Drugs List

Therapeutic Indications

Uses

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).

Septicaemia.

Endocarditis.

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

Administration

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.

Contraindications

Acute porphyria
Long QT syndrome
Torsade de pointes

Precautions and Warnings

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

Pregnancy

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.

Lactation

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
Anaphylaxis
Angioedema
Anorexia
Antibiotic-associated colitis
Cardiac symptoms
Chest pain
Cholestatic hepatitis
CNS disturbances
Confusion
Deafness
Decreased appetite
Diarrhoea
Elevation of liver enzymes
Eosinophilia
Erythema multiforme
Exacerbation of myasthenia gravis
Exanthema
Fever
Hallucinations
Hearing loss (reversible)
Hepatic failure
Hepatic impairment
Hepatitis
Hepatomegaly
Hypersensitivity reactions
Hypotension
Infantile hypertrophic pyloric stenosis
Interstitial nephritis
Jaundice
Malaise
Nausea
Optic neuropathy
Palpitations
Pancreatitis
Prolongation of QT interval
Pruritus
Pseudomembranous colitis
Seizures
Skin eruption
Stevens-Johnson syndrome
Tinnitus
Torsades de pointes
Toxic epidermal necrolysis
Urticaria
Ventricular arrhythmias
Ventricular tachycardia
Vertigo
Vomiting

Presentation

Infusions of erythromycin.

Drugs List

Therapeutic Indications

Uses

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).

Septicaemia.

Endocarditis.

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

Dosage

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.

Adults

Children

Neonates

Patients with Renal Impairment

Administration

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.

Contraindications

Acute porphyria
Long QT syndrome
Torsade de pointes

Precautions and Warnings

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

Pregnancy

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.

Lactation

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
Anaphylaxis
Angioedema
Anorexia
Antibiotic-associated colitis
Cardiac symptoms
Chest pain
Cholestatic hepatitis
CNS disturbances
Confusion
Deafness
Decreased appetite
Diarrhoea
Elevation of liver enzymes
Eosinophilia
Erythema multiforme
Exacerbation of myasthenia gravis
Exanthema
Fever
Hallucinations
Hearing loss (reversible)
Hepatic failure
Hepatic impairment
Hepatitis
Hepatomegaly
Hypersensitivity reactions
Hypotension
Infantile hypertrophic pyloric stenosis
Interstitial nephritis
Jaundice
Malaise
Nausea
Optic neuropathy
Palpitations
Pancreatitis
Prolongation of QT interval
Pruritus
Pseudomembranous colitis
Seizures
Skin eruption
Stevens-Johnson syndrome
Tinnitus
Torsades de pointes
Toxic epidermal necrolysis
Urticaria
Ventricular arrhythmias
Ventricular tachycardia
Vertigo
Vomiting

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: 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: 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: 01 April 2019
Last accessed: 01 October 2019