Nausea, vomiting, diarrhea/loose stools, stomach pain, or pain/redness at the injection site may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if you have any serious side effects, including: hearing changes (such as ringing in the ears, hearing loss), persistent nausea/vomiting, severe abdominal/stomach pain, unusual weakness/tiredness, dark urine, yellowing skin/eyes, muscle weakness.
Get medical help right away if any of these rare but very serious side effects occur: severe dizziness, fainting, fast/irregular heartbeat.
This medication may rarely cause a severe intestinal condition due to a bacteria called C. difficile. This condition may occur during treatment or weeks to months after treatment has stopped. Tell your doctor right away if you develop: diarrhea that doesn't stop, abdominal or stomach pain/cramping, blood/mucus in your stool.
If you have these symptoms, do not use anti-diarrhea or opioid products because they may make symptoms worse.
Use of this medication for prolonged or repeated periods may result in oral thrush or a new vaginal yeast infection. Contact your doctor if you notice white patches/sores in your mouth, a change in vaginal discharge, or other new symptoms.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
Incidence not known
- Blistering, peeling, or loosening of the skin
- chest pain or discomfort
- chills
- cough
- diarrhea
- difficulty with swallowing
- dizziness
- fainting
- fast, pounding, or irregular heartbeat or pulse
- hearing loss
- hives or welts, itching, skin rash
- irregular or slow heart rate
- irritation at the injection site
- joint or muscle pain
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- red, irritated eyes
- red skin lesions, often with a purple center
- redness of the skin
- sore throat
- sores, ulcers, or white spots in the mouth or on the lips
- tightness in the chest
- unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Incidence not known
- Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Portions of this document last updated: Nov. 01, 2022
Copyright © 2022 IBM Watson Health. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.
Useful when penicillin is the most appropriate drug but cannot be used because of hypersensitivity, including:
- Streptococcal infections,
- Treatment of syphilis or gonorrhea.
Action
Suppresses protein synthesis at the level of the 50S bacterial ribosome.
Therapeutic Effect(s):
Bacteriostatic action against susceptible bacteria.
Spectrum:Active against many gram-positive cocci, including:
- Streptococci,
- Staphylococci.
Gram-positive bacilli, including:
- Clostridioides,
- Corynebacterium.
Several gram-negative pathogens, notably:
- Neisseria,
- Legionella pneumophila.
- Mycoplasma and Chlamydia are also usually susceptible.
Pharmacokinetics
Absorption: Variable absorption from the duodenum after oral administration (dependent on salt form). Absorption of enteric-coated products is delayed. Minimal absorption may follow topical or ophthalmic use.
Distribution: Widely distributed. Minimal CNS penetration. Crosses placenta; enters breast milk.
Protein Binding: 70–80%.
Metabolism and Excretion: Partially metabolized by the liver, excreted mainly unchanged in the bile; small amounts excreted unchanged in the urine.
Half-life: Neonates: 2.1 hr; Adults: 1.4–2 hr.
TIME/ACTION PROFILE (blood levels)
ROUTEONSETPEAKDURATIONPO1 hr1–4 hr6–12 hrIVrapidend of infusion6–12 hr
Contraindication/Precautions
Contraindicated in:
- Hypersensitivity;
- Concurrent use of dihydroergotamine, ergotamine, lovastatin, pimozide, or simvastatin;
- Long QT syndrome
- Hypokalemia
- Hypomagnesemia
- Heart rate <50 bpm;
- Known alcohol intolerance (most topicals);
- Tartrazine sensitivity (some products contain tartrazine–FDC yellow dye #5);
- Products containing benzyl alcohol should be avoided in neonates.
Use Cautiously in:
- Liver/renal disease;
- OB: May be used in pregnancy to treat chlamydial infections or syphilis;
- Myasthenia gravis (may worsen symptoms);
- Geri: ↑ risk of ototoxicity if parenteral dose >4 g/day, ↑ risk of QTc interval prolongation.
Adverse Reactions/Side Effects
CV: TORSADES DE POINTES, VENTRICULAR ARRHYTHMIAS, QT interval prolongation
Derm: rash
EENT: ototoxicity
GI: CLOSTRIDIOIDES DIFFICILE-ASSOCIATED DIARRHEA (CDAD), nausea, vomiting, abdominal pain, cramping, diarrhea, hepatitis, infantile hypertrophic pyloric stenosis, pancreatitis (rare)
GU: interstitial nephritis
Local: phlebitis at iv site
Neuro: seizures (rare)
Misc: HYPERSENSITIVITY REACTIONS (including anaphylaxis)
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
Interactions
Drug-Drug
- Concurrent use with pimozide may ↑ levels and the risk for serious arrhythmias (concurrent use contraindicated); similar effects may occur with diltiazem, verapamil, ketoconazole, itraconazole, nefazodone, and protease inhibitors ; avoid concurrent use.
- May ↑ levels of ergotamine and dihydroergotamine and risk for acute ergot toxicity; concurrent use contraindicated.
- Concurrent use with lovastatin or simvastatin may ↑ risk of rhabdomyolysis.
- Concurrent use with amiodarone, dofetilide, or sotalol may ↑ risk of torsades de pointe; avoid concurrent use
- May ↑ verapamil levels and the risk for hypotension, bradycardia, and lactic acidosis.
- ↑ blood levels and effects of sildenafil, tadalafil, and vardenafil ; use lower doses.
- Concurrent rifabutin or rifampin may ↓ effect of erythromycin and ↑ risk of adverse GI reactions.
- ↑ levels and risk of toxicity from alfentanil, alprazolam, bromocriptine, carbamazepine, cyclosporine, cilostazol, diazepam, disopyramide, ergot alkaloids, felodipine, methylprednisolone, midazolam, quinidine, rifabutin, tacrolimus, triazolam, or vinblastine.
- May ↑ levels of lovastatin and simvastatin and ↑ the risk of myopathy/rhabdomyolysis.
- May ↑ serum digoxin levels.
- Theophylline may ↓ blood levels.
- May ↑ colchicine levels and the risk for toxicity; use lower starting and maximum dose of colchicine.
- May ↑ theophylline levels and the risk for toxicity; ↓ theophylline dose.
- May ↑ warfarin levels and the risk for bleeding.
Route/Dosage
250 mg of erythromycin base or stearate = 400 mg of erythromycin ethylsuccinate
Most Infections
PO (Adults): Base, stearate– 250 mg every 6 hr, or 333 mg every 8 hr, or 500 mg every 12 hr. Ethylsuccinate– 400 mg every 6 hr or 800 mg every 12 hr.
PO (Children >1 mo): Base and ethylsuccinate– 30–50 mg/kg/day divided every 6–8 hr (max = 2 g/day as base or 3.2 g/day as ethylsuccinate). Stearate– 30–50 mg/kg/day divided every 6 hr (max = 2 g/day).
PO (Neonates ): Ethylsuccinate– 20–50 mg/kg/day divided every 6–12 hr.
IV (Adults): 250–500 mg (up to 1 g) every 6 hr.
IV (Children >1 mo): 15–50 mg/kg/day divided every 6 hr (max = 4 g/day).
Acne
Topical (Adults and Children >12 yr): 2% gel, solution, or pledgets twice daily.
Availability (generic available)
Erythromycin Base
Delayed-release capsules: 250 mg , 333 mg
Delayed–release tablets: 250 mg, 333 mg, 500 mg
Erythromycin Ethylsuccinate
Oral suspension (fruit, cherry, orange, or banana flavor): 200 mg/5 mL, 400 mg/5 mL
Tablets: 400 mg
Erythromycin Lactobionate
Powder for injection (requires reconstitution and dilution): 500 mg/vial, 1 g
Erythromycin Stearate
Film-coated tablets: 250 mg
Erythromycin Topical Preparations
Gel: 2%
Pledgets: 2%
Solution: 2%
In Combination with: benzoyl peroxide (Benzamycin). See combination drugs.
Assessment
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
- Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.
Lab Test Considerations:
Monitor liver function tests periodically on patients receiving high-dose, long-term therapy.
- May cause ↑ serum bilirubin, AST, ALT, and alkaline phosphatase concentrations.
- May cause false ↑ of urinary catecholamines.
Potential Diagnoses
- Risk for infection (Indications) (Side Effects)
- Noncompliance (Patient/Family/Teaching)
Implementation
- PO Administer around the clock. Erythromycin film-coated tablets (base and stearate) are absorbed better on an empty stomach, at least 1 hr before or 2 hr after meals; may be taken with food if GI irritation occurs. Enteric-coated erythromycin (base) may be taken without regard to meals. Erythromycin ethylsuccinate is best absorbed when taken with meals. Take each dose with a full glass of water.
- Use calibrated measuring device for liquid preparations. Shake well before using.
- Do not crush or chew delayed-release capsules or tablets; swallow whole. Erythromycin base delayed-release capsules may be opened and sprinkled on applesauce, jelly, or ice cream immediately before ingestion. Entire contents of the capsule should be taken.
- Topical Cleanse area before application. Wear gloves during application.
IV Administration
- IV Add 10 mL of sterile water for injection without preservatives to 250- or 500-mg vials and 20 mL to 1-g vial. Solution is stable for 7 days after reconstitution if refrigerated.
- Intermittent Infusion: Dilution: Dilute in 0.9% NaCl or D5W. Concentration: 1–5 mg/mL.
- Rate: Administer slowly over 20–60 min to avoid phlebitis. Assess for pain along vein; slow rate if pain occurs; apply ice and notify health care professional if unable to relieve pain.
- Continuous Infusion: May also be administered as an infusion over 4 hr. Dilution: 0.9% NaCl, D5W, or LR. Concentration: 1 g/L.
- Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B lipid complex
- amphotericin B liposome
- MORE...
- ascorbic acid
- aztreonam
- cefazolin
- cefepime
- cefotetan
- cefoxitin
- dantrolene
- diazepam
- diazoxide
- doxycycline
- furosemide
- ganciclovir
- indomethacin
- ketorolac
- metaraminol
- nitroprusside
- pemetrexed
- pentobarbital
- phenytoin
- trimethoprim/sulfamethoxazole
Erythromycin Lactobionate
- Y-Site Compatibility:
- acyclovir
- alemtuzumab
- alfentanil
- MORE...
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- anidulafungin
- argatroban
- atropine
- azathioprine
- benztropine
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- butorphanol
- calcium chloride
- calcium gluconate
- cangrelor
- carboplatin
- carmustine
- caspofungin
- cefotaxime
- ceftriaxone
- cefuroxime
- chlorpromazine
- cisplatin
- cyanocobalamin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin hydrochloride
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin
- doxorubicin liposomal
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- epoetin alfa
- eptifibatide
- ertapenem
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fenoldopam
- fentanyl
- fluconazole
- fludarabine
- fluorouracil
- folic acid
- foscarnet
- fosphenytoin
- gemcitabine
- gentamicin
- glycopyrrolate
- granisetron
- hetastarch
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin
- irinotecan
- isoproterenol
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- lorazepam
- mannitol
- meperidine
- mesna
- methotrexate
- methyldopate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitoxantrone
- morphine
- multivitamins
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- norepinephrine
- octreotide
- ondansetron
- oxacillin
- oxaliplatin
- oxytocin
- paclitaxel
- palonosetron
- pamidronate
- pancuronium
- papaverine
- pentamidine
- perphenazine
- phenylephrine
- phytonadione
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- procainamide
- prochlorperazine
- promethazine
- propranolol
- protamine
- pyridoxine
- sodium acetate
- sodium bicarbonate
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiamine
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- vitamin B complex with C
- voriconazole
- zidovudine
- zoledronic acid
- Y-Site Incompatibility:
- amphotericin B deoxycholate
- amphotericin B lipid complex
- amphotericin B liposome
- MORE...
- ascorbic acid
- aztreonam
- cefazolin
- cefepime
- cefotetan
- cefoxitin
- dantrolene
- diazepam
- diazoxide
- doxycycline
- furosemide
- ganciclovir
- indomethacin
- ketorolac
- metaraminol
- nitroprusside
- pemetrexed
- pentobarbital
- phenytoin
- trimethoprim/sulfamethoxazole
Patient/Family Teaching
- Instruct patient to take medication around the clock and to finish the drug completely as directed, even if feeling better. Take missed doses as soon as remembered, with remaining doses evenly spaced throughout day. Advise patient that sharing of this medication may be dangerous.
- May cause nausea, vomiting, diarrhea, or stomach cramps; notify health care professional if these effects persist or if severe abdominal pain, yellow discoloration of the skin or eyes, darkened urine, pale stools, or unusual tiredness develops. May cause infantile hypertrophic pyloric stenosis in infants; notify health care professional if vomiting and irritability occur.
- Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several wk after discontinuation of medication.
- Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools).
- Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
- Instruct patient to notify health care professional if symptoms do not improve.
Evaluation/Desired Outcomes
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Improvement of acne lesions.
ERYTHROMYCIN† is a sample topic from the Davis's Drug Guide.
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Citation
Vallerand, April Hazard., et al. "ERYTHROMYCIN†." Davis's Drug Guide, 18th ed., F.A. Davis Company, 2023. Nursing Central Redesign, nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110750/all/ERYTHROMYCIN†.
Vallerand AHA, Sanoski CAC, Quiring CC. ERYTHROMYCIN†. Davis's Drug Guide. F.A. Davis Company; 2023. //nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110750/all/ERYTHROMYCIN†. Accessed December 2, 2022.
Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2023). ERYTHROMYCIN†. In Davis's Drug Guide (18th ed.). F.A. Davis Company. //nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110750/all/ERYTHROMYCIN†
Vallerand AHA, Sanoski CAC, Quiring CC. ERYTHROMYCIN† [Internet]. In: Davis's Drug Guide. F.A. Davis Company; 2023. [cited 2022 December 02]. Available from: //nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110750/all/ERYTHROMYCIN†.
* Article titles in AMA citation format should be in sentence-case
CopyDownloadTY - ELEC T1 - ERYTHROMYCIN† ID - 110750 A1 - Sanoski,Cynthia A, AU - Vallerand,April Hazard, AU - Quiring,Courtney, BT - Davis's Drug Guide UR - //nursing.unboundmedicine.com/nursingcentral/view/Davis-Drug-Guide/110750/all/ERYTHROMYCIN† PB - F.A. Davis Company ET - 18 DB - Nursing Central Redesign DP - Unbound Medicine ER -