Erythromycin

General
  • Type: Macrolide
  • Dosage Forms: PO, IV, topical
  • Common Trade Names:

Adult Dosing
  • 250-500mg PO q6h

Pre-endoscopy
  • 3mg/kg IV over 20-30min, 30-90min prior to endoscopy
    • Achieves endoscopy conditions equal to lavage[1]

Pediatric Dosing
  • Mild-moderate infections: 30-50 mg/kg/day PO divided q6-8hr
  • Severe infection: 60-100 mg/kg/day PO divided q6-8hr

Special Populations

Contraindications
  • Allergy to class/drug
  • QT prolongation

Adverse Reactions

Serious
  • Torsades, ventricular dysrhythmias
  • Pseudomembranous colitis
  • Hypertrophic pyloric stenosis
  • Seizures

Common
  • nausea/vomiting
  • diarrhea
  • urticaria
  • transaminitis
  • urticarial rash

Pharmacology
  • Half-life: 2 hours
  • Metabolism: Liver
  • Excretion: Bile/Renal
  • Mechanism of Action: Binds to 50S ribosomal unit → inhibiting protein synthesis

Antibiotic Sensitivities[2]
Group Organism Sensitivity
Gram PositiveStrep. Group A, B, C, GI
Strep. PneumoniaeI
Viridans strepX1
Strep. anginosus gpX1
Enterococcus faecalisR
Enterococcus faeciumR
MSSAI
MRSAR
CA-MRSAI
Staph. EpidermidisI
C. jeikeiumR
L. monocytogenesS
Gram NegativesN. gonorrhoeaeI
N. meningitidisX2
Moraxella catarrhalisI
H. influenzaeI
E. coliR
Klebsiella spR
E. coli/Klebsiella ESBL+R
E coli/Klebsiella KPC+R
Enterobacter sp, AmpC negR
Enterobacter sp, AmpC posR
Serratia spX1
Serratia marcescensR
Salmonella spR
Shigella spR
Proteus mirabilisX1
Proteus vulgarisR
Providencia sp.X1
Morganella sp.X1
Citrobacter freundiiX1
Citrobacter diversusX1
Citrobacter sp.X1
Aeromonas spX1
Acinetobacter sp.R
Pseudomonas aeruginosaR
Burkholderia cepaciaR
Stenotrophomonas maltophiliaR
Yersinia enterocoliticaR
Francisella tularensisX1
Brucella sp.R
Legionella sp.S
Pasteurella multocidaX1
Haemophilus ducreyiS
Vibrio vulnificusX1
MiscChlamydophila spS
Mycoplasm pneumoniaeS
Rickettsia spI
Mycobacterium aviumX1
AnaerobesActinomycesS
Bacteroides fragilisR
Prevotella melaninogenicaX1
Clostridium difficileX1
Clostridium (not difficile)I
Fusobacterium necrophorumR
Peptostreptococcus sp.I

Key
  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References
  1. Pateron D, et al. Erythromycin infusion or gastric lavage for upper gastrointestinal bleeding: a multicenter randomized controlled trial. Ann Emerg Med. 2011; 57(6):582-589.
  2. Sanford Guide to Antimicrobial Therapy 2014
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