Erythromycin

C difficile risk
Medium
Oral Bioavailability
Moderate

Dosing

PO: 250 - 500 mg PO QID

IV: 15 to 20 mg/kg/day divided every 6 hours (or 250 mg - 1 g IV q6h)

For patients known GBS NEGATIVE only250 mg IV q6h for 48 hours followed by 250 mg PO q6h for 5 days (in combination with ampicillin then amoxicillin)250 mg PO q6h x 10 days

Infuse over 60 minutes

<1200g1200 to 2000g>2000gAge >28 DaysAge 0 to 4 weeks: 10 mg/kg/dose IV/PO Q12HAge 0 to 7 days: 10 mg/kg/dose IV/PO Q12H Age >7 days: 10 mg/kg/dose IV/PO Q8HAge 0 to 7 days: 10 mg/kg/dose IV/PO Q12H Age >7 days: 10 mg/kg/dose IV/PO Q8HAll infants: 10 mg/kg/dose IV/PO Q8H

Prophylaxis of neonatal gonococcal or chlamydial ophthalmiaOintment: Apply 1cm ribbon to each lower conjunctival sac once by 1 hour of age

IV PO

IV: 2.5 mg/mL

  1. Reconstitute 1 gram vial with 20mL of sterile water for injection = 50 mg/mL
  2. Mix 9mL of 0.9% sodium chloride with 0.5mL of 50 mg/mL concentration in a 10mL empty sterile vial = 2.5 mg/mL

50 mg/mL = 7 days Refrigerated2.5 mg/mL = 24H Room Temperature

No dose adjustment required

General Information

  • Preterm prelabour rupture of membranes.

  • Gastrointestinal prokinetic agent (short term).

Pregnancy:

  • In most published studies, erythromycin therapy during pregnancy was not associated with an increase in the risk of birth defects.

  • There is limited evidence suggesting a small increase in the risk of congenital heart disease and pyloric stenosis, however, data is conflicting and this was not confirmed in other samples.

  • Decreased neonatal morbidity and mortality and longer duration of gestation have been observed in clinical trials of erythromycin treatment of pregnant women with premature rupture of the membranes.

  • Erythromycin estolate specifically is avoided in pregnancy due to potential maternal hepatotoxicity.

Breastfeeding:

  • Because of the low levels of erythromycin in breastmilk and use in infants in higher doses, it would not be expected to cause significant adverse effects in breastfed infants.

  • A case report and cohort study indicate that the risk of infantile hypertrophic pyloric stenosis might be increased by maternal use of erythromycin during the first two weeks of breastfeeding, but this has not been confirmed and data is conflicting.

  • Monitor the infant for gastrointestinal intolerance.

  • Monitor QTc in patients at increased risk.

  • Multiple drug interactions may exist, consult pharmacy.

  • Gastrointestinal intolerance

  • Abnormal hepatic function tests, cholestatic jaundice (most common with estolate), hepatitis

Substrate and inhibitor of CYP3A4 and P-glycoprotein/ABCB1, multiple drug interactions may exist

Do not use erythromycin esolate in pregnancy due to potential maternal hepatoxicity.

Antimicrobial Class: Macrolide.

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