E. e. s.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• Other antibiotics
• Anticoagulants, such as warfarin (Coumadin)
• Astemizole (Hismanal)
• Carbamazepine (Tegretol)
• Cisapride (Propulsid)
• Clozapine (Clozaril)
• Colchicine
• Cyclosporine (Neoral, Sandimmune)
• Digoxin (Lanoxin)
• Disopyramide (Norpace)
• Ergotamine
• Felodipine (Plendil)
• Lovastatin (Mevacor)
• Phenytoin (Dilantin)
• Pimozide (Orap)
• Terfenadine (Seldane)
• Theophylline (Theo-Dur)
• Triazolam (Halcion)
• Verapamil (Calan, Verelan)

This is not a complete list of erythromycin drug interactions. Ask your doctor or pharmacist for more information.

Oral:

Take erythromycin exactly as prescribed.

This medication comes in capsule, tablet, long-acting capsule, long-acting tablet, chewable tablet, suspension, and pediatric drop forms for oral use. It is usually taken 3 to 4 times daily.

Do not chew, divide, or break the long-acting capsules and tablets. Swallow these whole and take with a full glass of water.

Topical:

This medication also comes in topical solution and gel forms and as an ophthalmic ointment.

Injectable:

This medication is available in an injectable form to be given directly into a vein (IV) by a healthcare professional.

If you miss a dose, take the missed dose as soon as you remember. If it is almost time for the next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses of erythromycin at the same time.

If you take too much erythromycin, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If erythromycin is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Some brands of this medicine need to be stored in a refrigerator. Some brands of E. E. S. need to be stored at room temperature. If you have questions about how to store this medicine, talk with your pharmacist.
• Be sure you know how long you can store E. E. S. before you need to throw it away.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Check with your pharmacist about how to throw out unused drugs.

Some medicines can cause unwanted or dangerous effects when used with erythromycin. Your doctor may need to change your treatment plan if you use cisapride, pimozide, ergotamine, or dihydroergotamine.

Before you take erythromycin, tell your doctor if you have liver disease, myasthenia gravis, a heart rhythm disorder, a history of Long QT syndrome, or low levels of potassium or magnesium in your blood.

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Erythromycin will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking erythromycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Usual Adult Dose of Erythromycin for Campylobacter Gastroenteritis:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose of Erythromycin for Chancroid:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Lymphogranuloma Venereum:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Mycoplasma Pneumonia:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose of Erythromycin for Nongonococcal Urethritis:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Otitis Media:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Pharyngitis:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Pneumonia:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Skin or Soft Tissue Infection:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Syphilis -- Early:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Upper Respiratory Tract Infection:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Bronchitis:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Chlamydia Infection:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Lyme Disease:

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Legionella Pneumonia:

Although the dosage has not been established, clinical trials have used 1 to 4 g/day orally or IV in divided doses every 6 hours or by continuous infusion.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

1 g (stearate) or 800 mg (ethylsuccinate) orally two hours before procedure, then one-half the amount six hours after initial dose.

Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations. However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.

Usual Adult Dose for Bowel Preparation:

1 g (base) orally at 1, 2, and 11 PM the day before surgery (assuming 8 a.m. surgery time); given with oral neomycin 1 g and bowel evacuants.

Usual Adult Dose for Rheumatic Fever Prophylaxis:

250 mg orally twice a day.

Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and sulfonamides.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

20 mg/kg (ethylsuccinate or stearate) orally two hours before procedure, then one-half the amount six hours after initial dose.

Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations. However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.

Usual Pediatric Dose for Bowel Preparation:

20 mg/kg (base) orally at 1, 2, and 11 PM the day before surgery (assuming 8 a.m. surgery time); given with oral neomycin and bowel evacuants.

Usual Pediatric Dose for Pneumonia:

Neonatal chlamydial conjunctivitis and pneumonia: 50 mg/kg/day orally in divided doses every 6 hours for at least 2 weeks.

Usual Pediatric Dose for Chlamydia Infection:

Neonatal chlamydial conjunctivitis and pneumonia: 50 mg/kg/day orally in divided doses every 6 hours for at least 2 weeks.

Usual Pediatric Dose for Rheumatic Fever Prophylaxis:

250 mg orally twice a day.

Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and sulfonamides.

Usual Pediatric Dose for Pertussis:

40-50 mg/kg/day, orally, divided every 6 hours for 14 days; maximum dose: 2 g/day (not preferred agent for infants less than 1 month of age).

Applies to erythromycin: compounding powder, injectable powder for injection, oral capsule, oral delayed release capsule, oral delayed release tablet, oral granule for reconstitution, oral suspension, oral tablet, oral tablet chewable, oral tablet coated particles

General

The most common side effects associated with oral erythromycin were gastrointestinal and were dose-related.[Ref]

Gastrointestinal

Onset of pseudomembranous colitis symptoms has been reported during or after antibacterial therapy.[Ref]

Rare (less than 0.1%): Pancreatitis, pancreatitis without biliary obstruction
Frequency not reported: Nausea, abdominal pain, diarrhea, vomiting, anorexia, infantile hypertrophic pyloric stenosis, pseudomembranous colitis, Clostridium difficile associated diarrhea (ranging from mild diarrhea to fatal colitis)[Ref]

Cardiovascular

Life-threatening episodes of ventricular tachycardia associated with prolonged QT interval (torsades de pointes) have been reported following IV administration of erythromycin lactobionate.

QT prolongation has been reported both in otherwise healthy patients and in patients with a history of heart disease or who were on other potentially arrhythmogenic drugs. Most affected patients were receiving erythromycin intravenously. In a recent retrospective study of 278 consecutive patients who had received IV erythromycin lactobionate, 39% of 49 evaluable patients developed moderate to severe delay in ventricular repolarization (QTc interval greater than or equal to 500 msec) during treatment. Of the 278 patients, torsade de pointes was observed in one patient (less than 0.4%).

Arrhythmias and hypotension have been reported following IV administration.

One case of erythromycin-related polymorphous ventricular tachycardia reported in a patient treated for pneumonia was characterized by a normal QT interval.[Ref]

Frequency not reported: QT prolongation, ventricular arrhythmias, ventricular tachycardia, torsades de pointes, arrhythmias, hypotension, polymorphous ventricular tachycardia
Postmarketing reports: Torsades de pointes[Ref]

Hepatic

Rare (less than 0.1%): Hepatotoxicity, fulminant hepatic necrosis, false isolated elevations of serum glutamic oxaloacetic transaminase (SGOT) enzymes
Frequency not reported: Hepatic dysfunction (including increased liver enzymes), hepatocellular and/or cholestatic hepatitis (with or without jaundice), transient elevations of liver function tests, hepatitis, abnormal liver function test results, intrahepatic cholestasis[Ref]

Hepatic dysfunction (including increased liver enzymes) and hepatocellular and/or cholestatic hepatitis (with or without jaundice) have been reported with oral erythromycin.[Ref]

Hypersensitivity

Frequency not reported: Allergic reactions (ranging from urticaria to anaphylaxis), hypersensitivity reactions (presented as rash, eosinophilia, fever), hypersensitivity with noninfectious hepatitis[Ref]

Dermatologic

Rare (less than 0.1%): Skin rash, maculopapular rashes (generalized, pruritic)
Frequency not reported: Skin reactions (ranging from mild eruptions to erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis)[Ref]

Nervous system

Rare (less than 0.1%): Convulsions, reversible hearing loss, reversible ototoxicity
Frequency not reported: Exacerbation of myasthenia gravis symptoms, new onset of myasthenic syndrome[Ref]

Reversible hearing loss was reported primarily in patients with renal dysfunction and in patients receiving high doses of erythromycin.

Several published reviews have indicated that ototoxicity was associated with erythromycin dosages greater than 4 grams per day, preexisting liver or kidney disease, and advanced age. Recovery generally occurred within two weeks.[Ref]

Hematologic

A case of hemolytic anemia has been reported in a patient with severe underlying diseases and erythromycin-associated hepatitis.[Ref]

Rare (less than 0.1%): Reversible agranulocytosis
Frequency not reported: Hemolytic anemia[Ref]

Renal

Frequency not reported: Interstitial nephritis[Ref]

Psychiatric

Rare (less than 0.1%): Recurrent nightmares[Ref]

Local

Slow infusion of diluted erythromycin (continuously or intermittently over no less than 20 to 60 minutes) almost invariably alleviated venous irritation.[Ref]

Rare (less than 0.1%): Venous irritation with IV administration[Ref]

Some side effects of erythromycin may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.

Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.

250 mg orally twice a day.

Erythromycin is recommended by the American Heart Association for long-term prophylaxis of streptococcal upper respiratory tract infections in the prevention of recurrences of rheumatic fever in patients allergic to penicillin and sulfonamides.

20 mg/kg (ethylsuccinate or stearate) orally two hours before procedure, then one-half the amount six hours after initial dose.

Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations. However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this regimen if desired. Currently, clindamycin, first-generation cephalosporins (in patients who have not had an IgE-mediated anaphylactic reaction to penicillin), azithromycin or clarithromycin are drugs of choice for prophylaxis in penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures.

Erythromycin is excreted into human milk in small amounts. Erythromycin is considered compatible with breast-feeding by the American Academy of Pediatrics.