erythromycin ethylsuccinate (Rx)

Brand and Other Names:E.E.S., EryPed
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Dosing & Uses

AdultPediatric

Dosing Form & Strengths

tablet

  • 400mg

oral suspension

  • 200mg/5mL
  • 400mg/5mL

General Dosing Recommendations

400 mg PO q6hr

May increase up to 4 g/day depending on infection severity

Intestinal amebiasis

400 mg PO q6hr for 10-14 days

Legionnaire Disease

400-1000 mg PO q6hr for 21 days

Pertusis

40-50 mg/kg/day PO in divided doses for 5 to 14 days

Streptococcal infections

400 mg PO divided q12hr for 10 days

Primary syphilis

48-64 g PO individed doses for 10-15 days

Urethritis

Urethritis caused by C trachomatis or U urealyticum

800 mg PO q8hr for 7 days

Administration

May take with food

Renal Impairment

Dose adjustment not necessary

Hepatic Impairment

Use caution

Other Indications and Uses

Group A beta-hemolytic strep, Actinobacillus actinomycetemcomitans, Actinomyces israelii, Actinomyces naeslundii, Actinomyces odontolyticus, Afipia felis, Arachnia propionica, Arcanobacterium (Corynebacterium) haemolyticum, Bacillus anthracis, Bartonella henselae, Bartonella quintana, Bordetella pertussis, Borrelia burgdorferi, Borrelia recurrentis, C. diphtheriae, C. trachomatis, Klebsiella granulomatis, Campylobacter jejuni, Capnocytophaga ochracea, Chlamydia pneumonia (TWAR agent), Chlamydia psittaci, Chlamydia trachomatis, Chryseobacterium meningosepticum, Corynebacterium jeikeium (CDC group JK), Corynebacterium minutissimum, Corynebacterium ulcerans, Coxiella burnetii, E. histolytica, Erysipelothrix rhusiopathiae, H. ducreyi, H. influenzae, Kingella sp., Lactobacillus sp, Legionella pneumophilia, Leptospira interrogans, Leptotrichia buccalis, Leuconostoc species, Listeria, Mycobacterium chelonae, Mycobacterium fortuitum, M. catarrhalis, Mycoplasma pneumoniae, N. gonorrhoeae, Rhodococcus equi, S. aureus, S. pyogenes (group A beta-hemolytic streptococci), S. pneumoniae, Spirillum minus, Streptobacillus moniliformis, Streptococcus (Group C, G), Streptococcus agalactiae (Group B), Streptococcus bovis (Group D), Streptococcus intermedius group (S. anginosus, S intermedius, S. constellatus), Streptococcus pneumoniae (PCN sensitive, MIC <0.1 mcg/mL), Streptococcus pyogenes (Group A), Treponema pallidum, U. urealyticum, Ureaplasma urealyticum, Vibrio cholerae, Viridans streptococci

Off-label: Campylobacter jejuni, Calymmatobacterium granulomatis, Haemophilus ducreyi, prophylaxis in colorectal surgery, anthrax, tetanus, Lyme disease

First line: Afipia felis, Arcanobacterium (Corynebacterium) haemolyticum, Bartonella henselae, Bartonella quintana, Campylobacter jejuni, Capnocytophaga ochracea, Chlamydia pneumonia, Corynebacterium minutissimum, Corynebacterium ulcerans, Haemophilus ducreyi, Mycobacterium fortuitum, Ureaplasma urealyticum (others eg, Haemophilus ducreyi not unanimous)

Dosing Form & Strengths

tablet

  • 400mg

oral suspension

  • 200mg/5mL
  • 400mg/5mL

General Dosing Recommendations

Neonates

  • <1.2 kg: 20 mg/kg/day PO divided q12hr  
  • 1.2 kg or more, 0-7 days old: 20 mg/kg/day PO divided q12hr
  • ≥1.2 kg or more, 7 days or older: 30 mg/kg/day PO divided q8hr
  • Chlamydial conjunctivitis and pneumonia: 50 mg/kg/day PO divided q6hr for 14days

Children

  • Mild-to-moderate infections: 30-50 mg/kg/day PO divided q6-12hr
  • Severe infection: 60-100 mg/kg/day PO divided q6-12hr
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Interactions

Interaction Checker

and erythromycin ethylsuccinate

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Abdominal pain (8%)

            Headache (8%)

            Nausea (8%)

            Diarrhea (7%)

            Rash (3%)

            Vomiting (3%)

            Dyspepsia (2%)

            Flatulence (2%)

            Pain (2%)

            Pruritus (1%)

            Pseudomembranous colitis

            Hypertrophic pyloric stenosis

            Anaphylaxis

            Fever

            Mild allergic reactions

            Urticaria

            Skin eruptions

            Tinnitus

            <1%

            Cholestatic hepatitis

            Confusion

            Hallucinations

            Hearing loss

            Hypotension

            Nervous system effects including seizures

            Torsade de pointes

            Ventricular tachycardia

            Vertigo

            Postmarketing reports

            Interstitial nephritis

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            Warnings

            Contraindications

            Documented hypersensitivity

            Hepatic impairment

            History of hepatitis caused by macrolide

            Cholestatic hepatitis

            Coadministration with terfenadine (discontinued), astemizole (discontinued), cisapride, or pimozide

            Coadministration with ergotamine or dihydroergotamine (postmarketing reports of acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system)

            Cautions

            Risk of sudden death due to cardiac causes with concomitant use of oral erythromycin with drugs that inhibit CYP3A4

            Erythromycin is considered a moderate inhibitor of CYP3A4; may increase toxicity of CYP3A4 substrates

            Colchicine is a substrate for both CYP3A4 and the efflux transporter P-glycoprotein (P-gp); significant increase in colchicine plasma concentration is anticipated when coadministered with moderate CYP3A4 inhibitors; reduce the starting dose of colchicine and lower maximum colchicine dose

            Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur

            Associated with QT prolongation and infrequent cases of arrhythmia

            May increase LFTs in pregnant women

            GI effects: abdominal pain and cramping; diarrhea; nausea and vomiting

            Hepatic impairment

            Overgrowth of nonsusceptible bacteria or fungi

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: distributed in breast milk, use with caution; AAP categorizes as compatible with breastfeeding

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest

            Absorption

            Oral: Variable but better with salt forms than with base form; 18-45%; ethylsuccinate may be better absorbed with food

            Peak Plasma Time: 4 hr (base); 0.5-2.5 hr (ethylsuccinate); delayed with food due to differences in absorption

            Distribution

            Protein Bound: 75-80%

            Crosses placenta; enters breast milk

            Relative diffusion from blood into CSF: minimal even with inflammation

            Metabolism

            Via P450 enzyme CYP3A4

            Enzymes inhibited: CYP1A2, CYP3A4

            Elimination

            Half-life elimination: 1.4 hr

            Excretion: primarily feces; urine (2-15% as unchanged drug)

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            Formulary

            FormularyPatient Discounts

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            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
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