Erythromycin is a broad-spectrum, macrolide antibiotic with antibacterial activity. Erythromycin diffuses through the bacterial cell membrane and reversibly binds to the 50S subunit of the bacterial ribosome. This prevents bacterial protein synthesis. Erythromycin may be bacteriostatic or bactericidal in action, depending on the concentration of the drug at the site of infection and the susceptibility of the organism involved.
Erythromycin is a bacteriostatic antibiotic macrolide produced by Streptomyces erythreus. Erythromycin A is considered its major active component. Insensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins.
It inhibits bacterial protein synthesis by binding to bacterial 50S ribosomal subunits; binding inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins. Erythromycin may be bacteriostatic or bactericidal depending on the organism and drug concentration.
Mechanism of Action of Erythromycin
Erythromycin acts by penetrating the bacterial cell membrane and reversibly binding to the 50 S subunit of bacterial ribosomes or near the “P” or donor site so that binding of tRNA (transfer RNA) to the donor site is blocked. Translocation of peptides from the “A” or acceptor site to the “P” or donor site is prevented, and subsequent protein synthesis is inhibited. Erythromycin is effective only against actively dividing organisms. The exact mechanism by which erythmromycin reduces lesions of acne vulgaris is not fully known: however, the effect appears to be due in part to the antibacterial activity of the drug.
Indications of Erythromycin
- Acne vulgaris
- Bacterial infections
- Upper respiratory tract infection
- Dental abscess
- Bacterial endocarditis prevention
- Skin or soft tissue infection
- Bartonellosis
- Bowel preparation
- Bronchitis
- Bullous pemphigoid
- Campylobacter gastroenteritis
- Legionella pneumonia
- Lymphogranuloma venereum
- Mycoplasma pneumonia
- Nongonococcal urethritis
- Ocular rosacea
- Otitis media
- Pemphigoid
- Pertussis
- Pharyngitis
- Pneumonia
- Rheumatic fever prophylaxis
- Strep throat
- Chlamydial ophthalmia neonatorum
- Community acquired pneumonia
- Gastroparesis
- Granuloma inguinale
- Intestinal amebiasis caused by entamoeba histolytica
- Legionella pneumophila infections
- Lower respiratory tract infection
- Lymphogranuloma venereum
- Ophthalmia neonatorum (gonococcal)
- Postoperative Infections
- Primary syphilis
- Staphylococcal skin Infections
- Ureaplasma urethritis
- Skin and subcutaneous tissue bacterial infections caused by streptococcus pyogenes
- Superficial ocular infections
Contra-Indications of Erythromycin
- Clostridium difficile infection
- Myasthenia gravis
- Hearing loss
- Very rapid heartbeat – torsades de Pointes
- prolonged QT interval on EKG
- Abnormal EKG with QT changes from birth
- Liver problems
- Abnormal liver function tests
- Inflammation of the liver with stoppage of bile flow
Dosage of Erythromycin
Campylobacter Gastroenteritis
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Chancroid
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Lymphogranuloma Venereum
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Mycoplasma Pneumonia
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Mycoplasma Pneumonia
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Nongonococcal Urethritis
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Otitis Media
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Pharyngitis
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Pneumonia
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Soft Tissue Infection
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Syphilis – Early
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Upper Respiratory Tract Infection
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Bronchitis
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Chlamydia Infection
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Lyme Disease
- Mild to moderate infection: 250 to 500 mg (base, estolate, stearate) or 400 to 800 mg (ethylsuccinate) orally every 6 hours.
- Severe infection: 1 to 4 g/day IV in divided doses every 6 hours or by continuous infusion.
Legionella Pneumonia
- Although the dosage has not been established, clinical trials have used 1 to 4 g/day orally or IV in divided doses every 6 hours or by continuous infusion.
Pediatric Bacterial Endocarditis
- 20 mg/kg (ethylsuccinate or stearate) orally two hours before the procedure, then one-half the amount six hours after initial dose.
Side Effects of Erythromycin
The most common
- nausea, vomiting,
- allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
- sweating
- skin color change, mild diarrhea
- mild nausea
- loss of appetite
- vaginal discharge and itching
- swelling of feet or legs
- chest pain
- constipation
- cough
- diarrhea or loose stools
- difficulty with breathing
- dizziness
- heartburn
More common
- Abdominal or stomach pain, discomfort, or tenderness
- chills or fever
- difficulty with moving
- headache, severe and throbbing
- joint or back pain
- muscle aching or cramping
- muscle pains or stiffness
- chest pressure or squeezing pain in chest
- excessive sweating
- feeling of heaviness, pain, warmth and/or swelling in a leg or in the pelvis
- sudden tingling or coldness in an arm or leg
- sudden slow or difficult speech
- sudden drowsiness or need to sleep
- fast breathing
- sharp pain when taking a deep breath
- fast or slow heartbeat
- coughing up blood
- rust colored urine
- decreased amount of urine
Rare
- Anxiety
- change in vision
- seizures
- abnormal or fast heart rate
- tremors
- weight loss
- chest pain or tightness
- confusion
- cough
- Agitation
- arm, back, or jaw pain
- blurred vision
- chest pain or discomfort
- convulsions
- extra heartbeats
- fainting
- hallucinations
- headache
- irritability
Drug interactions of Erythromycin
Erythromycin may interact with following drugs,supplements & may change the efficacy of drugs
- alprazolam
- atorvastatin
- azithromycin
- azole antifungal agents (e.g., ketoconazole, itraconazole, fluconazole, posaconazole)
- bromazepam
- carbamazepine
- clindamycin
- clobazam
- clonazepam
- clopidogrel
- corticosteroids (e.g., methylprednisolone, prednisone, dexamethasone)
- cyclosporine
- diltiazem
- felodipine
- fexofenadine
- flurazepam
- levofloxacin
- lovastatin
- moxifloxacin
- phenytoin
- phosphodiesterase-5 inhibitors (e.g., sildenafil, tadalafil, vardenafil)
- quetiapine
- risperidone
- salmeterol
- simvastatin
- sotalol
- SSRIs (e.g., citalopram, fluoxetine, paroxetine, sertraline)
- telithromycin
- theophylline derivatives (e.g., theophylline, aminophylline, oxtriphylline)
- tricyclic antidepressants (e.g., amitriptyline, nortriptyline)
- trimipramine
- valproic acid
- verapamil
- warfarin
Pregnancy & Lactation
FDA pregnancy category B
Pregnancy
There is no evidence of hazard from erythromycin in human pregnancy. It has been in widespread use for a number of years without apparent ill consequence. Animal studies have shown no hazard.Erythromycin has been reported to cross the placental barrier in humans, but foetal plasma levels are generally low.
Lactation
This medication passes into breast milk. If you are a breast-feeding mother and are taking erythromycin, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
- Azithromycin
- Carbomycin
- Cethromycin
- Clarithromycin
- Dirithromycin
- Mitemcinal
- Oleandomycin
- Roxithromycin
- Spiramycin
- Telithromycin
- Tylosin
References
People Also Reading
Clarithromycin; Uses, Dosage, Side effects, Drug Interactions
Folinic Acid; Uses, Dosage, Side Effects, Drug Interactions
Cethromycin; Uses, Dosage, Side Effects, Drug Interactions
Cyclosporine; Uses, Dosage, Side Effects, Drug Interactions
Telithromycin; Uses, Dosage, Side Effects, Drug Interactions
Roxithromycin; Uses, Dosage, Side Effects, Drug Interactions
Levosalbutamol/Levalbuterol; Indications, Dosage, Side Effects, Drug Interactions
Oxtriphylline; Uses, Dosage, Side Effects, Drug Interactions
Bupropion; Uses, Dosage, Side Effects, Drug Interactions
Haloperidol; Uses, Dosage, Side Effects, Drug Interactions
Salbutamol; Indications, Dosage, Side effects, Drug Interactions, Pregnancy
Lovastatin; Uses, Dosage, Side Effects, Drug Interactions
About the author