- Discussion:
- for group A strep (pyogenes), alpha hemolytic strep and n. gonorrhea, s. pneumoniae, mycoplasma, legionnaire's, soft tissue infection with s.aureus;
- adult: 250-500mg PO qid or 500mg-1gm IV qid;
- IV administration of erythromycin is painful and may cause thrombophlebitis;
- this is minimized by giving: 500mg/250-500 ml IV fluid slowly over 6hrs;
- prophylaxis of bacterial endocarditis: 1gm PO 2hr before procedure; and 0.5gm PO 6hrs later;
- peds: 20-40 mg/kg/24hr upto max dose of 2 gm/24hr IV or PO in 4 DD;
- Supplied:
- powder for injection as lactobionate and gluceptate salts 250mg, 500mg, 1gm;
- base as tablets 250mg, 333mg, 500mg and caps: 125mg, 250mg;
- estolate as chewable tablets 125mg, 250mg and caps: 125mg, 250mg,
- estolate salt is associatted with cholestatic jaundice;
- supplied drops 100 mg/1 ml, susp 125, 250 mg/5 ml, chewable tap 125, 250 mg;
- suspension 125mg/5ml, 250mg/5ml; stearate as tablets 250mg, 500mg;
- ethylsuccinate as chewable tablets 200 mg and tabs: 400 mg and suspension 200mg/ml, 400 mg/ml;
- Cautions:
- beware GI complaints, jaundice;
- erythromycin base not well absorbed from the GI tract and often used as part of the " condon bowel prep"
- a 2-3 day prep that includes oral laxatives and cleansing enemas; for an 8 am operation, 1 gm of erythromycin base and 1 gm of neomycin are given at about 1 pm, 3pm, an 11 pm the day prior to surgery;
- diffusion from blood into CSF minimal even w/ inflammation;
- ratio of CSF to blood level (%): normal meninges: 1-12, inflammed meninges: 7-25;
- 15 % of dose will be excreted in urine (w/ nl R F(x))
- dosing regimens for patients with renal in-sufficiency:
- dose for 70kg adult (gm/dosing interval in hours):
- CrCl: > 80, 0.5-1/6
- CrCl: 50-79, 0.5-1/6
- CrCl: 30-49, 0.5-1/6
- CrCl: 10-29, 0.5-1/6
- otoxicity; requires - dose reductionin hepatic dysfunction;
- will increase action of benzodiazepines, will increase levels of carbamazepine (nystagmus, N/V ataxia);
- will increase effectiveness of cortisol, increase serum levels digoxin, will increase serum levels of theophyllin;
- may cause N/V, seizures, apnea;
- with oral anticoagulants may increase PT;
- use lactobionate salt with caution in neonates as it contains benzyl alcohol
Impetigo contagiosa III. Comparative efficacy of oral erythromycin and topical mupirocin.