Absorption: Variable absorption from the duodenum after oral administration (dependent on salt form). Absorption of enteric-coated products is delayed. Minimal absorption may follow topical or ophthalmic use.
Concurrent use with pimozide may ↑ levels and the risk for serious arrhythmias (concurrent use contraindicated); similar effects may occur with diltiazem, verapamil, ketoconazole, itraconazole, nefazodone, and protease inhibitors ; avoid concurrent use.
250 mg of erythromycin base or stearate = 400 mg of erythromycin ethylsuccinate
Most Infections
PO (Adults): Base, stearate– 250 mg every 6 hr, or 333 mg every 8 hr, or 500 mg every 12 hr. Ethylsuccinate– 400 mg every 6 hr or 800 mg every 12 hr.
PO (Children >1 mo): Base and ethylsuccinate– 30–50 mg/kg/day divided every 6–8 hr (max = 2 g/day as base or 3.2 g/day as ethylsuccinate). Stearate– 30–50 mg/kg/day divided every 6 hr (max = 2 g/day).
PO (Neonates ): Ethylsuccinate– 20–50 mg/kg/day divided every 6–12 hr.
IV (Adults): 250–500 mg (up to 1 g) every 6 hr.
IV (Children >1 mo): 15–50 mg/kg/day divided every 6 hr (max = 4 g/day).
Acne
Topical (Adults and Children >12 yr): 2% gel, solution, or pledgets twice daily.
Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before receiving results.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of Clostridioides difficile-associated diarrhea (CDAD). May begin up to several wk following cessation of therapy.
Lab Test Considerations:
Monitor liver function tests periodically on patients receiving high-dose, long-term therapy.
May cause ↑ serum bilirubin, AST, ALT, and alkaline phosphatase concentrations.
PO Administer around the clock. Erythromycin film-coated tablets (base and stearate) are absorbed better on an empty stomach, at least 1 hr before or 2 hr after meals; may be taken with food if GI irritation occurs. Enteric-coated erythromycin (base) may be taken without regard to meals. Erythromycin ethylsuccinate is best absorbed when taken with meals. Take each dose with a full glass of water.
Use calibrated measuring device for liquid preparations. Shake well before using.
Do not crush or chew delayed-release capsules or tablets; swallow whole. Erythromycin base delayed-release capsules may be opened and sprinkled on applesauce, jelly, or ice cream immediately before ingestion. Entire contents of the capsule should be taken.
Topical Cleanse area before application. Wear gloves during application.
IV Add 10 mL of sterile water for injection without preservatives to 250- or 500-mg vials and 20 mL to 1-g vial. Solution is stable for 7 days after reconstitution if refrigerated.
Intermittent Infusion: Dilution: Dilute in 0.9% NaCl or D5W. Concentration: 1–5 mg/mL.
Rate: Administer slowly over 20–60 min to avoid phlebitis. Assess for pain along vein; slow rate if pain occurs; apply ice and notify health care professional if unable to relieve pain.
Continuous Infusion: May also be administered as an infusion over 4 hr. Dilution: 0.9% NaCl, D5W, or LR. Concentration: 1 g/L.
Instruct patient to take medication around the clock and to finish the drug completely as directed, even if feeling better. Take missed doses as soon as remembered, with remaining doses evenly spaced throughout day. Advise patient that sharing of this medication may be dangerous.
May cause nausea, vomiting, diarrhea, or stomach cramps; notify health care professional if these effects persist or if severe abdominal pain, yellow discoloration of the skin or eyes, darkened urine, pale stools, or unusual tiredness develops. May cause infantile hypertrophic pyloric stenosis in infants; notify health care professional if vomiting and irritability occur.
Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several wk after discontinuation of medication.
Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools).
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected, or if breast feeding.
Instruct patient to notify health care professional if symptoms do not improve.