal Impairment

• CrCl >10ml/min: Caution; no dose adjustment recommended
• In moderate to severely impaired renal function, toxicity has been reported and dose adjustment in these cases may be warranted:
  - Administration of doses of ≥4g/day may increase the risk for the development of erythromycin-induced hearing loss in elderly patients, particularly those with reduced renal function
  - In moderate to severely impaired renal function (with a level of serum creatinine of 2.0mg/dl, kidney failure with anuria), for adolescents >14 years old and adults (with a bodyweight >50kg) the Max daily dose is 2g/24hrs
• CrCl<10ml/min: Caution; dose adjustment recommended 
  IV: Reduce dose to 50%-75% of the normal dose, to be administered with the usual treatment regimen; Max: 2g/24hrs
  Oral (sus): Max: 1.5g/24hrs
  For severe infections, dosage may be doubled. Duration of dosage regimen is dependent on the nature of the infection and is at the discretion of the physician
  Erythromycin is not removed by haemodialysis or peritoneal dialysis. For patients who have regular dialysis, an additional dose is therefore not recommended

Hepatic Impairment

• Caution; no dose adjustment recommended (tab, sus)
• Mild to moderate: Caution; no dose adjustment recommended (inj)
  In the presence of normal hepatic function, erythromycin is concentrated in the liver and excreted in the bile. Although the effect of hepatic dysfunction on the excretion of erythromycin and its half-life in such patients is not known, caution should be exercised in administering the antibiotic in such cases particularly if patients with acute hepatic insufficiency receive high doses of erythromycin. In that case, monitoring of serum levels and dosage reduction will be required
• Severe: Contraindicated (inj)

Elderly

• Caution; no dose adjustment recommended 
  Elderly may be more susceptible to drug-associated effects on the QT-interval

Porphyria Information

• Porphyrinogenic (P)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Hallucinations
• Unmasking or worsening of myasthenia gravis
• Transient CNS disorders
  - Confusion
  - Epileptic seizures
  - Convulsions
  - Headaches
  - Sleepiness
  - Vertigo
• Malaise

Cardiovascular Disorders

• Palpitations
• Cardiac arrhythmias
• Atrioventricular block
• QTc interval prolongation
• Ventricular extrasystole
• Ventricular arrhythmia (Torsades des pointed)  
• Ventricular tachycardias
• Thrombophlebitis
• Hypotension
• Chest pain
• Cardiac arrest
• Ventricular fibrillation

Respiratory Disorders

• Dyspnoea (including asthmatic conditions)

Gastrointestinal Disorders

• Retching
• Nausea and vomiting
• Abdominal pains
• Flatulence
• Abdominal discomfort
• Cramps
• Soft stools
• Diarrhoea
• Infantile hypertrophic pyloric stenosis
• Pancreatitis
• Pseudomembranous colitis (rarely associated with erythromycin therapy)

Hepatobiliary Disorders

• Cholestasis (long-term treatment)
• Cholestatic jaundice (long-term treatment)
• Cholestatic hepatitis
• Hepatitis-like symptoms
• Hepatomegaly
• Hepatic failure
• Hepatic dysfunction
• Increased alanine aminotransferase
• Increased aspartate aminotransferase
• Increased alkaline phosphatase
• Increased bilirubin
• Increased gamma-glutamyl transpeptidase

Genitourinary Disorders

• Interstitial nephritis

Endocrine and Metabolic Disorders

• Anorexia
• Increased lactate dehydrogenase

Musculoskeletal Disorders

• Swollen joints

Skin and Subcutaneous Tissue Disorders

• Pain and/or irritation at the site of injection
• Hyperaemia
• Urticarial exanthema
• Pruritus
• Skin eruptions
• Erythema multiforme exudativum
• Stevens-Johnson syndrome
• Toxic epidermal necrolysis (Lyell's syndrome, especially in children of all ages)
• Acute generalised exanthematous pustulosis

Immune, Blood and Lymphatic System Disorders

• Superinfections caused by resistant bacteria or fungi
  - Oral candidiasis
  - Vaginal candidiasis
• Pseudomembranous colitis
• Eosinophilia
• Allergic reactions
• Allergic oedema
• Angioedema
• Anaphylactic reaction
  - Anaphylactic shock
  - Anaphylaxis
• Fever
• Drug fever

Sensory Disorders

• Diplopia
• Blurred vision
• Mitochondrial optic neuropathy (tab, sus)
• Tinnitus
• Deeafness/ Transient loss of hearing (in renal/hepatic impairment; high doses)

• Alfuzosin
• Dopaminergic rye ergot alkaloids
• Buspirone
• Carbamazepine
• Cyclosporine
• Colchicine
• Disopyramide
• Ebastine
• Halofantrine
• Lumefantrine
• Tacrolimus
• Theophylline
• Tolterodine
• Triazolam
• CYP3A4 substrates
• Acenocoumarol
• Alfentanil
• Bromocriptine
• Cilostazol
• Hexobarbiton
• Methylprednisolone
• Midazolam
• Omeprazole
• Valproate
• Vinblastine
• Antimycotics
• Fluconazole
• Ketoconazole
• Antihistimine H1 antagonists
• Astemizole
• Terfenadine
• Pimozide
• Cisapride
• Mizolastine
• Sildenafil
• Benzodiazepines
• Alprazolam
• Clozapine
• Zopiclone
• Warfarin
• Fexofenadine
• HMG-CoA reductase inhibitors
• Simvastatin
• Atorvastatin
• Lovastatin
• Ergot alkaloids
• Ergotamine
• Dihydroergotamine
• Digoxin
• CYP3A4 inhibitors
• CYP3A4 inducers
• Rifampicin
• Phenytoin
• Phenobarbital
• Cimetidine
• Protease inhibitors
• Amisulpiride
• Classes IA and III antiarrhythmics
• Certain neuroleptics
• Tricyclic antidepressants
• Tetracyclic antidepressants
• Arsenic trioxide
• Methadone
• Budipine
• Certain fluoroquinolones
• Imidazole
• Antimalarial agents
• Pentamidine (IV)  
• Verapamil
• Quinidine
• Rifabutin
• Domperidone
• Itraconazole
• Contraceptives
• Bactericidal beta-lactam antibiotics
• Penicillin
• Cephalosporin
• Clindamycin
• Lincomycin
• Chloramphenicol
• Streptomycin
• Tetracyclines
• Colistin
• Oral anticoagulants
• Rivaroxaban

Other interactions

• St. John's wort (Hypericum perforatum)  
• Interference with laboratory tests (See additional prescribing points)

Specific cases may require

• Erythromycin serum level
• Electrocardiogram
• Renal function
• Hepatic function

Administration directions

• DO NOT administer as intra-arterial, intramuscular and IV bolus (inj)

IV administration instructions

Preparation of the solution for administration

1. Reconstitution

• Do NOT use 0.9% sodium chloride solution
• To allow a proper dissolution, gently agitate the vial to loosen powder contents prior to reconstitution
• Prepare an initial solution corresponding to 50mg/ml of erythromycin base by adding 20ml of water for injections to the content of the vial of erythromycin. When adding the solvent, please make sure that it makes contact with all the walls of the vials (by holding the vial horizontally for example)
• Shake well until complete dissolution. The dissolution can be difficult and take a few minutes

• The reconstituted solution can be kept in the refrigerator for 24hrs

2. Dilution

Only a 0.9% sodium chloride solution or 5% glucose solution should be used

• Intermittent infusion: The solution is prepared by mixing the content of the reconstituted vial of erythromycin (20ml) to 200ml or to 500ml of one of the dilution solvents, giving a final concentration for the diluted solution of respectively 5mg/ml or 2mg/ml
• Continuous infusion: The solution is prepared by mixing the content of the reconstituted vial of erythromycin (20ml) to 500ml or to 1000ml of one of the dilution solvents, giving a final concentration for the diluted solution of respectively 2mg/ml or 1mg/ml
• The diluted solution can be kept in the refrigerator for 24hrs. The diluted solution is administered without addition any other substance whatsoever
• In children, adjust the quantity of initial solution for dilution and the volume of infusion to the dosage chosen according to the child's weight

3. Infusion

• Erythromycin can be administered in continuous or intermittent infusion
• The infusion should be administered over 60mins as a rapid infusion is more likely to be associated with local irritative effects as well as QT interval prolongation, arrhythmias or hypotension
• A longer period of infusion should be used in patients with risk factors or previous evidence of arrhythmias
• Not less than 200ml of diluent should be used for preparing intermittent I.V. solutions so as to minimise venous irritation
• The erythromycin concentration should not exceed 5mg per ml and an erythromycin concentration of 1mg/ml (0.1% solution) is recommended
• Erythromycin should only be administered intravenously. Intra-arterial injection is strictly contraindicated. It can lead to angiospasm with ischaemia. Intramuscular administration and IV bolus injection are also contraindicated
• Intravenous therapy should be replaced by oral administration after 2-7 days. In the interest of sustaining successful treatment, erythromycin should be continued for a further 2-3 days after symptoms have disappeared

Interference with laboratory tests

• Erythromycin interferes with the fluorometric determination of urinary catecholamines

Erythromycin exerts its antimicrobial action by binding to the 50S ribosomal subunit of susceptible microorganisms and suppresses protein synthesis. Erythromycin does not bind to cytoplasmic membranes of the host cells. This is a possible explanation of its low toxicity and safety record. Erythromycin is bacteriostatic and bactericidal depending on its concentration and the type of organism. It inhibits protein synthesis by binding to ribosomal subunits, inhibiting translocation of aminoacyl transfer RNA and inhibiting polypeptide synthesis without causing any alteration in the nucleic acid cycle.

Spectrum of activity: Gram-positive bacteria such as Listeria monocytogenes, Corynebacterium diphtheriae (as an adjunct to antitoxin), Corynebacterium minutissimumStaphylococci spp, Streptococcus pyogenes, Streptococci spp (including Enterococci); Gram-negative bacteria such as Haemophilus influenzae, Neisseria meningitidis, Neisseria gonorrhoeae, Legionella pneumophila, Moraxella (Branhamella) catarrhalis, Bordetella pertussis, Campylobacter spp; Mycoplasma such as Mycoplasma pneumoniae, Ureaplasma urealyticum; and other organisms such as Treponema pallidum, Chlamydia spp, Chlamydia trachomatis; Chlamydia pneumoniae; Chlamydia psittaci, Clostridia spp, L-forms, the agents causing trachoma and lymphogranuloma venereum; Actinomyces sp.; Arcanobacter sp., Campylobacter jejuni, Haemophilus ducreyi, K. granulomatis, Legionella sp.

Tablet 250mg

• Betamycin (Be-tabs) 
• Eryko-250 (Dezzo Trading) 
• Racemin (Gulf Drug) 

Capsule 250mg

• Adco Erythromycin (Adcock Ingram)
• Erymycin AF  (Pharmacare)
• Purmycin (Pharmacare)
• Spectrasone (Alliance)
• Xeramel (F.D.C. SA) 

Suspension (per 5ml) 125mg/5ml

• Adco Erythromycin (Adcock Ingram)
• Betamycin Granules 125mg (Ranbaxy Pharmaceuticals)
• Dyna-Erythromycin (Thebe)
• Erymycin P (Pharmacare)
• Purmycin (Pharmacare)
• Spectrasone (Alliance)
• Xeramel (F.D.C. SA)

Suspension (per 5ml) 250mg

• Erymycin PF (Pharmacare)
• Purmycin (Pharmacare)
• Spectrasone (Alliance)
• Xeramel SF (F.D.C. SA)

Injection (per vial) 1000mg

• Erythrocin iv (Pharmaco) originator

Also available in the following forms: Topical solution and lotion.