By Susan C. Haussler, EdD, RN, CNE
Reviewed by Marina Sehman, PharmD, CSP
Last Update: August 20, 2024
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What is it?
Erythromycin is the first antibiotic of the macrolide group. This group contains substances consisting of a lactone ring and several radicals. It was discovered in 1952 and is still used since microorganisms slowly develop resistance to it. This antibiotic is effective against a variety of bacteria, including those parasitizing inside cells, such as Legionella. It is used both in medicine and in veterinary medicine for the treatment of bacterial diseases in cattle, sheep, pigs and poultry.
Like other macrolides, this substance is one of the safest antibiotics. It can be used during pregnancy, although not recommended for use during lactation. Its proportion penetrating into milk varies depending on the type:
- in humans – about 0.1% of the dose taken;
- in cows – 3.8% of the dose taken.
Indications
This antibiotic is prescribed in the following cases:
- diphtheria (including bacterial disease carrier);
- whooping cough (including prevention);
- trachoma;
- brucellosis;
- Legionnaires’ disease;
- erythrasma;
- listeriosis;
- scarlet fever;
- amebic dysentery;
- gonorrhea;
- conjunctivitis of the newborn;
- pneumonia in children;
- urinary infections in pregnant women caused by Chlamydia trachomatis;
- primary syphilis (in patients with penicillin allergy);
- uncomplicated chlamydia in adults (with localization in the lower urinary tract and rectum) with intolerance or ineffectiveness of tetracyclines;
- infections of the upper respiratory tract (tonsillitis, otitis media, sinusitis);
- biliary tract infection (cholecystitis);
- infections of the upper and lower respiratory tract (tracheitis, bronchitis, pneumonia);
- infections of the skin and soft tissues (pustular skin diseases, including juvenile acne, infected wounds, pressure sores, II-III degree burns, trophic ulcers);
- infections of the mucous membrane of the eyes;
- prevention of exacerbations of streptococcal infection (tonsillitis, pharyngitis) in patients with rheumatism;
- prevention of infectious complications during therapeutic and diagnostic procedures (including preoperative preparation of the intestine, dental interventions, endoscopy, in patients with heart defects).
Dosage and mode of application
It is taken orally. A single dose for adults and adolescents over 14 years old is 250-500 mg, daily – 1-2 g. The interval between doses lasts for up 6 hours. For severe infections, the daily dose may be increased to 4 g.
- Children from 4 months to 18 years, depending on age, body weight and severity of infection – 30-50 mg/kg/day in 2-4 doses; children of 3 months old – 20-40 mg/kg/day. In the case of more severe infections, the dose may be doubled.
- Diphtheria carriage – 250 mg 2 times/day. The course dose for the treatment of primary syphilis is 30-40 g, the duration of treatment is 10-15 days.
- Amebic dysentery (adults), 250 mg 4 times/day, children 30-50 mg/kg/day; course duration is 10-14 days.
- Legionellosis, the dosage regimen is 500 mg-1 g 4 times/day for 14 days.
- Gonorrhea, 500 mg every 6 hours for 3 days, then 250 mg every 6 hours for 7 days.
- Preoperative preparation of the intestine to prevent infectious complications – orally, 1 g for 19 hours, 18 hours and 9 hours before the start of the operation (3 g in total).
- Prevention of streptococcal infection (tonsillitis, pharyngitis) for adults – 20–50 mg/kg/day, for children – 20–30 mg/kg/day, the course duration is at least 10 days.
- Prevention of septic endocarditis in patients with heart defects, 1 g for adults and 20 mg/kg for children, 1 hour before the treatment or diagnostic procedure, then 500 mg for adults and 10 mg/kg for children, again after 6 hours.
- Whooping cough – 40-50 mg/kg/day for 5-14 days.
- Pneumonia in children – 50 mg/kg/day in 4 divided doses, for at least 3 weeks.
- Urinary infections during pregnancy – 500 mg 4 times/day for at least 7 days or (if this dosage is poorly tolerated) – 250 mg 4 times/day for at least 14 days.
- In adults, with uncomplicated chlamydia and tetracycline intolerance – 500 mg 4 times/day for at least 7 days.
Contraindications
Erythromycin is contraindicated in the following cases:
- hypersensitivity;
- hearing loss;
- simultaneous use of terfenadine or astemizole;
- lactation period.
Take care when taking this drug in the following cases:
- arrhythmias (in the anamnesis);
- prolongation of the QT interval;
- jaundice (in history);
- liver failure;
- renal failure.
Side effects
Hypersensitivity reactions: skin allergic reactions (urticaria, other forms of rash), eosinophilia; rarely – anaphylactic shock.
Nausea, vomiting, gastralgia, tenesmus, abdominal pain, diarrhea, dysbiosis; rarely – oral candidiasis, pseudomembranous enterocolitis (both during and after treatment), abnormal liver function, cholestatic jaundice, increased activity of hepatic transaminases, pancreatitis, hearing loss and/or tinnitus (with high doses, more than 4 g/day, hearing loss after drug withdrawal is usually reversible).
Rare side effects are tachycardia, prolongation of the QT interval, ventricular arrhythmias, including ventricular tachycardia in patients with a prolonged QT interval.
Pregnancy and breastfeeding
Erythromycin is contraindicated during lactation as it can penetrate into breast milk.
Interactions
- Tubular secretion blocking drugs prolong T1 / 2 of erythromycin.
- It is incompatible with lincomycin, clindamycin and chloramphenicol (antagonism).
- It reduces the bactericidal effect of beta-lactam antibiotics (penicillins, cephalosporins).
- When taken concurrently with drugs metabolized in the liver (theophylline, carbamazepine, valproic acid, hexobarbital, phenytoin, alfentanil, disopyramide, lovastatin, bromocriptine), the concentration of these drugs in the plasma may increase (it is an inhibitor of microsomal liver enzymes).
- It enhances the nephrotoxicity of cyclosporine (especially in patients with concomitant renal failure).
- It reduces clearance of triazolam and midazolam and therefore may enhance the pharmacological effects of benzodiazepines.
- When taken simultaneously with terfenadine or astemizole, there is the possibility of arrhythmia, vasoconstriction, dysesthesia.
- It slows down the elimination (enhances the effect) of methylprednisolone, felodipine and coumarin anticoagulants.
- When combined with lovastatin, rhabdomyolysis increases.
- It increases the bioavailability of digoxin.
- It reduces the effectiveness of hormonal contraception.
Safety Precautions
With long-term therapy, it is necessary to monitor the laboratory parameters of the hepatic function.
Symptoms of cholestatic jaundice may develop several days after the start of therapy, but the risk of development increases after 7-14 days of continuous therapy. The likelihood of the ototoxic effect is higher in patients with renal and hepatic insufficiency, as well as in elderly patients.
Some resistant strains of Haemophilus influenza are sensitive to the simultaneous administration of erythromycin and sulfonamides.
It may interfere with the determination of catecholamines in the urine and the activity of hepatic transaminases in the blood. It is contraindicated in the liver or renal failure.
How to buy Erythromycin?
Nowadays, it becomes possible to buy this antibiotic online. We insist on undergoing the consultation with a doctor. The healthcare giver will prescribe the recommended dosage and regimen. It is very dangerous to self-medicate. It becomes rather simple to make an order of this product online using the link below but strictly follow all the given recommendations.
You may make an order with several steps. Your parcel will be delivered in the stated periods of time. You are welcome to ask any questions relating to delivery, time of processing and many other aspects. The quality of our generic medications is high. They are produced by certified pharmaceutical companies only.
About the Author
Susan C. Haussler, EdD, RN, CNE, is a renowned nurse educator and leader, currently serving as an Associate Editor at our journal and as a faculty member at the University of Massachusetts–Boston. Based in Boston, Massachusetts, her extensive experience in clinical practice and academic instruction, along with her contributions to nursing literature, underscore her commitment to enhancing nursing education and healthcare outcomes. Dr. Haussler’s work, bolstered by her academic credentials, plays a crucial role in developing future nursing professionals.
Disclaimer: The information provided on this site is solely for educational purposes and is not a replacement for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional before altering your medical treatment or medications. Relying on this content instead of seeking professional advice is not recommended.