erythromycin lactobionate (Rx)Brand and Other Names:Erythrocin Lactobionate

 
 
 

Dosing & Uses

AdultPediatric

Dosing Form & Strengths

injection

  • 500mg
  • 1g

General Dosing Recommendations

15-20 mg/kg/day IV divided q6hr; infuse IV over 1 hr  

Up to 4 g/day may be administered for severe infections

Geriatric: Increased risk for hearing loss in elderly patients with 4 g/day or more

Acute Pelvic Inflammatory Disease

500 mg IV q6hr for 3 days; follow by 500 mg PO q12hr

Legionaire Disease

1-4 g IV in divided doses

Streptococcal Infections

250 mg PO q12hr

Renal Impairment

CrCl <10 mL/min: Administer 50-75% of usual dose

Other Indications & 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

injection

  • 500mg
  • 1g

Usual Dosage Range, Infants & Children

15-20 mg/kg/day IV divided q6hr; infuse IV over 1 hr  

Higher doses may be administered for severe infection; not to exceed 4 g/day

Renal Impairment

CrCl <10 mL/min: Administer 50-75% of usual dose

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Interactions

Interaction Checker

erythromycin lactobionate and

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

            QT prolongation

            Venous irritation

            Ventricular arrhythmias

            <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 w/ 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; discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur

            Ventricular arrhythmias

            Associated with QT prolongation and infrequent cases of arrhythmia

            May increase LFTs in pregnant women

            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

            Peak Plasma Time: 2 hr (base)

            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: 1.4 hr

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

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            Administration

            IV Compatibilities

            Solution: 0.9% NaCl

            Additive: Ampicillin, cimetidine, diphenhydramine, hydrocortisone, lidocaine, penicillin G potassium, pentobarbital, KCl, prochlorperazine, ranitidine, Na bicarb, verapamil

            Y-site (partial list): Acyclovir, amiodarone, diltiazem, esmolol, heparin, hydromorphone, labetalol, lorazepam, meperidine, morphine, tacrolimus, aminB/C, zidovudine

            IV Incompatibilities

            Solution (usually 10-15% decomposition): D5/LR, D5/NS, D5W (?), Normosol M, Normosol R, LR, Ringer's

            Additive: Aminophylline, ascorbic acid (may be conc-dependent), heparin, vitamin B/C

            Syringe: Ampicillin, heparin

            Not spec: Carbenicillin, cefazolin, epinephrine, tetracycline

            IV Preparation

            Infusion: Reconstitute 250 or 500 mg vials with 10 mL SWI without preservatives; 1 g vials with 20 mL

            Intermittent infusion: Dilute 250-500 mg in 100-250 mL D5W or 0.9% NaCl

            Continuous infusion: Final concentration of 1 g/L

            IV Administration

            Intermittent Infusion: Over 20-60 min

            Continuous Infusion: Over 6-24 hr

            Storage

            Store at controlled room temperature

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            Images

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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
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