Dosing & Uses
Dosing Form & Strengths
General Dosing Recommendations
250 mg PO q6hr, OR
500 mg PO q12hr (if daily dose does not exceed 1 g)
May increase up to 4 g/day depending on infection severity
500 mg PO q6hr for 10-14 days
1-4 g/day PO in divided doses for 21 days
Urethritis caused by C trachomatis or U urealyticum
500 mg PO q6hr for 7 days; alternatively 333 mg PO q8hr for 7 days
30-40 g PO in divided doses for 10-15 days
Dose adjustment not necessary
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
General Dosing Recommendations
Severe infection: 60-100 mg/kg/day PO divided q6-8hr
Not to exceed 4 g/day
Pneumonia of Infancy
50 mg/kg/day PO divided q6hr for at least 3 weeks
Serious - Use Alternative
Significant - Monitor Closely
Abdominal pain (8%)
Hypertrophic pyloric stenosis
Mild allergic reactions
Nervous system effects including seizures
Torsade de pointes
History of hepatitis caused by macrolide
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)
Risk of sudden death due to cardiac causes w/ concomitant use of oral erythromycin w/ 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
Pregnancy & Lactation
Pregnancy Category: B
Lactation: distributed in breast milk, use with caution; AAP categorizes as compatible with breastfeeding
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.
Mechanism of Action
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest
Oral: variable but better with salt forms than with base form
Peak Plasma Time: 4 hr (base)
Protein Bound: 75-80%
Crosses placenta; enters breast milk
Relative diffusion from blood into CSF: minimal even with inflammation
Via P450 enzyme CYP3A4
Enzymes inhibited: CYP1A2, CYP3A4
Half-Life: 1.4 hr
Excretion: Primarily feces; urine (2-15% as unchanged drug)
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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.
|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.|
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