Erythromycin (Oral)

Indications

Erythromycin is highly effective in the treatment of a wide variety of clinical infections, such as
  • Upper respiratory tract infections: Tonsillitis, peritonsillar abscess, pharyngitis, laryngitis, sinusitis, and secondary infections in cold and influenza.
  • Lower respiratory tract infections: Tracheitis, acute and chronic bronchitis. Mycoplasma pneumoniae (lobar pneumonia, broncho pneumonia, primary atypical pneumoniae), bronchiectasis.
  • Skin and soft tissue infections: Boils and carbuncles, paronychia, abscesses, pustular acne, impetigo, cellulitis, furuncolosis, erythrasma.
  • Veneral infections: Non-specific urethritis, syphilis (if the patient is allergic to penicillin).
  • Gastro-intestinal infections: Cholecystitis, Staphylococcal enterocolitis, infectious diarrhoea, & cholera.
  • Ear and oral infections: 0titis media and otitis externa, gingivitis, dental abscesses.
  • Prophylaxis: Pre-operative and post-operative, trauma, burns, rheumatic fever.
  • Other infections: Diphtheria, whooping cough.

Therapeutic Class

Anti-diarrhoeal Antimicrobial drugs, Macrolides

Pharmacology

Erythromycin inhibits microsomal protein synthesis in susceptible organisms by inhibiting the translocation process. Specific binding to the 50S subunit or 70S ribosome occurs in these organisms but there is no binding to the stable 80S mammalian ribosome. Erythromycin is active against many Grampositive bacteria, some Gram-negative bacteria and against mycoplasmas and chlamydia.

Dosage & Administration

Adult and Child over 8 years: 250-500 mg every 6 hours or 0.5-1 gm every 12 hours. This may be increased up to 4 gm daily according to severity of infections.

Child of 2-8 years: 250 mg every 6 hours, doses doubled for severe infections.

Child up to 2 years: 125 mg every 6 hours.

Neonates: 30 to 45 mg/kg daily in 3 divided doses. 

Elderly: Same as for adults.

If administration on a twice daily schedule is desirable, one half of the total daily dose may be given every 12 hours, one hour before meal.

Amoebic dysentery:
  • Adult: 250 - 500 mg four times daily for 10 - 14 days.
  • Children: 30 - 50 mg/kg/day in divided doses for 10 - 14 days.
Pertussis: 30 - 50 mg/kg/day in divided doses for 5-14 days depending upon eradication of a positive culture.
Streptococcal infections: In the treatment of group A beta haemolytic streptococcal infections, therapeutic dosage of Erythromycin should be administered for at least 10 days.

Acne: The usual dosage regimen of erythromycin in the treatment of acne is 500 mg twice daily for 3 months. Then the dose is to be reduced to 250 mg twice daily for another 3 months.

Early Syphilis: 500 mg 4 times daily for 14 days.
Uncomplicated genital Chlamydia nongonococcal Urethritis: 500 mg twice daily for 14 days.

Prophylaxis: In continuous prophylaxis of streptococcal infections in person with a rheumatic heart disease, the dosage is 250 mg twice daily.

When Erythromycin is used prior to surgery to prevent endocarditis caused by alpha haemolytic streptococci, a recommended schedule:
  • For children: 20 mg/Kg 1.5 - 2 hours pre-operatively and 10 mg/kg every 6 hours for 8 doses post-operatively.
  • For adults: The dose is 1 g, 1.5 - 2 hours pre-operatively and 500 mg every 6 hours for 8 doses post-operatively.

Interaction

Theophylline: The use of Erythromycin in patients who are receiving concomitant high doses of theophylline may be associated with an increase in serum theophylline and potential theophylline toxicity. If symptoms of toxicity develop, the dose of theophylline should be reduced. 

Digoxin: Concomitant administration of Erythromycin and Digoxin has been reported to result in elevated digoxin serum levels.

Contraindications

Erythomycin is contraindicated in patients with a known hypersensitivity to this drug.

Side Effects

Generally erythromycin is well tolerated and serious adverse effects are rare. Side-effects are gastrointestinal and are dose-related. They include nausea, vomiting, abdominal pain, diarrhea and anorexia. Mild allergic reactions, such as urticaria and skin rashes have occurred. Serious allergic reactions, including anaphylaxis may occur.

Pregnancy & Lactation

Pregnancy: There are no adequate and well-controlled studies in pregnant women about administration of Erythromycin therefore; this drug should be used during pregnancy only if clearly needed.

Lactation: Erythromycin is excreted in breast milk; therefore, caution should be exercised when Erythromycin is administered to a nursing woman.

Precautions & Warnings

Since Erythromycin is metabolized principally by the liver, caution should be exercised when erythromycin is administered to patients with impaired hepatic function. There have been reports of hepatic dysfunction with or without jaundice occurring in patients taking oral Erythromycin.

Overdose Effects

In case of overdosage, Erythromycin should be discontinued. Overdosage should be handled with the prompt elimination of unabsorbed drug and all other appropriate measures should be instituted. Erythromycin is not removed by peritoneal dialysis or haemodialysis.

Reconstitution

Direction for reconstitution of suspension: Shake the bottle to loosen powder. Add 60 ml (12 measuring spoonful) of boiled and cooled water to the dry powder of the bottle. For ease of preparation, add water to the bottle in two proportions. Shake well after each addition until all the powder is in suspension.

Note: Shake the suspension well before each use. Keep the bottle tightly closed. The reconstituted suspension should be stored in a cool and dry place, preferably in refrigerator and unused portion should be discarded after 7 days.

Storage Conditions

Store between 15-25°C. Reconstituted powder for oral suspension: Store between 2-8°C.

Available Brand Names

  • Tablet A-Mycin
    250 mg
    Aristopharma Ltd.
    Unit Price : ৳ 5.15
  • Tablet A-Mycin
    500 mg
    Aristopharma Ltd.
    Unit Price : ৳ 9.00
  • Powder for Suspension A-Mycin
    125 mg/5 ml
    Aristopharma Ltd.
    100 ml bottle : ৳ 84.75
  • Powder for Suspension A-Mycin
    250 mg/5 ml
    Aristopharma Ltd.
    100 ml bottle : ৳ 100.00
  • Powder for Suspension A-Mycin
    200 mg/5 ml
    Aristopharma Ltd.
    60 ml bottle : ৳ 60.00
  • Powder for Suspension Acryth
    125 mg/5 ml
    Monicopharma Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Arigram
    125 mg/5 ml
    Central Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Tablet Cpmycin
    250 mg
    Cosmo Pharma Laboratories Ltd.
    Unit Price : ৳ 4.00
  • Powder for Suspension E-Lid
    125 mg/5 ml
    Syntho Laboratories Ltd.
    100 ml bottle : ৳ 54.00
  • Powder for Suspension E-ROX
    125 mg/5 ml
    Desh Pharmaceuticals Ltd.
    100 ml bottle : ৳ 70.00
  • Tablet E-ROX
    500 mg
    Desh Pharmaceuticals Ltd.
    Unit Price : ৳ 7.00
  • Tablet E-Rox 500
    500 mg
    Desh Pharmaceuticals Ltd.
    Unit Price : ৳ 7.00
  • Powder for Suspension E-Rox 500
    125 mg/5 ml
    Desh Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Ecin
    125 mg/5 ml
    Gaco Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Edry
    125 mg/5 ml
    Edruc Ltd.
    100 ml bottle : ৳ 60.00
  • Tablet EM
    500 mg
    Modern Pharmaceuticals Ltd.
    Unit Price : ৳ 8.00
  • Powder for Suspension EM
    125 mg/5 ml
    Modern Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Emycin
    125 mg/5 ml
    Medimet Pharmaceuticals Ltd.
    100 ml bottle : ৳ 61.00
  • Tablet Emycin
    250 mg
    Medimet Pharmaceuticals Ltd.
    Unit Price : ৳ 4.75
  • Powder for Suspension Ermac
    125 mg/5 ml
    Opsonin Pharma Ltd.
    100 ml bottle : ৳ 84.73
  • Powder for Suspension ERO
    125 mg/5 ml
    Hudson Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Tablet Erocin
    500 mg
    ACME Laboratories Ltd.
    Unit Price : ৳ 10.35
  • Tablet Erocin
    250 mg
    ACME Laboratories Ltd.
    Unit Price : ৳ 5.18
  • Powder for Suspension Erocin
    125 mg/5 ml
    ACME Laboratories Ltd.
    100 ml bottle : ৳ 84.75
  • Powder for Suspension Erode
    125 mg/5 ml
    United Chemicals & Pharmaceuticals Ltd.
    100 ml bottle : ৳ 70.17
  • Powder for Suspension Erom
    125 mg/5 ml
    Kemiko Pharmaceuticals Ltd.
    100 ml bottle : ৳ 69.50
  • Tablet Erom
    250 mg
    Kemiko Pharmaceuticals Ltd.
    Unit Price : ৳ 4.87
  • Tablet Erom
    500 mg
    Kemiko Pharmaceuticals Ltd.
    Unit Price : ৳ 8.63
  • Powder for Suspension Eromac
    125 mg/5 ml
    General Pharmaceuticals Ltd.
    100 ml bottle : ৳ 61.23
  • Powder for Suspension Eromed
    125 mg/5 ml
    Aexim Pharmaceuticals Ltd.
    100 ml bottle : ৳ 55.00
  • Tablet Eromycin
    250 mg
    Square Pharmaceuticals Ltd.
    Unit Price : ৳ 5.18
  • Pediatric Drops Eromycin
    200 mg/5 ml
    Square Pharmaceuticals Ltd.
    60 ml drop : ৳ 60.40
  • Powder for Suspension Eromycin
    125 mg/5 ml
    Square Pharmaceuticals Ltd.
    100 ml bottle : ৳ 69.53
  • Tablet Eromycin DS
    500 mg
    Square Pharmaceuticals Ltd.
    Unit Price : ৳ 10.35
  • Tablet Erosa
    500 mg
    Biopharma Laboratories Ltd.
    Unit Price : ৳ 8.00
  • Powder for Suspension Erosa
    125 mg/5 ml
    Biopharma Laboratories Ltd.
    100 ml bottle : ৳ 54.95
  • Tablet Erosa
    250 mg
    Biopharma Laboratories Ltd.
    Unit Price : ৳ 4.52
  • Powder for Suspension Erosite
    125 mg/5 ml
    Sharif Pharmaceuticals Ltd.
    100 ml bottle : ৳ 69.53
  • Powder for Suspension Errin
    125 mg/5 ml
    Radiant Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.18
  • Tablet Ery
    250 mg
    Alco Pharma Ltd.
    Unit Price : ৳ 5.17
  • Tablet Ery
    500 mg
    Alco Pharma Ltd.
    Unit Price : ৳ 10.33
  • Powder for Suspension Ery
    125 mg/5 ml
    Alco Pharma Ltd.
    100 ml bottle : ৳ 82.01
  • Tablet Erybac
    250 mg
    Drug International Ltd.
    Unit Price : ৳ 4.05
  • Powder for Suspension Erybac
    125 mg/5 ml
    Drug International Ltd.
    100 ml bottle : ৳ 60.20
  • Tablet Erybac
    500 mg
    Drug International Ltd.
    Unit Price : ৳ 8.05
  • Powder for Suspension Erylin
    125 mg/5 ml
    Cosmic Pharma Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Erymex
    125 mg/5 ml
    Ibn-Sina Pharmaceuticals Ltd.
    100 ml bottle : ৳ 84.50
  • Tablet Erymex
    500 mg
    Ibn-Sina Pharmaceuticals Ltd.
    Unit Price : ৳ 10.25
  • Powder for Suspension Erynet
    125 mg/5 ml
    Bristol Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Eryseem
    125 mg/5 ml
    Seema Pharmaceuticals Ltd.
    100 ml bottle : ৳ 56.00
  • Tablet Eryseem-500
    500 mg
    Seema Pharmaceuticals Ltd.
    Unit Price : ৳ 8.00
  • Powder for Suspension Eryth
    125 mg/5 ml
    Marksman Pharmaceuticals Ltd.
    100 ml bottle : ৳ 55.00
  • Powder for Suspension Erythin
    125 mg/5 ml
    ACI Limited
    100 ml bottle : ৳ 61.47
  • Powder for Suspension Erythro
    125 mg/5 ml
    Medicon Pharmaceuticals Ltd.
    100 ml bottle : ৳ 69.31
  • Powder for Suspension Erythromycin-A
    125 mg/5 ml
    Ad-din pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Erythrox
    125 mg/5 ml
    Renata Limited
    100 ml bottle : ৳ 69.31
  • Powder for Suspension Eryzen
    125 mg/5 ml
    Zenith Pharmaceuticals Ltd.
    100 ml bottle : ৳ 57.02
  • Tablet Eryzen
    500 mg
    Zenith Pharmaceuticals Ltd.
    Unit Price : ৳ 8.66
  • Tablet Eryzen
    250 mg
    Zenith Pharmaceuticals Ltd.
    Unit Price : ৳ 4.38
  • Powder for Suspension Ethro
    125 mg/5 ml
    Pharmadesh Laboratories Ltd.
    100 ml bottle : ৳ 61.22
  • Powder for Suspension Etrocin
    125 mg/5 ml
    Beximco Pharmaceuticals Ltd.
    100 ml bottle : ৳ 84.74
  • Tablet Etrocin
    500 mg
    Beximco Pharmaceuticals Ltd.
    Unit Price : ৳ 9.03
  • Tablet Etrocin
    250 mg
    Beximco Pharmaceuticals Ltd.
    Unit Price : ৳ 4.80
  • Tablet Firmac
    500 mg
    Incepta Pharmaceuticals Ltd.
    Unit Price : ৳ 8.60
  • Tablet Firmac
    250 mg
    Incepta Pharmaceuticals Ltd.
    Unit Price : ৳ 4.50
  • Powder for Suspension Ilocin
    125 mg/5 ml
    Doctor’s Chemical Works Ltd.
    100 ml bottle : ৳ 60.00
  • Tablet Ilocin
    500 mg
    Doctor’s Chemical Works Ltd.
    Unit Price : ৳ 8.00
  • Powder for Suspension Kumucin
    125 mg/5 ml
    Kumudini Pharma Ltd.
    100 ml bottle : ৳ 55.00
  • Powder for Suspension Mac
    125 mg/5 ml
    Orion Pharma Ltd.
    100 ml bottle : ৳ 60.46
  • Powder for Suspension Mac DS
    250 mg/5 ml
    Orion Pharma Ltd.
    70 ml bottle : ৳ 74.49
  • Powder for Suspension Macas
    125 mg/5 ml
    Asiatic Laboratories Ltd.
    100 ml bottle : ৳ 56.86
  • Tablet Macery
    250 mg
    Pacific Pharmaceuticals Ltd.
    Unit Price : ৳ 5.00
  • Tablet Macery
    500 mg
    Pacific Pharmaceuticals Ltd.
    Unit Price : ৳ 10.00
  • Powder for Suspension Macery
    125 mg/5 ml
    Pacific Pharmaceuticals Ltd.
    100 ml bottle : ৳ 84.00
  • Powder for Suspension Macin
    125 mg/5 ml
    Hallmark Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Makcin
    125 mg/5 ml
    Techno Drugs Ltd.
    100 ml bottle : ৳ 59.72
  • Powder for Suspension Mitrocin
    125 mg/5 ml
    Millat Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.00
  • Tablet Mitrocin
    500 mg
    Millat Pharmaceuticals Ltd.
    Unit Price : ৳ 8.51
  • Tablet Mitrocin
    250 mg
    Millat Pharmaceuticals Ltd.
    Unit Price : ৳ 3.45
  • Powder for Suspension Mitrocin DS
    250 mg/5 ml
    Millat Pharmaceuticals Ltd.
    100 ml bottle : ৳ 103.00
  • Powder for Suspension Mycin
    125 mg/5 ml
    Ambee Pharmaceuticals Ltd.
    100 ml bottle : ৳ 60.20
  • Tablet Mycin
    500 mg
    Ambee Pharmaceuticals Ltd.
    Unit Price : ৳ 8.03
  • Powder for Suspension Pedicin
    125 mg/5 ml
    Rangs Pharmaceuticals Ltd.
    100 ml bottle : ৳ 69.64
  • Powder for Suspension Throcin
    125 mg/5 ml
    Globe Pharmaceuticals Ltd.
    100 ml bottle : ৳ 56.00
  • Powder for Suspension Zerobac
    125 mg/5 ml
    Chemist Laboratories Ltd.
    100 ml bottle : ৳ 60.00
  • Powder for Suspension Zuracin
    125 mg/5 ml
    Rephco Pharmaceuticals Ltd.
    100 ml bottle : ৳ 61.07