I. Mechanism of action

  1. Reversibly binds 50S ribosomal subunit
  2. Inhibits protein synthesis

II. Bacterial resistance Mechanisms

  1. Impermeability of bacterial outer membranes
    1. Especially Gram Negative Organisms
  2. Production of enzymes that alter ribosomal targets

III. Adverse Effects

  1. Gastrointestinal upset
  2. Nausea
  3. Cholestatic Jaundice
  4. Multiple drug interactions

IV. Complications

V. Pharmacokinetics

  1. Half life: 1.5 hours

VI. Drug Interactions

  1. Interactions may also occur with extended spectrum
    1. Clarithromycin
    2. Telithromycin
    3. Less likely to occur with Azithromycin
  2. QT Prolongation (Erythromycin with an agent below)
    1. Calcium Channel Blockers increase Erythromycin level
      1. Verapamil
      2. Diltiazem
    2. Other potent CYP3A4 inhibitors
      1. Ketoconazole
      2. Itraconazole
      3. Nefazodone
      4. Protease Inhibitors
  3. References
    1. Ray (2004) N Engl J Med 351:1089-96 [PubMed]

VII. Oral Preparations (Take with food to reduce GI Upset)

  1. Erythromycin base 1000 mg/day PO divided bid-qid
  2. Erythromycin ethyl succinate (EES)
    1. Adult: 400 mg PO qid
    2. Child: 30-50 mg/kg/day PO divided qid

VIII. Parenteral Preparation: Erythromycin lactobionate

  1. Dose: 15 to 20 mg/kg/day IV divided every 6 hours
  2. Maximum: 4 grams

Images: Related links to external sites (from Google)

Cost: Medications

erythromycin (on 1/21/2015 at Medicaid.Gov Survey of pharmacy drug pricing)
ERYTHROMYCIN 0.5% EYE OINTMENT Generic $2.81 per gram
ERYTHROMYCIN 2% GEL Generic $0.84 per gram
ERYTHROMYCIN 2% PLEDGETS Generic $1.07 each
ERYTHROMYCIN 2% SOLUTION Generic $0.60 per ml
ERYTHROMYCIN 250 MG FILMTAB Generic $5.72 each
ERYTHROMYCIN 500 MG FILMTAB Generic $8.62 each
ERYTHROMYCIN DR 250 MG CAP Generic $3.70 each
ERYTHROMYCIN EC 250 MG CAP Generic $3.70 each
ERYTHROMYCIN ES 400 MG TAB Generic $5.60 each
ERYTHROMYCIN-BENZOYL GEL Generic $1.00 per gram

Ontology: Erythromycin (C0014806)

Definition (CHV) a kind of antibiotics
Definition (CHV) a kind of antibiotics
Definition (NCI) 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.
Definition (MSH) A bacteriostatic antibiotic macrolide produced by Streptomyces erythreus. Erythromycin A is considered its major active component. In sensitive 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.
Definition (CSP) bacteriostatic antibiotic macrolide produced by Streptomyces erythreus; in sensitive 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.
Definition (PDQ) A broad-spectrum, topical 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. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39234&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39234&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C476" NCI Thesaurus)
Concepts Antibiotic (T195) , Organic Chemical (T109)
MSH D004917
SnomedCT 332341008, 30427009, 372694001
LNC LP15115-6, MTHU003043
English Erythromycin, Erythromycin A, Erythromycin [skin], erythromycin, ERYTHROMYCIN, erythromycin (medication), Erythromycin Base, Erythromycin [Chemical/Ingredient], erythromycins, erythromycin base, Erythromycin [skin] (product), Erythromycin product, Erythromycin (product), Erythromycin (substance), Erythromycin, NOS, Erythromycin [skin] (substance), Erythromycin base, Erythromycins
Swedish Erytromycin
Czech erythromycin
Finnish Erytromysiini
Italian Eritromicina A, Eritromicina
Russian ERITROMITSIN, ЭРИТРОМИЦИН
Japanese エリスロシン(Erythromycin), エリスリット, タカスノン, エリスロマイシン, アイロタイシン
Croatian ERITROMICIN
Polish Erytromycyna
Spanish eritromicina (uso dermatológico) (producto), eritromicina (uso dermatológico), eritromicina (piel) (producto), eritromicina (piel), eritromicina (producto), eritromicina (sustancia), eritromicina, Eritromicina
French Érythromycine
German Erythromycin
Portuguese Eritromicina

Ontology: Macrolides (C0282563)

Definition (MSH) A group of often glycosylated macrocyclic compounds formed by chain extension of multiple PROPIONATES cyclized into a large (typically 12, 14, or 16)-membered lactone. Macrolides belong to the POLYKETIDES class of natural products, and many members exhibit ANTIBIOTIC properties.
Definition (NCI) A term used to describe a chemical structure of a compound containing a large lactone ring, usually with a 14 or 16-membered ring structure. The prototypical compounds within the macrolide class are the erythromycin-based antibiotics; however, many compounds with this chemical structure are being developed for other diseases.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D018942
SnomedCT 428787002
English Macrolides, Macrolide (substance), Macrolide, Macrolides [Chemical/Ingredient], macrolides, macrolide
Swedish Makrolider
Czech makrolidy
Finnish Makrolidit
Russian MAKROLIDY, МАКРОЛИДЫ
Spanish macrólido, macrólido (sustancia), Macrólidos
Japanese マクロライド
Polish Makrolidy
Croatian MAKROLIDI
Norwegian Not Translated[Macrolides]
French Macrolides
German Makrolide
Italian Macrolidi
Portuguese Macrolídeos