Erythromycin ethylsuccinate oral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of erythromycin.
Drugs List
Therapeutic Indications
Uses
Treatment of infections caused by erythromycin-sensitive organisms
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 infection: otitis media and otitis externa, mastoiditis.
Oral infections: gingivitis, Vincent's angina.
Eye infections: blepharitis.
Skin and soft tissue infections: boils and carbuncles, paronychia, abscesses, pustular acne, impetigo, cellulitis, erysipelas.
Gastrointestinal infections: cholecystitis, staphylococcal enterocolitis.
Other infections: diphtheria, syphilis, gonorrhoea, pelvic inflammatory disease, osteomyelitis, urethritis, lymphogranuloma venereum, prostatitis, scarlet fever.
Unlicensed Uses
Gastrointestinal stasis
Dosage
Adults
Treatment of infection
Mild to moderate infection
2g daily, taken as 250mg to 500mg every 6 hours or 500mg to 1g every 12 hours.
Severe infection
4g daily in divided doses.
Acne vulgaris
250mg three times daily for one to four weeks and then reduced to twice daily until improvement occurs.
The following alternative dosing schedules may be suitable:
Chronic prostatitis
250mg to 500mg four times a day. Total dose may be given in two divided doses. In severe infections increase to 4g daily, given in divided doses.
Early syphilis
500mg four times a day for fourteen days.
Uncomplicated genital chlamydia
500mg twice a day for fourteen days.
Non-gonococcal urethritis
500mg twice a day for fourteen days.
Rosacea
500mg twice a day for six to twelve weeks.
Prevention of secondary cases of invasive group A streptococcal infection
250mg to 500mg every 6 hours for ten days.
Prevention of secondary case of diphtheria in non-immune patients
500mg, given every 6 hours for seven days. If nasopharyngeal swabs are positive after the first seven days of therapy, treat for a further ten days.
Prevention of pneumococcal infection in asplenia or in patients with sickle-cell disease
500mg twice a day. Antibiotic prophylaxis is not fully reliable.
Children
Children aged 8 to 18 years
Mild to moderate
1g to 2g daily in divided doses. Take as 250mg to 500mg every 6 hours or 500mg to 1g every 12 hours.
Severe infections
4g daily in divided doses.
Acne vulgaris
250mg three times daily for one to four weeks and then reduced to twice daily until improvement occurs.
Children aged 2 to 8 years
1g daily as 250mg every 6 hours or 30mg/kg daily in divided doses. For severe infections up to 50mg/kg daily in divided doses.
Children aged under 2 years
500mg in divided doses. This may be given as 125mg every 6 hours or 250mg every 12 hours.
Alternatively, give 30mg/kg daily in divided doses. For severe infections up to 50mg/kg daily in divided doses.
The following alternative dosing schedules may be suitable:
Acne vulgaris
Children aged 12 to 18 years
500mg twice a day.
Infantile acne
Children aged 1 month to 2 years
250mg in one single, or two divided doses.
Early syphilis
Children aged 12 to 18 years
500mg every 6 hours for fourteen days.
Uncomplicated genital chlamydia or Non-gonococcal urethritis or Pelvic inflammatory disease
Children aged 12 to 18 years
500mg twice daily for fourteen days.
Children aged 2 to 12 years
250mg twice daily for fourteen days.
Children aged 1 month to 2 years
12.5mg/kg four times daily for fourteen days.
Prevention of pneumococcal infection in asplenia or in patients with sickle-cell disease
Children aged 8 to 18 years
500mg twice daily.
Children aged 2 to 8 years
250mg twice daily.
Children aged 1 month to 2 years
125mg twice daily.
Antibiotic prophylaxis is not fully reliable. Antibacterial prophylaxis may be discontinued in children over 5 years of age with sickle-cell disease who have received pneumococcal immunisation.
Prevention of secondary case of diphtheria in non-immune patient
Children aged 8 to 18 years
500mg every 6 hours for seven days.
Children aged 2 to 8 years
250mg every 6 hours for seven days.
Children aged 1 month to 2 years
125mg every 6 hours for seven days.
Treat for further ten days if nasopharyngeal swabs positive after first seven days treatment.
Prevention of recurrence of rheumatic fever
Children aged 2 to 18 years
250mg twice daily.
Children aged 1 month to 2 years
125mg twice daily.
Prevention of secondary case of invasive group A streptococcal infection
Children aged 8 to 18 years
250mg to 500mg every 6 hours for ten days.
Children aged 2 to 8 years
250mg every 6 hours for ten days.
Children aged 1 month to 2 years
125mg every 6 hours for ten days.
Chlamydial ophthalmia; Pertussis
Children aged 8 to 18 years
250mg to 500mg four times a day. For severe infections increase to 500mg to 1g, given every 6 hours. Total dose may be given in two divided doses.
Children aged 2 to 8 years
250mg four times a day. For severe infections increase to 500mg, given every 6 hours. Total dose may be given in two divided doses.
Children aged 1 month to 2 years
125mg four times a day. For severe infections increase to 250mg, given every 6 hours. Total dose may be given in two divided doses.
Gastro-intestinal stasis (unlicensed)
3mg/kg four times daily.
Neonates
Children aged under 2 years
Mild to moderate infection
500mg in divided doses. Take as 125mg every 6 hours or 250mg every 12 hours, alternatively as 30mg/kg daily in divided doses.
Severe infections
50mg/kg daily in divided doses.
The following alternative dosing schedule may be suitable:
Susceptible infections
12.5mg/kg every 6 hours.
Gastrointestinal stasis (unlicensed)
3mg/kg four times daily.
Patients with Renal Impairment
A maximum dose of is 1.5g daily is recommended in patients with severe renal impairment due to risk of ototoxicity.
Administration
Reconstitution
Suspension: granules for oral suspension need to be reconstituted with water before use. See product information for details.
Contraindications
Porphyria
Torsade de pointes
Long QT syndrome
Precautions and Warnings
Erythromycin ethylsuccinate suspension
Hereditary fructose intolerance
Glucose-galactose malabsorption syndrome
Neonates under 14 days old
Restricted sodium intake
Some formulations contain sucrose
Presentations with sorbitol unsuitable in hereditary fructose intolerance
All formulations of erythromycin ethylsuccinate
Hepatic impairment
Renal impairment - glomerular filtration rate below 10ml per minute
Myasthenia gravis
Pregnancy
Breastfeeding
Electrolyte imbalance
Family history of long QT syndrome
History of torsade de pointes
Prolonged use may result in superinfection with non-susceptible organisms
May affect results of some laboratory tests
Reduce dose in patients with a glomerular filtration rate below 10ml per minute
Advise patient not to take St John's wort concurrently
Discontinue if allergic reaction occurs
May exacerbate myasthenia gravis
Monitor serum electrolytes
Correct electrolyte disorders before treatment
Perform ECG before and during treatment
Discontinue of symptoms of myocardial infarction occur
Discontinue at once if pseudomembranous colitis occurs
Consider C. difficile if diarrhoea occurs within 2 months of treatment
Consider pseudomembranous colitis if patient presents with severe diarrhoea
Infantile hypertrophic pyloric stenosis (IHPS) has been reported in infants receiving erythromycin. The benefits of therapy must be carefully weighed against the risks of developing IHPS. If the infant experiences vomiting or irritability, patients should be advised to contact their physician immediately. The risk of IHPS is increased in the first two weeks after birth. Parents or carers should seek medical advice if vomiting or irritability with feeding occurs in infants during treatment with erythromycin.
Pregnancy and Lactation
Pregnancy
Use erythromycin with caution during pregnancy.
The manufacturer advises caution if erythromycin is used during pregnancy. Use only if potential benefit outweighs the risk.
Lactation
Use erythromycin with caution during breastfeeding.
The manufacturer advises caution if erythromycin is used when breastfeeding. Available data indicates erythromycin is present in human breast milk. Hypertrophic pyloris stenosis has been reported in exposed infants, however LactMed (2015) suggest adverse effects are unlikely.
Side Effects
Nausea
Vomiting
Abdominal discomfort
Diarrhoea
Hypersensitivity reactions
Hearing loss
Anaphylaxis
Skin eruption
Erythema multiforme
Stevens-Johnson syndrome
Toxic epidermal necrolysis
CNS disturbances
Seizures
Tinnitus
Cardiac symptoms
Chest pain
Palpitations
Dizziness
Pseudomembranous colitis
Hepatic impairment
Hepatitis
Increases in hepatic enzymes
Jaundice
Cholestatic hepatitis
Prolongation of QT interval
Ventricular tachycardia
Torsades de pointes
Infantile hypertrophic pyloric stenosis
Pancreatitis
Interstitial nephritis
Urticaria
Rash
Myasthenia gravis-like syndrome
Eosinophilia
Anorexia
Hepatomegaly
Hepatic failure
Hallucinations
Pruritus
Exanthema
Hypotension
Angioneurotic oedema
Optic neuropathy
Effects on Laboratory Tests
Erythromycin interferes with the fluorometric determination of urinary catecholamines.
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: November 2019
Reference Sources
Summary of Product Characteristics: Erythroped A 500mg Tablets. Amdipharm Plc. Revised January 2018.
Summary of Product Characteristics: Erythromycin Suspension 125mg/5ml SF. Amdipharm Plc. Revised April 2018.
Summary of Product Characteristics: Erythromycin Suspension 250mg/5ml SF. Amdipharm Plc. Revised April 2018.
Summary of Product Characteristics: Erythromycin Suspension 500mg/5ml SF. Amdipharm Plc. Revised April 2018.
Summary of Product Characteristics: Erythromycin Ethylsuccinate 125mg/5ml. Pinewood Healthcare. Revised March 2018.
Summary of Product Characteristics: Erythromycin Ethylsuccinate 250mg/5ml. Pinewood Healthcare. Revised March 2018.
Summary of Product Characteristics: Erythromycin Ethylsuccinate 500mg/5ml. Pinewood Healthcare. Revised March 2018.
Summary of Product Characteristics: Primacine 125mg/5ml Sugar Free Granules for Oral Suspension. Pinewood Healthcare. Revised March 2018.
Summary of Product Characteristics: Primacine 250mg/5ml Sugar Free Granules for Oral Suspension. Pinewood Healthcare. Revised March 2018.
Summary of Product Characteristics: Primacine 500mg/5ml Sugar Free Granules for Oral Suspension. Pinewood Healthcare. Revised March 2018.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 07 October 2021
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Erythromycin. Last revised: 1 April 2019
Last accessed: 7 June 2019
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.