ERYTHROMYCINS (Systemic)

Some commonly used brand names are:

In the U.S.?

• E-Base ¹
• E-Mycin ¹
• ERYC ¹
• Ery-Tab ¹
• E.E.S. ³
• EryPed ³
• Erythro ³
• Erythrocin ⁶
• Erythrocot ⁶
• Ilotycin ¹
• Ilosone ²
• My-E ⁶
• PCE ¹
• Wintrocin ⁶

In Canada?

• Apo-Erythro ¹
• Apo-Erythro E-C ¹
• Apo-Erythro-ES ³
• Apo-Erythro-S ⁶
• E-Mycin ¹
• E.E.S. ³
• Erybid ¹
• EryPed ³
• ERYC-250 ¹
• ERYC-333 ¹
• Erythrocin ⁵
• Erythrocin ⁶
• Erythromid ¹
• Ilosone ²
• Ilotycin ⁴
• Novo-rythro ²
• Novo-rythro ⁶
• Novo-rythro Encap ¹
• PCE ¹

Category

• Antiacne agent, systemic?Erythromycin Base; Erythromycin Estolate; Erythromycin Ethylsuccinate; Erythromycin Stearate
• Antibacterial,systemic?Erythromycin Base; Erythromycin Estolate; Erythromycin Ethylsuccinate; ErythromycinGluceptate; Erythromycin Lactobionate; Erythromycin Stearate
• Bowelpreparation, preoperative, adjunct?ErythromycinBase

Description

Erythromycins (eh-rith-roe-MYE-sins) are used to treat many kinds of infections. Erythromycinsare also used to prevent ''strep'' infections in patients with a history ofrheumatic heart disease who may be allergic to penicillin.

These medicines may also be used to treat Legionnaires' disease and forother problems as determined by your doctor. They will not work for colds,flu, or other virus infections.

Erythromycins are available only with your doctor's prescription, in thefollowing dosage forms:

Oral
• Erythromycin Base
  • Delayed-release capsules (U.S. and Canada)
  • Delayed-release tablets (U.S. and Canada)
  • Tablets (U.S. and Canada)
• Erythromycin Estolate
  • Capsules (U.S. and Canada)
  • Oral suspension (U.S. and Canada)
  • Tablets (U.S. and Canada)
• Erythromycin Ethylsuccinate
  • Chewable tablets (U.S. and Canada)
  • Oral suspension (U.S. and Canada)
  • Tablets (U.S. and Canada)
• Erythromycin Stearate
  • Oral suspension (Canada)
  • Tablets (U.S. and Canada)

Parenteral
• Erythromycin Gluceptate
  • Injection (U.S. and Canada)
• Erythromycin Lactobionate
  • Injection (U.S. and Canada)

Before Using This Medicine

In deciding to use a medicine,the risks of taking the medicine must be weighed against the good it willdo. This is a decision you and your doctor will make. For erythromycins, thefollowing should be considered:

Allergies?Tell your doctor if you have ever had any unusual orallergic reaction to erythromycins, or any related medicines, such as azithromycinor clarithromycin. Also tell your health care professional if you are allergicto any other substances, such as foods, preservatives, or dyes.

Pregnancy?Erythromycin estolate has caused side effects involvingthe liver in some pregnant women. However, none of the erythromycins has beenshown to cause birth defects or other problems in human babies.

Breast-feeding?Erythromycins pass into the breast milk. However,erythromycins have not been shown to cause problems in nursing babies.

Children?This medicine has been tested in children and, ineffective doses, has not been shown to cause different side effects or problemsin children than it does in adults.

Older adults?This medicine has been tested and has not been shownto cause different side effects or problems in older people than it does inyounger adults. However, older adults may be at increased risk of hearingloss, especially if they are taking high doses of erythromycin and/or havekidney or liver disease.

Other medicines?Although certain medicines should not be usedtogether at all, in other cases two different medicines may be used togethereven if an interaction might occur. In these cases, your doctor may want tochange the dose, or other precautions may be necessary. When you are takingor receiving erythromycins, it is especially important that your health careprofessional know if you are taking any of the following:

• Acetaminophen (e.g., Tylenol) (with long-term, high-dose use) or
• Amiodarone (e.g., Cordarone) or
• Anabolic steroids (nandrolone [e.g., Anabolin], oxandrolone [e.g.,Anavar], oxymetholone [e.g., Anadrol], stanozolol [e.g., Winstrol]) or
• Androgens (male hormones) or
• Antithyroid agents (medicine for overactive thyroid) or
• Carmustine (e.g., BiCNU) or
• Chloroquine (e.g., Aralen) or
• Dantrolene (e.g., Dantrium) or
• Daunorubicin (e.g., Cerubidine) or
• Disulfiram (e.g., Antabuse) or
• Divalproex (e.g., Depakote) or
• Estrogens (female hormones) or
• Etretinate (e.g., Tegison) or
• Gold salts (medicine for arthritis) or
• Hydroxychloroquine (e.g., Plaquenil) or
• Mercaptopurine (e.g., Purinethol) or
• Methotrexate (e.g., Mexate) or
• Methyldopa (e.g., Aldomet) or
• Naltrexone (e.g., Trexan) (with long-term, high-dose use) or
• Oral contraceptives (birth control pills) containing estrogen or
• Other anti-infectives by mouth or by injection (medicine for infection)or
• Phenothiazines (acetophenazine [e.g., Tindal], chlorpromazine [e.g.,Thorazine], fluphenazine [e.g., Prolixin], mesoridazine [e.g., Serentil],perphenazine [e.g., Trilafon], prochlorperazine [e.g., Compazine], promazine[e.g., Sparine], promethazine [e.g., Phenergan], thioridazine [e.g., Mellaril],trifluoperazine [e.g., Stelazine], triflupromazine [e.g., Vesprin], trimeprazine[e.g., Temaril]) or
• Phenytoin (e.g., Dilantin) or
• Plicamycin (e.g., Mithracin) or
• Valproic acid (e.g., Depakene)?Use of these medicines witherythromycins, especially erythromycin estolate, may increase the chance ofliver problems

• Aminophylline (e.g., Somophyllin) or
• Caffeine (e.g., NoDoz) or
• Oxtriphylline (e.g., Choledyl) or
• Theophylline (e.g., Somophyllin-T, Theo-Dur)?Use of these medicineswith erythromycins may increase the chance of side effects from aminophylline,caffeine, oxtriphylline, or theophylline

• Astemizole (e.g., Hismanal) or
• Terfenadine (e.g., Seldane)?Use of astemizole or terfenadinewith erythromycins may cause heart problems, such as an irregular heartbeat;these medicines should not be used together

• Carbamazepine (e.g., Tegretol)?Use of carbamazepine with erythromycinmay increase the side effects of carbamazepine or increase the chance of liverproblems

• Chloramphenicol (e.g., Chloromycetin) or
• Clindamycin (e.g., Cleocin) or
• Lincomycin (e.g., Lincocin)?Use of these medicines with erythromycinsmay decrease the effectiveness of these other antibiotics

• Cyclosporine (e.g., Sandimmune) or
• Warfarin (e.g., Coumadin)?Use of any of these medicines witherythromycins may increase the side effects of these medicines

Other medical problems?The presence of other medicalproblems may affect the use of erythromycins. Make sure you tell your doctorif you have any other medical problems, especially:

• Heart disease?High doses of erythromycin may increase the chanceof side effects in patients with a history of an irregular heartbeat

• Liver disease?Erythromycins, especially erythromycin estolate,may increase the chance of side effects involving the liver

• Loss of hearing?High doses of erythromycins may, on rare occasion,cause hearing loss, especially if you have kidney or liver disease

Proper Use of This Medicine

Generally,erythromycins are best taken with a full glass (8 ounces) of water on an emptystomach (at least 1 hour before or 2 hours after meals). If stomach upsetoccurs, these medicines may be taken with food. If you have questions aboutthe erythromycin medicine you are taking, check with your health care professional.

For patients taking the oral liquid form ofthis medicine:

• This medicine is to be taken by mouth even if it comes in a dropperbottle. If this medicine does not come in a dropper bottle, use a speciallymarked measuring spoon or other device to measure each dose accurately. Theaverage household teaspoon may not hold the right amount of liquid.
• Do not use after the expiration date on the label. The medicine maynot work properly after that date. Check with your pharmacist if you haveany questions about this.

For patients taking the chewable tablet formof this medicine:

• Tablets must be chewed or crushed before they are swallowed.

For patients taking the delayed-release capsule form(with enteric-coated pellets) or the delayed-release tablet form ofthis medicine:

• Swallow capsules or tablets whole. Do not break or crush. If youare not sure about which type of capsule or tablet you are taking, check withyour pharmacist.

To help clear up your infection completely, keep takingthis medicine for the full time of treatment, even if you begin tofeel better after a few days. If you have a ''strep''infection, you should keep taking this medicine for at least 10 days. Thisis especially important in ''strep'' infections. Serious heart problems coulddevelop later if your infection is not cleared up completely. Also,if you stop taking this medicine too soon, your symptoms may return.

This medicine works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses.Also, it is best to take the doses at evenly spaced times day and night.For example, if you are to take 4 doses a day, the doses should be spacedabout 6 hours apart. If this interferes with your sleep or other daily activities,or if you need help in planning the best times to take your medicine, checkwith your health care professional.

Dosing?The dose of erythromycin will be differentfor different patients. Follow your doctor's orders orthe directions on the label. The following information includes onlythe average doses of erythromycin. If your dose is different,do not change it unless your doctor tells you to do so.

The number of capsules or tablets or teaspoonfuls of suspension that youtake depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, andthe length of time you take the medicine depend on the medical problem forwhich you are taking erythromycin.

For erythromycin base
• For oral dosage forms (capsules, tablets):
  • For treatment of infections:
    • Adults and teenagers?250 to 500 milligrams (mg) two to fourtimes a day.
    • Children?Dose is based on body weight. The usual dose is 7.5to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight fourtimes a day, or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weighttwo times a day.
  • For prevention of heart infections:
    • Adults and teenagers?Take 1 gram two hours before your dentalappointment or surgery, then 500 mg six hours after taking the first dose.
    • Children?Dose is based on body weight. The usual dose is 20mg per kg (9.1 mg per pound) of body weight two hours before the dental appointmentor surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hoursafter taking the first dose.

For erythromycin estolate
• For oral dosage forms (capsules, oralsuspension, tablets):
  • For treatment of infections:
    • Adults and teenagers?250 to 500 milligrams (mg) two to fourtimes a day.
    • Children?Dose is based on body weight. The usual dose is 7.5to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight fourtimes a day, or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weighttwo times a day.
  • For prevention of heart infections:
    • Adults and teenagers?Take 1 gram two hours before your dentalappointment or surgery, then 500 mg six hours after taking the first dose.
    • Children?Dose is based on body weight. The usual dose is 20mg per kg (9.1 mg per pound) of body weight two hours before the dental appointmentor surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hoursafter taking the first dose.

For erythromycin ethylsuccinate
• For oral dosage forms (oral suspension,tablets):
  • For treatment of infections:
    • Adults and teenagers?400 to 800 milligrams (mg) two to fourtimes a day.
    • Children?Dose is based on body weight. The usual dose is 7.5to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight fourtimes a day, or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weighttwo times a day.
  • For prevention of heart infections:
    • Adults and teenagers?Take 1.6 grams two hours before your dentalappointment or surgery, then 800 mg six hours after taking the first dose.
    • Children?Dose is based on body weight. The usual dose is 20mg per kg (9.1 mg per pound) of body weight two hours before the dental appointmentor surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hoursafter taking the first dose.

For erythromycin gluceptate
• For injection dosage forms:
  • For treatment of infections:
    • Adults and teenagers?250 to 500 milligrams (mg) injected intoa vein every six hours; or 3.75 to 5 mg per kilogram (kg) (1.7 to 2.3 mg perpound) of body weight injected into a vein every six hours.
    • Children?Dose is based on body weight. The usual dose is 3.75to 5 mg per kg (1.7 to 2.3 mg per pound) of body weight injected into a veinevery six hours.

For erythromycin lactobionate
• For injection dosage forms:
  • For treatment of infections:
    • Adults and teenagers?250 to 500 milligrams (mg) injected intoa vein every six hours; or 3.75 to 5 mg per kilogram (kg) (1.7 to 2.3 mg perpound) of body weight injected into a vein every six hours.
    • Children?Dose is based on body weight. The usual dose is 3.75to 5 mg per kg (1.7 to 2.3 mg per pound) of body weight injected into a veinevery six hours.

For erythromycin stearate
• For oral dosage forms (oral suspension,tablets):
  • For treatment of infections:
    • Adults and teenagers?250 to 500 milligrams (mg) two to fourtimes a day.
    • Children?Dose is based on body weight. The usual dose is 7.5to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight fourtimes a day; or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weighttwo times a day.
  • For prevention of heart infections:
    • Adults and teenagers?Take 1 gram two hours before your dentalappointment or surgery, then 500 mg six hours after taking the first dose.
    • Children?Dose is based on body weight. The usual dose is 20mg per kg (9.1 mg per pound) of body weight two hours before the dental appointmentor surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hoursafter taking the first dose.

Missed dose?If you miss a dose of this medicine, take it assoon as possible. This will help to keep a constant amount of medicine inthe blood. However, if it is almost time for your next dose, skip the misseddose and go back to your regular dosing schedule. Do not double doses.

Storage?To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store the capsule or tablet form of erythromycins in the bathroom,near the kitchen sink, or in other damp places. Heat or moisture may causethe medicine to break down.
• Store the oral liquid form of some erythromycins in the refrigeratorbecause heat will cause this medicine to break down. However, keep the medicinefrom freezing. Follow the directions on the label.
• Do not keep outdated medicine or medicine no longer needed. Be surethat any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

If yoursymptoms do not improve within a few days, or if they become worse, checkwith your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine maycause some unwanted effects. Although not all of these side effects may occur,if they do occur they may need medical attention.

Check with your doctor immediately if any ofthe following side effects occur:

Less common

Fever; nausea; skin rash, redness, or itching; stomach pain (severe); unusual tiredness or weakness; vomiting; yellow eyes or skin-with erythromycinestolate (rare with other erythromycins)

Less common?with erythromycin injection only

Pain, swelling, or redness at place of injection

Rare

Fainting (repeated); irregular or slowheartbeat; loss of hearing (temporary)

Other sideeffects may occur that usually do not need medical attention. These side effectsmay go away during treatment as your body adjusts to the medicine. However,check with your doctor if any of the following side effects continue or arebothersome:

More common

Abdominal or stomach cramping and discomfort; diarrhea; nausea or vomiting

Less common

Sore mouth or tongue; vaginal itchingand discharge

Other sideeffects not listed above may also occur in some patients. If you notice anyother effects, check with your doctor.

Additional Information

Once a medicine has been approvedfor marketing for a certain use, experience may show that it is also usefulfor other medical problems. Although these uses are not included in productlabeling, erythromycins are used in certain patients with the following medicalconditions:

• Acne
• Actinomycosis
• Anthrax
• Chancroid
• Gastroparesis
• Lyme disease
• Lymphogranuloma venereum
• Relapsing fever

Other than the above information, there is no additional information relatingto proper use, precautions, or side effects for these uses.