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(eh-RITH-row-MY-sin)
AK-Mycin, A/T/S, Akne-mycin, DelMycin, E-Base, E-Mycin, E.E.S., Emgel, Eramycin, Erygel, Ery-sol, EryTab, Eryc, Erycette, Eryderm, Erymax, EryPed, Erythrocin Stearate, ETS, Ilosone, Ilotycin, Ilotycin Gluceptate, PCE Dispertab, Robimycin, Wyamycin S,  Alti-Erythromycin, Wyamycin S, Alti-Erythromycin, Apo-Erythro Base, Apo-Erythro E-C, Diomycin, Erybid, Erythro-Base, Erythromid, Ilotycin Ophthalmic, Novorythro Encap, PCE, PMS-Erythromycin
Class: Antibiotic/macrolide

 Action Interferes with microbial protein synthesis.

 Indications

Oral/intravenous use: Treatment of infections of respiratory tract, skin and skin structure, and sexually transmitted diseases due to susceptible organisms; treatment of pertussis, diphtheria, erythrasma, intestinal amebiasis, conjunctivitis of newborn and Legionnaire’s disease; prevention of attacks of rheumatic fever; prevention of bacterial endocarditis; treatment of acute otitis media (in combination with sulfisoxazole). Ophthalmic use: Treatment of superficial ocular infections due to strains of susceptible organism. Topical use: Infection prophylaxis in minor cuts, wounds, burns and skin abrasions; treatment of acne vulgaris. Unlabeled use(s): Treatment of Neisseria gonorrhoeae in pregnancy; treatment of diarrhea caused by Campylobacter jejuni; as alternative to penicillin in selected infections.

 Contraindications Hypersensitivity to erythromycin or any macrolide antibiotic; pre-existing liver disease (with estolate salt); epithelial herpes simplex keratitis; fungal disease of eye; vaccinia or varicella (ophthalmic use).

 Route/Dosage

Systemic Use

ADULTS: PO 250–500 mg of base (400–800 mg ethylsuccinate) q 6 hr or 500 mg q 12 hr or 333 mg q 8 hr. IV 15–20 mg/kg/day; up to 4 g/day in very severe infections. CHILDREN: PO 30 to 50 mg/kg/day in divided doses.

Acute Ocular Infection

ADULTS & CHILDREN: Ophthalmic 0.5 inch ribbon of ointment placed in eye q 3–4 hr.

Mild to Moderate Ocular Infection

ADULTS & CHILDREN: Ophthalmic 0.5 inch ribbon of ointment placed in eye bid-tid.

Prophylaxis of Neonatal Gonococcal or Chlamydia Conjunctivitis

NEONATES: Ophthalmic 0.2–0.4 inch ribbon of ointment placed in each conjunctival sac at time of delivery.

Skin Infections

ADULTS & CHILDREN: Topical Apply 1–4 times daily to affected area.

Acne Vulgaris

ADULTS & CHILDREN: Topical Apply bid.

 Interactions

Anticoagulants: May increase anticoagulant effects. Antihistamines, non-sedating (eg, astemizole, terfenadine): May increase antihistamine levels and cause serious adverse cardiovascular events, including ventricular arrhythmias and death. Bromocriptine: May increase serum bromocriptine levels. Carbamazepine: May result in serious carbamazepine toxicity. Clindamycin, topical: Antagonism may occur with topical erythromycin. Cyclosporine: May cause increased cyclosporine levels with renal toxicity. Digoxin: May cause increased digoxin levels. Lovastatin: Severe myopathy or rhabdomyolysis may occur. Methylprednisolone: May decrease clearance of methylprednisolone. Theophyllines: May increase theophylline plasma concentration.

 Lab Test Interferences None well documented.

 Adverse Reactions

DERM: Rash; photosensitivity; erythema and peeling (topical use). GI: Diarrhea; nausea; vomiting abdominal pain/cramping. GU: Vaginitis. HEPA: Hepatotoxicity (primarily with estolate salt). OTHER: Venous irritation or phlebitis with IV administration.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Acne therapy: Cumulative irritant effect may occur. Hepatic impairment: Use drug cautiously. Hepatic dysfunction, with or without jaundice, has occurred. Cholestatic hepatitis has occurred. Hypersensitivity: Serious reactions, including anaphylaxis, have occurred. Ophthalmic ointments: May slow corneal epithelial healing. Ototoxicity: May occur, especially in patients with renal or hepatic insufficiency and elderly patients and with administration of large doses. Pseudomembranous colitis: Consider possibility in patients in whom diarrhea develops. Superinfection: Prolonged use of antibiotics may result in bacterial or fungal overgrowth of nonsusceptible microorganisms.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

Oral

  • Administer with full glass of water 1 hr before or 2 hr after meals. If GI upset is significant, give with food or milk. Do not crush tablets or allow patient to chew them.

Parenteral

  • Use only Sterile Water for Injection for reconstitution. Do not use diluents containing preservatives or organic salts.
  • Dilute reconstituted drug in 1–5 mg/ml in 0.9% Sodium Chloride. If D5W is used, buffer solution with Sodium Bicarbonate or neutralize (add 1 ml/100 ml of solution).
  • Administer IV infusion at slow rate over 30–60 min to reduce venous irritation.
  • Piggyback vial must be used within 8 hr of preparation if stored at room temperature or 24 hr if refrigerated.
  • Frozen solution may be stored for 30 days. Thaw in refrigerator and use within 8 hr after thawing. Do not refreeze thawed solution.

Topical

  • With topical use, cleanse affected area with 0.9% Sodium Chloride before application.
  • For ophthalmic use, have patient tilt head back, pull lid down, place medication in conjunctival sac and have patient close eyes. Take care not to touch lids.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note any hypersensitivity to macrolide antibiotics and history of liver disease, fungal disease or colitis.
  • Culture and sensitivity testing should be done to determine organism sensitivity.
  • Obtain baseline LFTs and CBC.
  • Monitor LFTs routinely.
  • Monitor I&O.
  • Monitor for signs and symptoms of superinfection (ie, thrush, vaginal yeast, perianal irritation, vaginal discharge, black furry tongue).
  • Monitor for diarrhea, nausea, vomiting or abdominal discomfort. Contact physician if these symptoms are persistent.
  • If skin rash, respiratory distress or urticaria occur, stop infusion immediately and notify physician.
  • Monitor IV site if using IV route. Change IV heparin locks q 3 days or per institution guidelines.
  • If patient is undergoing oral anticoagulant therapy, monitor PT.
OVERDOSAGE: SIGNS & SYMPTOMS
  Severe nausea, vomiting, diarrhea, epigastric distress, hearing loss, vertigo

 Patient/Family Education

  • Advise patient to take medication with full glass of water 1 hr before or 2 hr after meals. If extreme GI distress occurs, drug may be taken with food or milk.
  • Inform patient that following ophthalmic administration, temporary blurring of vision or stinging may occur. Advise patient to notify physician if redness, irritation or pain persists or worsens. Instruct patient to use medication 1 hr before driving.
  • Instruct patient to notify physician if nausea, vomiting, diarrhea, abdominal pain, jaundice, dark urine, pale stools, unusual fatigue or signs of superinfection occur.
  • Instruct patient to follow complete course of therapy.
  • When used topically for treatment of acne vulgaris, caution patient not to use otc peeling, abrasive agents or abrasive sponges because cumulative irritant effect may occur.
  • When drug is used topically, advise patient to avoid exposure to sunlight and to use sunscreen or wear protective clothing to avoid photosensitivity reaction.

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