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Erythromycin lactobionate parenteral

Updated 2 Feb 2023 | Macrolides


Infusions of erythromycin.

Drugs List

  • erythromycin lactobionate 1g powder for concentrate for solution for infusion
  • Therapeutic Indications


    Antibiotic sensitive infections

    Erythromycin lactobionate is indicated in severe and immunocompromised cases of infections caused by sensitive organisms where high blood levels are required at the earliest opportunity or when the oral route is compromised. Types of infection include:

    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.

    Prophylaxis: peri-operative secondary infection prophylaxis, severe trauma and burns secondary infection prophylaxis, endocarditis prophylaxis (dental procedures).



    Other infections: diphtheria, syphilis and gonorrhoea (in cases of penicillin allergy), osteomyelitis, urethritis, lymphogranuloma venereum, prostatitis, scarlet fever.

    Unlicensed Uses

    Control of gastro-intestinal motility

    Gastro-intestinal stasis


    Intravenous administration of erythromycin is suitable for patients who are unable to tolerate oral medication or when it is necessary to produce a high blood concentration to control severe infections.
    Oral administration should replace parenteral administration as soon as possible.


    Mild to moderate infections
    25mg/kg daily, given in divided doses (equivalent to 1g to 2g daily).

    Immunocompromised patients and severe infections
    50mg/kg daily preferably by continuous infusion (equivalent to 4g daily).

    Chronic prostatitis
    6.25mg/kg every 6 hours. Double to 12.5mg/kg every 6 hours in severe infections.


    Treatment of infection
    Children aged 1 month to 18 years
    12.5mg/kg (maximum 1g per dose) four times daily.
    Doses can be doubled in severe infections.

    Gastrointestinal stasis (unlicensed)
    Children aged 1 month to 1 year
    3mg/kg four times daily.


    Treatment of infection
    10mg/kg to 15mg/kg three times daily.
    10mg/kg to 12.5mg/kg every 6 hours.

    Gastrointestinal stasis (unlicensed)
    3mg/kg four times daily.

    Patients with Renal Impairment

    A maximum dose of 1.5g daily is recommended in patients with renal impairment due to risk of ototoxicity.


    For continuous or intermittent intravenous infusion after reconstitution and dilution.

    The manufacturer suggests continuous intravenous infusion is preferred. If it is decided to administer the doses as an intermittent infusion, then the erythromycin concentration should not exceed 5mg/ml and the time of each infusion should be between 20 and 60 minutes.


    Acute porphyria
    Long QT syndrome
    Torsade de pointes

    Precautions and Warnings

    Family history of long QT syndrome
    Neonates under 14 days old
    Electrolyte imbalance
    Hepatic impairment
    History of torsade de pointes
    Myasthenia gravis
    Renal impairment

    Correct electrolyte disorders before treatment
    Reduce dose in patients with severe renal impairment
    Contains benzyl alcohol: Associated with Gasping Syndrome in premature baby
    Patient should be converted to oral therapy as soon as possible
    Perform ECG before and during treatment
    Increased risk of infantile hypertrophic pyloric stenosis
    Monitor serum electrolytes
    Consider C. difficile if diarrhoea occurs within 2 months of treatment
    Consider pseudomembranous colitis if patient presents with diarrhoea
    Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
    Prolonged use may result in superinfection with non-susceptible organisms
    May affect results of some laboratory tests
    Discontinue permanently if AGEP is diagnosed
    Advise patient not to take St John's wort concurrently
    Advise to contact Dr. if vomiting or irritability with feeding occurs

    Erythromycin should not be used during and for two weeks after treatment with CYP3A4 inducers.

    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 with feeding, parents 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.

    The Drug Database for Acute Porphyria classifies erythromycin lactobionate as porphyrinogenic and should only be prescribed on urgent indications.

    Pregnancy and Lactation


    Use erythromycin lactobionate with caution during pregnancy.

    The manufacturer advises caution if erythromycin lactobionate is used during pregnancy. Use only if potential benefit outweighs the risk. Observational human studies have reported cardiovascular malformations after exposure to erythromycin during early pregnancy. Erythromycin crosses the placental barrier. Infants born to women treated during pregnancy for early syphilis should receive appropriate treatment for congenital syphilis. Maternal macrolide exposure within 7 weeks of delivery has been reported to result in an increased risk of infantile hypertrophic pyloric stenosis.


    Use erythromycin lactobionate with caution during breastfeeding.

    The manufacturer advise erythromycin lactobionate may be used with caution during breastfeeding. The small amounts of erythromycin in milk are unlikely to cause adverse effects in the infant. However, the infant should be monitored for irritability and possible effects on the gastrointestinal flora (e.g. diarrhoea, candidiasis). A greater risk of infantile hypertrophic pyloric stenosis has been reported in breastfed infants when a macrolide antibiotic has been administered to the mother.

    Side Effects

    Abdominal discomfort
    Altered liver function tests
    Antibiotic-associated colitis
    Cardiac symptoms
    Chest pain
    Cholestatic hepatitis
    CNS disturbances
    Decreased appetite
    Elevation of liver enzymes
    Erythema multiforme
    Exacerbation of myasthenia gravis
    Hearing loss (reversible)
    Hepatic failure
    Hepatic impairment
    Hypersensitivity reactions
    Infantile hypertrophic pyloric stenosis
    Interstitial nephritis
    Optic neuropathy
    Prolongation of QT interval
    Pseudomembranous colitis
    Skin eruption
    Stevens-Johnson syndrome
    Torsades de pointes
    Toxic epidermal necrolysis
    Ventricular arrhythmias
    Ventricular tachycardia

    Effects on Laboratory Tests

    Erythromycin interferes with the fluorometric determination of urinary catecholamines.


    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 ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: October 2019

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 3rd edition (2015) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. Wolters Kluwer Health, Philadelphia.

    The Renal Drug Handbook. Fourth Edition (2014) ed. Ashley, C and Dunleavy, A, Radcliffe Publishing Ltd, London.

    Summary of Product Characteristics: Erythromycin Lactobionate 1g powder for solution for infusion. ADVANZ Pharma. Revised January 2018.

    NICE Evidence Services Available at: Last accessed: 07 October 2021

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Erythromycin. Last revised: 01 April 2019
    Last accessed: 01 October 2019

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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