Formulary
Erythromycin: Indications, Dosing, Side Effects and Interactions
Erythromycin clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 11 min read
Erythromycin: Indications, Dosing, Side Effects and Interactions
Erythromycin clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Susceptible infections in patients with penicillin hypersensitivity (e.g. respiratory-tract infections (including Legionella infection), skin and oral infections, and campylobacter enteritis)**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day, alternatively 500-1000 mg twice daily, increased to 500-1000 mg 4 times a day, increased dose may be used in severe infections.
- **Adult** (By Mouth): 250-500 mg 4 times a day, alternatively 500-1000 mg twice daily, increased to 500-1000 mg 4 times a day, increased dose may be used in severe infections.
- **Child** (By Intravenous Infusion): 12.5 mg/kg every 6 hours (max. per dose 1 g).
- **Adult** (By Intravenous Infusion): 6.25 mg/kg every 6 hours (max. per dose 500 mg), for mild infections when oral treatment not possible, increased to 12.5 mg/kg every 6 hours (max. per dose 1 g), increased dose may be used in severe infections.
**Impetigo,Secondary bacterial infection of eczema**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day for 5-7 days.
- **Adult** (By Mouth): 250-500 mg 4 times a day for 5-7 days.
**Cellulitis,Erysipelas**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day for 5-7 days then review.
- **Adult** (By Mouth): 500 mg 4 times a day for 5-7 days then review.
**Prevention of recurrent cellulitis (specialist use only),Prevention of recurrent erysipelas (specialist use only)**
- **Adult** (By Mouth): 250 mg twice daily.
**Mild diabetic foot infection**
- **Adult** (By Mouth): 500 mg 4 times a day for 7 days then review.
**Leg ulcer infection**
- **Adult** (By Mouth): 500 mg 4 times a day for 7 days.
**Community-acquired pneumonia**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day for 5 days.
- **Adult** (By Mouth): 500 mg 4 times a day for 5 days.
**Acute cough [if systemically very unwell or at higher risk of complications]**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day for 5 days, alternatively 500-1000 mg twice daily for 5 days.
- **Adult** (By Mouth): 250-500 mg 4 times a day for 5 days, alternatively 500-1000 mg twice daily for 5 days.
**Acute sore throat**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day for 5 days, alternatively 500-1000 mg twice daily for 5 days.
- **Adult** (By Mouth): 250-500 mg 4 times a day for 5 days, alternatively 500-1000 mg twice daily for 5 days.
**Acute otitis media**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day for 5-7 days, alternatively 500-1000 mg twice daily for 5-7 days.
**Early syphilis**
- **Adult** (By Mouth): 500 mg 4 times a day for 14 days.
**Uncomplicated genital chlamydia**
- **Adult** (By Mouth): 500 mg twice daily for 14 days.
**Chronic prostatitis**
- **Adult** (By Mouth): 250-500 mg 4 times a day, total daily dose may alternatively be given in two divided doses, dose may be increased to 4 g daily in divided doses in severe infections.
- **Adult** (By Intravenous Infusion): 6.25 mg/kg every 6 hours (max. per dose 500 mg), for mild infections when oral treatment is not possible, increased to 12.5 mg/kg every 6 hours (max. per dose 1 g), increased dose may be used in severe infections.
**Prevention and treatment of pertussis**
- **Child** (By Mouth): 8-17 years 250-500 mg 4 times a day, alternatively 500-1000 mg twice daily, increased to 500-1000 mg 4 times a day, increased dose may be used in severe infections.
- **Adult** (By Mouth): (consult local protocol).
**Mild diphtheria [confirmed or probable]**
- **Child** (By Mouth): 12-17 years 500 mg 4 times a day for 14 days, alternatively 1 g twice daily for 14 days.
- **Adult** (By Mouth): 500 mg 4 times a day for 14 days, alternatively 1 g twice daily for 14 days.
**Prevention of secondary case of diphtheria**
- **Child** (By Mouth): 12-17 years 500 mg 4 times a day for 7 days, alternatively 1 g twice daily for 7 days.
- **Adult** (By Mouth): 500 mg 4 times a day for 7 days, alternatively 1 g twice daily for 7 days.
**Prevention of secondary case of invasive group A streptococcal infection [penicillin-allergic patients who are pregnant or within 28 days of delivery]**
- **Child** (By Mouth): 8-17 years 250-500 mg every 6 hours for 10 days.
- **Adult** (By Mouth): 250-500 mg every 6 hours for 10 days.
**Prevention of pneumococcal infection in asplenia or in patients with sickle-cell disease (if penicillin-allergic)**
- **Adult** (By Mouth): 500 mg twice daily, antibiotic prophylaxis is not fully reliable. It may be discontinued in those with sickle-cell disease who have received pneumococcal immunisation and who do not have a history of severe pneumococcal infection.
**Rosacea**
- **Adult** (By Mouth): 500 mg twice daily courses usually last 6-12 weeks and are repeated intermittently.
**Acne**
- **Adult** (By Mouth): 500 mg twice daily.
**Gastro-intestinal stasis**
- **Adult** (By Mouth): 250-500 mg 3 times a day for up to 4 weeks, to be taken before food.
- **Adult** (By Intravenous Infusion): 3 mg/kg 3 times a day.
**Prophylaxis of intrauterine infection [in preterm prelabour rupture of membranes]**
- **Adult** (By Mouth): 250 mg 4 times a day for up to 10 days or until established labour, whichever is sooner.
**Susceptible infections in patients with penicillin hypersensitivity (e.g. respiratory-tract infections (including Legionella infection), skin and oral infections, and campylobacter enteritis) for erythromycin**
- **Neonate** (By mouth): 12.5 mg/kg every 6 hours.
- **Child 1-23 months** (By mouth): 125 mg 4 times a day, alternatively 250 mg twice daily, increased to 250 mg 4 times a day, increased dose may be used in severe infections.
- **Child 2-7 years** (By mouth): 250 mg 4 times a day, alternatively 500 mg twice daily, increased to 500 mg 4 times a day, increased dose may be used in severe infections.
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day, alternatively 500-1000 mg twice daily, increased to 500-1000 mg 4 times a day, increased dose may be used in severe infections.
- **Neonate** (By intravenous infusion): 10-12.5 mg/kg every 6 hours.
- **Child** (By intravenous infusion): 12.5 mg/kg every 6 hours (max. per dose 1 g).
**Impetigo, Secondary bacterial infection of eczema for erythromycin**
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day for 5-7 days.
**Cellulitis, Erysipelas for erythromycin**
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day for 5-7 days then review.
**Community-acquired pneumonia for erythromycin**
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day for 5 days.
**Acute cough [if systemically very unwell or at higher risk of complications] for erythromycin**
- **Child 1-23 months** (By mouth): 125 mg 4 times a day for 5 days, alternatively 250 mg twice daily for 5 days.
- **Child 2-7 years** (By mouth): 250 mg 4 times a day for 5 days, alternatively 500 mg twice daily for 5 days.
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day for 5 days, alternatively 500-1000 mg twice daily for 5 days.
**Acute sore throat for erythromycin**
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day for 5 days, alternatively 500-1000 mg twice daily for 5 days.
**Acute otitis media for erythromycin**
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day for 5-7 days, alternatively 500-1000 mg twice daily for 5-7 days.
**Early syphilis for erythromycin**
- **Child 12-17 years** (By mouth): 500 mg 4 times a day for 14 days.
**Uncomplicated genital chlamydia for erythromycin**
- **Child 12-17 years** (By mouth): 500 mg twice daily for 14 days.
**Prevention and treatment of pertussis for erythromycin**
- **Neonate** (By mouth): 12.5 mg/kg every 6 hours.
- **Child 1-23 months** (By mouth): 125 mg 4 times a day, alternatively 250 mg twice daily, increased to 250 mg 4 times a day, increased dose may be used in severe infections.
- **Child 2-7 years** (By mouth): 250 mg 4 times a day, alternatively 500 mg twice daily, increased to 500 mg 4 times a day, increased dose may be used in severe infections.
- **Child 8-17 years** (By mouth): 250-500 mg 4 times a day, alternatively 500-1000 mg twice daily, increased to 500-1000 mg 4 times a day, increased dose may be used in severe infections.
- **Neonate** (By intravenous infusion): 10-12.5 mg/kg every 6 hours.
- **Child** (By intravenous infusion): 12.5 mg/kg every 6 hours (max. per dose 1 g).
**Mild diphtheria [confirmed or probable] for erythromycin**
- **Neonate** (By mouth): 10-15 mg/kg 4 times a day for 14 days, alternatively 20-30 mg/kg twice daily for 14 days.
- **Child 1 month-11 years** (By mouth): 10-15 mg/kg 4 times a day (max. per dose 500 mg) for 14 days, alternatively 20-30 mg/kg twice daily (max. per dose 1 g) for 14 days.
- **Child 12-17 years** (By mouth): 500 mg 4 times a day for 14 days, alternatively 1 g twice daily for 14 days.
**Prevention of secondary case of diphtheria for erythromycin**
- **Neonate** (By mouth): 10-15 mg/kg 4 times a day for 7 days, alternatively 20-30 mg/kg twice daily for 7 days.
- **Child 1 month-11 years** (By mouth): 10-15 mg/kg 4 times a day (max. per dose 500 mg) for 7 days, alternatively 20-30 mg/kg twice daily (max. per dose 1 g) for 7 days.
- **Child 12-17 years** (By mouth): 500 mg 4 times a day for 7 days, alternatively 1 g twice daily for 7 days.
**Prevention of secondary case of invasive group A streptococcal infection [penicillin-allergic patients who are pregnant or within 28 days of delivery] for erythromycin**
- **Child 8-17 years** (By mouth): 250-500 mg every 6 hours for 10 days.
**Prevention of pneumococcal infection in asplenia or in patients with sickle-cell disease (if penicillin-allergic) for erythromycin**
- **Child 1-23 months** (By mouth): 125 mg twice daily, antibiotic prophylaxis is not fully reliable.
- **Child 2-7 years** (By mouth): 250 mg twice daily, antibiotic prophylaxis is not fully reliable. It may be discontinued in those over 5 years of age with sickle-cell disease who have received pneumococcal immunisation and who do not have a history of severe pneumococcal infection.
- **Child 8-17 years** (By mouth): 500 mg twice daily, antibiotic prophylaxis is not fully reliable. It may be discontinued in those with sickle-cell disease who have received pneumococcal immunisation and who do not have a history of severe pneumococcal infection.
**Prevention of recurrence of rheumatic fever for erythromycin**
- **Child 1-23 months** (By mouth): 125 mg twice daily.
- **Child 2-17 years** (By mouth): 250 mg twice daily.
**Infantile acne for erythromycin**
- **Child 1-23 months** (By mouth): 250 mg once daily, alternatively 125 mg twice daily.
**Acne for erythromycin**
- **Child 12-17 years** (By mouth): 500 mg twice daily.
**Gastro-intestinal stasis for erythromycin**
- **Neonate** (By mouth): 3 mg/kg 4 times a day.
- **Child** (By mouth): 3 mg/kg 4 times a day.
- **Neonate** (By intravenous infusion): 3 mg/kg 4 times a day.
- **Child 1-11 months** (By intravenous infusion): 3 mg/kg 4 times a day.
Cautions
With intravenous use Electrolyte disturbances (predisposition to QT interval prolongation); may aggravate myasthenia gravis; predisposition to QT interval prolongation With oral use Electrolyte disturbances (predisposition to QT interval prolongation); may aggravate myasthenia gravis; predisposition to QT interval prolongation Cautions For erythromycin With systemic use Avoid in Acute porphyrias
Side effects
Common or very common Appetite decreased; diarrhoea; dizziness; gastrointestinal discomfort; gastrointestinal disorders; headache; hearing impairment; insomnia; nausea; pancreatitis; paraesthesia; skin reactions; taste altered; vasodilation; vision disorders; vomiting Uncommon Angioedema; anxiety; arrhythmias; candida infection; chest pain; constipation; drowsiness; eosinophilia; hepatic disorders; leucopenia; neutropenia; palpitations; QT interval prolongation; severe cutaneous adverse reactions (SCARs); tinnitus; vertigo Rare or very rare Infantile hypertrophic pyloric stenosis (in children); myasthenia gravis; nephritis tubulointerstitial; pseudomembranous enterocolitis Frequency not known Clostridioides difficile colitis; hallucination; hypotension; seizure; smell altered; thrombocytopenia; tongue discolouration Side-effects For erythromycin General side-effects: Rare or very rare Hearing loss (can occur after large doses) Specific side-effects: Frequency not known With oral use Cerebral impairment With parenteral use Atrioventricular block
Interactions
**Other interactions (2):**
- Any sunburn should be allowed to heal before the start of treatment with Aknemycin Plus.
- Aknemycin Plus should not be used concomitantly with other skin medications particularly those containing keratolytic agents (see section 4.3), as this may exacerbate any skin irritation that is...
Pregnancy
Use only if potential benefit outweighs risk M (recommendation also supported by specialist sources). When used for Early syphilis: Avoid (drug may not reach fetus in adequate concentration to prevent congenital syphilis). A
Breast feeding
With systemic use: Only small amounts in milk-not known to be harmful.
Hepatic impairment
With systemic use: Manufacturer advises caution.
Renal impairment
Dose adjustments With systemic use: Some manufacturers advise consider dose reduction in moderate to severe impairment (ototoxicity) (consult product literature).
Medicinal forms
Tablet,Tablet,Suspension,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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