Macrolide

Aka: Macrolide, Erythromycin

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II. Mechanism of action

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

III. Bacterial resistance mechanisms

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

IV. Adverse Effects

  1. Gastrointestinal upset
  2. Nausea
  3. Cholestatic Jaundice
  4. Multiple Drug Interactions

V. Complications

  1. Candida Vaginitis infection
  2. Gram Negative Folliculitis

VI. Pharmacokinetics

  1. Half life: 1.5 hours

VII. 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]

VIII. 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

IX. Parenteral Preparation: Erythromycin lactobionate

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

X. Activity Spectrum

  1. Major indications for Erythromycin
    1. Chlamydia pneumoniae
    2. Chlamydia trachomatis
      1. Pneumoniae or Conjunctivitis
      2. Pelvic infection in pregnancy
    3. Legionella pneumophila
    4. Mycoplasma pneumoniae
    5. Bordetella pertussis
    6. Corynebacterium diphtheriae
    7. Campylobacter jejuni
  2. Other organisms covered
    1. Ureaplasma urealyticum
    2. Treponema pallidum (Syphilis)
    3. Staphylococcus
    4. Streptococcus
    5. Bacillus anthracis
    6. Clostridium species

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Related Studies

Cost: Medications

erythromycin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ERYTHROMYCIN 0.5% EYE OINTMENT Generic $2.63 per gram
ERYTHROMYCIN 2% GEL Generic $0.75 per gram
ERYTHROMYCIN 2% SOLUTION Generic $0.41 per ml
ERYTHROMYCIN 200 MG/5 ML SUSP Generic $1.65 per ml
ERYTHROMYCIN 250 MG TABLET Generic $4.75 each
ERYTHROMYCIN 400 MG/5 ML SUSP Generic $2.55 per ml
ERYTHROMYCIN 500 MG TABLET Generic $8.25 each
ERYTHROMYCIN DR 250 MG TABLET Generic $4.53 each
ERYTHROMYCIN DR 500 MG TABLET Generic $4.85 each
ERYTHROMYCIN-BENZOYL GEL Generic $1.70 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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