Erythromycin
Erythromycin
E.E.S., EryPed, Ery-Tab, PCE, Erythrocin (lactobionate IV); topical Erygel, Akne-Mycin; ophthalmic ointment
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Summary
Common uses
Atypical pneumonia (Mycoplasma, Legionella, Chlamydophila)0, Streptococcal pharyngitis (penicillin-allergic)0, Pertussis treatment and prophylaxis0, Inflammatory acne (topical)0, Gastroparesis (off-label, low-dose prokinetic)0, Neonatal ophthalmia prophylaxis (topical ointment)0
Pharmacy
Starting dose
250-500 mg PO QID; 7.5-12.5 mg/kg IV q6h; topical and ophthalmic per formulation
Preparations
250, 500 mg base or stearate tablets; ER tablets; ethyl succinate 200 mg/5 mL suspension; 500 mg, 1 g IV (lactobionate); 2% topical solution/gel; 0.5% ophthalmic ointment
US FDA Max
4 g/d (rarely tolerated due to GI effects)
Pharmacology
Routes
Oral, IV, topical, ophthalmic
Onset
Hours
Duration
6-8 hours
Half-life
~1.5-2 hours[1]
Bioavailability
~30-65% (oral; acid-labile, hence enteric-coated formulations; food affects absorption variably)[1]
Pregnancy
Generally considered safe; commonly used in pregnancy.[citation needed]
Legal status
OTC (ophthalmic ointment) and Rx-only (other forms) in US
Purported mechanism
Erythromycin reversibly binds the 23S rRNA of the bacterial 50S ribosomal subunit, blocking peptide chain translocation and inhibiting protein synthesis.0 The prokinetic effect is mechanistically distinct: erythromycin agonizes motilin receptors on GI smooth muscle, triggering migratory motor complexes — a property exploited in gastroparesis (often tachyphylactic). QT-interval prolongation and significant CYP3A4 inhibition (statins, calcineurin inhibitors, warfarin, theophylline) limit modern systemic use compared with azithromycin and clarithromycin[1].
References
- ↑ 1.0 1.1 1.2 FDA Prescribing Information, Ery-Tab (erythromycin), Arbor Pharmaceuticals, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050207s058lbl.pdf