erythromycin ethylsuccinate (Rx) - E.E.S., EryPed

Dosing Form & Strengths

General Dosing Recommendations

400 mg PO q6hr

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

Amebiasis

400 mg PO q6hr x10-14 days

Legionnaires Disease

400-1000 mg PO q6hr x21 days

Urethritis

Urethritis caused by C trachomatis or U urealyticum

800 mg PO TID x7 days

Administration

May take with food

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

General Dosing Recommendations

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

Contraindications

Documented hypersensitivity

Hepatic impairment

History of hepatitis caused by macrolide

Cholestatic hepatitis

Coadministration with terfenadine, astemizole, 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

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: 75-90%

Crosses placenta; enters breast milk

Relative diffusion from blood into CSF: minimal even with inflammation

Metabolism

Via P450 enzyme CYP3A4

Elimination

Half-Life: 1.4 hr

Excretion: primarily feces; urine (2-15% as unchanged drug) Enzymes inhibited: CYP1A2, CYP3A4