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Erythromycin

J01F - Macrolides, lincosamides and streptogramins ATC J01FA01 Small molecule approved 1964 Oral Parenteral Topical Natural product

🧬 Cross-allergy: Macrolides

JFDA label: Rythromac suspension 200mg

Mechanism of Action

Inhibitor of Bacterial 70S ribosome — Bacterial 70S ribosome inhibitor

TargetActionGene / class
Bacterial 70S ribosome efficacy INHIBITOR

Indications

Approved

  • Acne Vulgaris — acne
  • Bacterial Infections — bacterial disease
  • Eye Infections — eye infection
  • Infections — infection
  • Whooping Cough — whooping cough

Off-label

  • Bulimia Nervosa
  • Carcinoma, Non-Small-Cell Lung
  • Chlamydia Infections
  • Colorectal Neoplasms
  • Epidermolysis Bullosa
  • Feeding and Eating Disorders
  • Gastrointestinal Hemorrhage
  • Gastroparesis
  • HIV Infections
  • Hematemesis
  • Pneumonia
  • Pulmonary Disease, Chronic Obstructive
  • Stomach Neoplasms

Antimicrobial Spectrum

Expected / intrinsic spectrum (EUCAST breakpoints & labels) — not local resistance. Source: EUCAST v16 · curated · openfda-label.

Bacteria

OrganismActivityMIC
Bacillus spp. Susceptible 0.5 mg/L
Campylobacter jejuni/coli Susceptible 4.0 mg/L
Chlamydia trachomatis Active
Entamoeba histolytica Active
Haemophilus influenzae Active
Legionella pneumophila Active
Listeria monocytogenes Active
Moraxella catarrhalis Susceptible 0.25 mg/L
Mycoplasma pneumoniae Susceptible 0.5 mg/L
Neisseria gonorrhoeae Active
Staphylococcus aureus Active
Staphylococcus spp. Susceptible 11.0 mg/L
Streptococcus A/B/C/G Susceptible 0.251 mg/L
Streptococcus pneumoniae Susceptible 0.25 mg/L
Streptococcus pneumoniae Susceptible 0.251 mg/L
Streptococcus pyogenes Susceptible 0.25 mg/L
Treponema pallidum Active
Campylobacter jejuni/coli Resistant 8.0 mg/L
Streptococcus pneumoniae Resistant 1.0 mg/L
Streptococcus pyogenes Resistant 1.0 mg/L

Class profile

gramStatusGram+
spectrumBreadthModerate
atypicalCoverageYes
isBactericidal0
moaCategoryProtein synthesis inhibitor (50S ribosomal, 23S rRNA)
pdIndexTime-dependent
postAntibioticEffectShort
mrsaCoverage0
resistanceMechanismsTarget site methylation (erm genes),Active efflux (mef genes),Ribosomal mutation

Contraindications

Source: openFDA

  • Erythromycin is contraindicated in patients with known hypersensitivity to this antibiotic. Erythromycin is contraindicated in patients taking terfenadine, astemizole, cisapride, pimozide, ergotamine, or dihydroergotamine. (See PRECAUTIONS – Drug Interactions. ) Do not use erythromycin concomitantly with HMG CoA reductase inhibitors (statins) that are extensively metabolized by CYP3A4 (lovastatin or simvastatin), due to the increased risk of myopathy, including rhabdomyolysis. Absolute

Adverse Reactions

Very Common >10%Common 1–10%Uncommon 0.1–1% Rare 0.01–0.1%Very Rare <0.01%Not Known

Skin and subcutaneous tissue disorders (2)

Not Known Erythema · Itching

General disorders and administration site conditions (1)

Not Known Dryness

Dosing

Source: openFDA

In most patients, erythromycin delayed-release tablets, are well absorbed and may be dosed orally without regard to meals. However, optimal blood levels are obtained when erythromycin delayed-release tablets, 250 mg, erythromycin delayed-release tablets, 333 mg and erythromycin delayed-release tablets, 500 mg tablets are given in the fasting state (at least 1/2 hour and preferably 2 hours before meals). Adults The usual dose is 250 mg four times daily in equally spaced doses. The 333 mg tablet is recommended if dosage is desired every 8 hours. If twice-a-day dosage is desired, the recommended dose is 500 mg every 12 hours. Dosage may be increased up to 4 g per day according to the severity of the infection. However, twice-a-day dosing is not recommended when doses larger than 1 g daily are administered. Children Age, weight, and severity of the infection are important factors in determining the proper dosage. The usual dosage is 30 to 50 mg/kg/day, in equally divided doses. For more severe infections, this dose may be doubled but should not exceed 4 g per day. In the treatment of streptococcal infections of the upper respiratory tract (e.g., tonsillitis or pharyngitis), the therapeutic dosage of erythromycin should be administered for at least ten days. The American Heart Association suggests a dosage of 250 mg of erythromycin orally, twice a day in long-term prophylaxis of streptococcal upper respiratory tract infections for the prevention of recurring attacks of rheumatic fever in patients allergic to penicillin and sulfonamides.1 Conjunctivitis of the Newborn Caused by Chlamydia trachomatis Oral erythromycin suspension 50 mg/kg/day in 4 divided doses for at least 2 weeks. 3 Pneumonia of Infancy Caused by Chlamydia trachomatis Although the optimal duration of therapy has not been established, the recommended therapy is oral erythromycin suspension 50 mg/kg/day in 4 divided doses for at least 3 weeks. Urogenital Infections During Pregnancy Due to Chlamydia trachomatis Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of erythromycin by mouth four times a day or two erythromycin 333 mg tablets orally every 8 hours on an empty stomach for at least 7 days. For women who cannot tolerate this regimen, a decreased dose of one erythromycin 500 mg tablet orally every 12 hours, one 333 mg tablet orally every 8 hours or 250 mg by mouth four times a day should be used for at least 14 days. 3 For adults with uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis, when tetracycline is contraindicated or not tolerated 500 mg of erythromycin by mouth four times a day or two 333 mg tablets orally every 8 hours for at least 7 days. 3 For patients with nongonococcal urethritis caused by Ureaplasma urealyticum when tetracycline is contraindicated or not tolerated 500 mg of erythromycin by mouth four times a day or two 333 mg tablets orally every 8 hours for at least seven days. 3 Primary Syphilis 30 to 40 g given in divided doses over a period of 10 to 15 days. Acute Pelvic Inflammatory Disease Caused by N. Gonorrhoeae 500 mg Erythrocin Lactobionate-I.V. (erythromycin lactobionate for injection, USP) every 6 hours for 3 days, followed by 500 mg of erythromycin base orally every 12 hours, or 333 mg of erythromycin base orally every 8 hours for 7 days. Intestinal Amebiasis Adults 500 mg every 12 hours, 333 mg every 8 hours or 250 mg every 6 hours for 10 to 14 days. Children 30 to 50 mg/kg/day in divided doses for 10 to 14 days. Pertussis Although optimal dosage and duration have not been established, doses of erythromycin utilized in reported clinical studies were 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days. Legionnaires' Disease Although optimal dosage has not been established, doses utilized in reported clinical data were 1 to 4 g daily in divided doses. Preoperative Prophylaxis for Elective Colorectal Surgery Listed below is an exam

Warnings & Precautions

Source: openFDA

Warnings & Precautions

Hepatotoxicity There have been reports of hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice, occurring in patients receiving oral erythromycin products. QT Prolongation Erythromycin has been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Cases of torsades de pointes have been spontaneously reported during postmarketing surveillance in patients receiving erythromycin. Fatalities have been reported. Erythromycin should be avoided in patients with known prolongation of the QT interval, patients with ongoing proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, and in patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents. Elderly patients may be more susceptible to drug-associated effects on the QT interval. Syphilis in Pregnancy There have been reports suggesting that erythromycin does not reach the fetus in adequate concentration to prevent congenital syphilis. Infants born to women treated during pregnancy with oral erythromycin for early syphilis should be treated with an appropriate penicillin regimen. Clostridium difficile Associated Diarrhea Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including erythromycin delayed-release tablets, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile . C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile , and surgical evaluation should be instituted as clinically indicated. Drug Interactions Serious adverse reactions have been reported in p

Pregnancy & Lactation

Pregnancy

Lactation

Probably Compatible Hale L2

Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.

LactMed: monitor the infant.

Monitoring

EfficacyCulture and susceptibility testing; clinical resolution (temperature, WBC, CRP, procalcitonin)
ToxicityRenal function (dose adjustment in renal impairment); hepatic function for hepatically cleared agents; signs of C. difficile infection (diarrhoea)
Clinical pearlCulture results guide de-escalation to narrower-spectrum therapy. Review antibiotic appropriateness at 48–72 h (antimicrobial stewardship).
CounselingComplete the full course. Report persistent diarrhoea, rash, or lack of improvement after 48–72 h.

Chemistry & Properties

2D structure
FormulaC37H67NO13
Molecular weight733.94 g/mol
IUPAC name(3R,4S,5S,6R,7R,9R,11R,12R,13S,14R)-6-[(2S,3R,4S,6R)-4-(dimethylamino)-3-hydroxy-6-methyloxan-2-yl]oxy-14-ethyl-7,12,13-trihydroxy-4-[(2R,4R,5S,6S)-5-hydroxy-4-methoxy-4,6-dimethyloxan-2-yl]oxy-3,5,7,9,11,13-hexamethyl-oxacyclotetradecane-2,10-dione
CAS114-07-8
PubChem CID12560
InChIKeyULGZDMOVFRHVEP-RWJQBGPGSA-N
logP1.79 (XLogP 2.7)
Polar surface area193.91 Ų
H-bond acceptors / donors14 / 5
Drug-likeness (QED)0.24
Lipinski violations2
SMILESCC[C@H]1OC(=O)[C@H](C)[C@@H](O[C@H]2C[C@@](C)(OC)[C@@H](O)[C@H](C)O2)[C@H](C)[C@@H](O[C@@H]2O[C@H](C)C[C@H](N(C)C)[C@H]2O)[C@](C)(O)C[C@@H](C)C(=O)[C@H](C)[C@@H](O)[C@]1(C)O

Biology & Pharmacokinetics

Pharmacokinetics

BBB penetrantNo

Enzyme interactions

EnzymeRoleDetail
CYP2B6Inhibitor
CYP2C19Substrate
CYP3A4Substrate IC₅₀ 2.2838822745859857 µM

Receptor binding (top 1)

TargetActionAffinity
Motilin Binding pKi 6.2

Transporters

BCRP (Inhibitor)BCRP (Inhibitor)BSEP (Inhibitor)BSEP (Inhibitor)MATE1 (Inhibitor)MDR1 (Inhibitor)MRP (Inhibitor)MRP1 (Inhibitor)MRP1 (Inhibitor)MRP2 (Inhibitor)MRP3 (Inhibitor)MRP4 (Inhibitor)OAT2 (Inhibitor)OATP (Inhibitor)OATP1A2 (Inhibitor)OATP1B1 (Inhibitor)OATP1B1 (Inhibitor)OATP1B3 (Inhibitor)OATP1B3 (Inhibitor)OATP2B1 (Inhibitor)OCT1 (Inhibitor)OCTN2 (Inhibitor)P-gp (Inhibitor)BCRP (Substrate)BSEP (Substrate)MDR1 (Substrate)MRP2 (Substrate)OAT2 (Substrate)OATP1A2 (Substrate)OATP1B1 (Substrate)P-gp (Substrate)Transporter(unspecified) (Substrate)

Drug–drug interactions (100+, DDInter)

Interacting drugSeverityManagement
Acalabrutinib major
Alfentanil major
Alfuzosin major
Amiodarone major
Amisulpride major
Amprenavir major
Anagrelide major
Anisindione major
Arsenic trioxide major
Artemether major
Astemizole major
Atorvastatin major
Avanafil major
Avapritinib major
Axitinib major
Bedaquiline major
Benzhydrocodone major
Bepridil major
Berotralstat major
Betrixaban major
Boceprevir major
Bosutinib major
Brexpiprazole major
Brigatinib major
Butorphanol major
Cabergoline major
Cabozantinib major
Carbamazepine major
Ceritinib major
Cerivastatin major
Chloroquine major
Cilostazol major
Cisapride major
Citalopram major
Clarithromycin major
Cobicistat major
Cobimetinib major
Colchicine major
Conivaptan major
Crizotinib major

Showing 40 of 100+.

Registered Products (17)

BrandForm / strengthPackAgentCitizen (JOD)
Erocin Eye Ointment Ointment 0.5 % 5 g tube Amman Pharmaceutical Indusries 1.250
AKNE-MYCIN OINTMENT Ointment 2 % 10 g tube pack varies Reda Jardaneh Drug Store 1.400
ERYTHRODAR 200 G.F.SUSP. Suspension 200 mg/5 ml 100 ml Dar Al Dawa Development and Investment Co Ltd/Jordan 1.400
Rythromac suspension Suspension 200 mg/5 ml 100 ml AL-RAM PHARMA.INDUS.CO.LTD/JORDAN 1.400
Oftalmolosa Cusi Erythromycin E/O Cream 0.5 % 3.5 g tube Jarzeem Drug Store 1.620
Rythromac -200mg tablets Tablet 200 mg 20 tab AL-RAM PHARMA.INDUS.CO.LTD/JORDAN 1.700
Erythrodar 250 Tabs Tablet (as ethylsuccinate)250 mg 20 tab pack varies Dar Al Dawa Development and Investment Co Ltd/Jordan 1.790
Erythrodar Forte Tablet Tablet (as Ethylsuccinate)400 mg 16 tab pack varies Dar Al Dawa Development and Investment Co Ltd/Jordan 1.910
Rythromac-400 mg tablets Tablet 400 mg 16 tab AL-RAM PHARMA.INDUS.CO.LTD/JORDAN 1.910
Erythrodar Forte Tablet Tablet (as Ethylsuccinate)400 mg 20 tab pack varies Dar Al Dawa Development and Investment Co Ltd/Jordan 2.380
AKNE-MYCIN SOLUTION Solution 2 % 25 ml pack varies Reda Jardaneh Drug Store 3.490
AKNE-MYCIN EMULSION Emulsion 1 % 25 g Reda Jardaneh Drug Store 4.080
Spotex Cream 4 % 30 g tube PELLA PHARMACEUTICALS CO.LTD/JORDAN 5.310
Rythiderm Lotion Lotion 40 mg/ml, 12 mg/ml 30 ml Hikma Pharmaceuticals Co.Ltd/Jordan 6.180
Zineryt Lotion Lotion 40 mg/ml, 12 mg/ml 30 ml Shawi & Rushedat Drug Store 8.230
Erythrodar 250 Tabs Tablet (as ethylsuccinate)250 mg 500 tab pack varies Dar Al Dawa Development and Investment Co Ltd/Jordan 29.700
Erythrodar Forte Tablet Tablet (as Ethylsuccinate)400 mg 500 tab pack varies Dar Al Dawa Development and Investment Co Ltd/Jordan 37.540