Eryped (erythromycin ethylsuccinate) Antibiotic Uses & Side Effects

What is Eryped (erythromycin ethylsuccinate)?

E.E.S. (erythromycin ethylsuccinate) is indicated in the treatment of infections caused by susceptible strains
of the designated organisms in the diseases listed below

Upper respiratory tract infections of mild to moderate degree caused by
Streptococcus
pyogenes, Streptococcus pneumoniae, or Haemophilus influenzae
(when used concomitantly with adequate doses of sulfonamides, since many
strains of H. influenzae are not susceptible to the erythromycin concentrations
ordinarily achieved). (See appropriate sulfonamide labeling for prescribing
information.)
Lower-respiratory tract infections of mild to moderate severity caused by
Streptococcus
pneumoniae or Streptococcus pyogenes.
Listeriosis caused by Listeria monocytogenes.
Pertussis (whooping cough) caused by Bordetella pertussis. Erythromycin
is effective in eliminating the organism from the nasopharynx of infected individuals
rendering them noninfectious. Some clinical studies suggest that erythromycin
may be helpful in the prophylaxis of pertussis in exposed susceptible individuals.
Respiratory tract infections due to Mycoplasma pneumoniae.
Skin and skin structure infections of mild to moderate severity caused by
Streptococcus
pyogenes or Staphylococcus aureus (resistant staphylococci may emerge
during treatment).
Diphtheria: Infections due to Corynebacterium diphtheriae , as an adjunct
to antitoxin, to prevent establishment of carriers and to eradicate the organism
in carriers.
Erythrasma: In the treatment of infections due to Corynebacterium minutissimum.
Intestinal amebiasis caused by Entamoeba histolytica (oral erythromycins
only). Extraenteric amebiasis requires treatment with other agents.
Acute pelvic inflammatory disease caused by Neisseria gonorrhoeae: As
an alternative drug in treatment of acute pelvic inflammatory disease caused
by N. gonorrhoeae in female patients with a history of sensitivity to
penicillin. Patients should have a serologic test for syphilis before receiving
erythromycin as treatment of gonorrhea and a follow-up serologic test for syphilis
after 3 months.
Syphilis caused by Treponema pallidum: Erythromycin is an alternate
choice of treatment for primary syphilis in patients allergic to the penicillins.
In treatment of primary syphilis, spinal fluid examinations should be done before
treatment and as part of follow-up after therapy.
Erythromycins are indicated for the treatment of the following infections caused
by Chlamydia trachomatis:
- conjunctivitis of the newborn,
- pneumonia of
  infancy, and
- urogenital infections during pregnancy.
- When tetracyclines are
  contraindicated or not tolerated, erythromycin is indicated for the treatment
  of uncomplicated urethral, endocervical, or rectal infections in adults due
  to Chlamydia trachomatis.
When tetracyclines are contraindicated or not tolerated, erythromycin is indicated
for the treatment of nongonococcal urethritis caused by Ureaplasma urealyticum.
Legionnaires’ Disease caused by Legionella pneumophila.
- Although no
  controlled clinical efficacy studies have been conducted, in vitro and
  limited preliminary clinical data suggest that erythromycin may be effective
  in treating Legionnaires’ Disease.

Prophylaxis

Prevention of Initial Attacks of Rheumatic Fever

Penicillin is considered by the American Heart Association to be the drug of
choice in the prevention of initial attacks of rheumatic fever (treatment of
Streptococcus pyogenes infections of the upper respiratory tract, e.g.,
tonsillitis or pharyngitis). Erythromycin is indicated for the treatment of
penicillin-allergic patients.³ The therapeutic dose should be administered
for 10 days.

Prevention of Recurrent Attacks of Rheumatic Fever

Penicillin or sulfonamides are considered by the American Heart Association
to be the drugs of choice in the prevention of recurrent attacks of rheumatic
fever. In patients who are allergic to penicillin and sulfonamides, oral erythromycin
is recommended by the American Heart Association in the long-term prophylaxis
of streptococcal pharyngitis (for the prevention of recurrent attacks of rheumatic
fever).³

What are the side effects of Eryped?

The most frequent side effects of oral erythromycin preparations are
gastrointestinal and are dose-related. They include nausea, vomiting, abdominal
pain, diarrhea and anorexia. Symptoms of hepatitis, hepatic dysfunction and/or
abnormal liver function test results may occur.

Onset of pseudomembranous colitis symptoms may occur during or after
antibiotic treatment.

Erythromycin has been associated with QT prolongation and ventricular arrhythmias,
including ventricular tachycardia and torsades de pointes.

Allergic reactions ranging from urticaria to anaphylaxis have occurred. Skin
reactions ranging from mild eruptions to erythema multiforme, Stevens- (erythromycin ethylsuccinate) Johnson
syndrome, and toxic epidermal necrolysis have been reported rarely.

There have been rare reports of pancreatitis and convulsions.

There have been isolated reports of reversible hearing loss occurring chiefly
in patients with renal insufficiency and in patients receiving high doses of
erythromycin.

What is the dosage for Eryped?

Erythromycin ethylsuccinate suspensions and Filmtab tablets may be administered
without regard to meals.

Children

Age, weight, and severity of the infection are important factors in determining
the proper dosage. In mild to moderate infections the usual dosage of erythromycin
ethylsuccinate for children is 30 to 50 mg/kg/day in equally divided doses every
6 hours. For more severe infections this dosage may be doubled. If twice-a-day
dosage is desired, one-half of the total daily dose may be given every 12 hours.
Doses may also be given three times daily by administering one-third of the
total daily dose every 8 hours.

The following dosage schedule is suggested for mild to moderate infections:

Body Weight
Total Daily Dose

Under 10 lbs
30-50 mg/kg/day
15-25 mg/kg/q 12 h

10 to 15 lbs
200 mg

16 to 25 lbs
400 mg

26 to 50 lbs
800 mg

51 to 100 lbs
1200 mg

over 100 lbs
1600 mg

Adults

400 mg erythromycin ethylsuccinate every 6 hours is the usual dose. Dosage
may be increased up to 4 g per day according to the severity of the infection.
If twice-a-day dosage is desired, one-half of the total daily dose may be given
every 12 hours. Doses may also be given three times daily by administering one-third
of the total daily dose every 8 hours.

For adult dosage calculation, use a ratio of 400 mg of erythromycin activity
as the ethylsuccinate to 250 mg of erythromycin activity as the stearate, base
or estolate.

In the treatment of streptococcal infections, a therapeutic dosage of erythromycin
ethylsuccinate should be administered for at least 10 days. In continuous prophylaxis
against recurrences of streptococcal infections in persons with a history of
rheumatic heart disease, the usual dosage is 400 mg twice a day.

For Treatment of Urethritis Due to C. trachomatis or U. urealyticum

800 mg three times a day for 7 days.

For Treatment of Primary Syphilis

Adults: 48 to 64 g given in divided doses over a period of 10 to 15 days.

For Intestinal Amebiasis

Adults

400 mg four times daily for 10 to 14 days.

Children

30 to 50 mg/kg/day in divided doses for 10 to 14 days.

For Use in 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.

For Treatment of Legionnaires’ Disease

Although optimal doses have not been established, doses utilized in reported
clinical data were those recommended above (1.6 to 4 g daily in divided doses.)

QUESTION

Bowel regularity means a bowel movement every day.
See Answer

What drugs interact with Eryped?

Erythromycin use in patients who are receiving high doses of theophylline may
be associated with an increase in serum theophylline levels (erythromycin ethylsuccinate) and potential theophylline
toxicity. In case of theophylline toxicity and/or elevated serum theophylline
levels, (erythromycin ethylsuccinate) the dose of theophylline should be reduced while the patient is receiving
concomitant erythromycin therapy.

Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients
receiving concurrent verapamil, belonging to the calcium channel blockers drug
class.

Concomitant administration of erythromycin and digoxin has been reported to
result in elevated digoxin serum levels. (erythromycin ethylsuccinate)

There have been reports of increased anticoagulant effects when erythromycin
and oral anticoagulants were used concomitantly. Increased anticoagulation effects
due to interactions of erythromycin with various oral anticoagulants may be
more pronounced in the elderly.

Erythromycin is a substrate and inhibitor of the 3A isoform subfamily of the
cytochrome p450 enzyme system (CYP3A). Coadministration of erythromycin and
a drug primarily metabolized tions. Interactions with other drugs metabolized
by the CYP3A isoform are also possible. The following CYP3A based drug interactions
have been observed with erythromycin products in post-marketing experience:

Ergotamine/dihydroergotamine

Concurrent use of erythromycin and ergotamine or dihydroergotamine has been
associated in some patients with acute ergot toxicity characterized by severe
peripheral vasospasm and dysesthesia.

Triazolobenzodiazepines (such as triazolam and alprazolam) and related benzodiazepines

Erythromycin has been reported to decrease the clearance of triazolam and midazolam,
and thus, may increase the pharmacologic effect of these benzodiazepines.

HMG-CoA Reductase Inhibitors

Erythromycin has been reported to increase concentrations of HMG-CoA reductase
inhibitors (e.g., lovastatin and simvastatin). Rare reports of rhabdomyolysis
have been reported in patients taking these drugs concomitantly.

Sildenafil (Viagra)

Erythromycin has been reported to increase the systemic exposure (AUC) of sildenafil.
Reduction of sildenafil dosage should be considered. (See Viagra package insert.)

There have been spontaneous or published reports of CYP3A based interactions
of erythromycin with cyclosporine, carbamazepine, tacrolimus, alfentanil, disopyramide,
rifabutin, quinidine, methylprednisolone, cilostazol, vinblastine, and bromocriptine.

Concomitant administration of erythromycin with cisapride, pimozide,
astemizole, or terfenadine is contraindicated.

In addition, there have been reports of interactions of erythromycin with drugs
not thought to be metabolized by CYP3A, including hexobarbital, phenytoin, and
valproate.

Erythromycin has been reported to significantly alter the metabolism of the
nonsedating antihistamines terfenadine and astemizole when taken concomitantly.
Rare cases of serious cardiovascular adverse events, including electrocardiographic
QT/QT_c interval prolongation, cardiac arrest, torsades de pointes,
and other ventricular arrhythmias have been observed.
In addition, deaths have been reported rarely with concomitant administration
of terfenadine and erythromycin.

There have been post-marketing reports of drug interactions when erythromycin
is co-administered with cisapride, resulting in QT prolongation, cardiac
arrhythmias, ventricular tachycardia, ventricular fibrillation, and torsades de
pointes, most likely due to inhibition of hepatic metabolism of cisapride by
erythromycin. Fatalities have been reported.

Drug/Laboratory Test Interactions

Erythromycin interferes with the fluorometric determination of urinary catecholamines.

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Is Eryped safe to take while pregnant or breastfeeding?

There is no evidence of teratogenicity or any other adverse effect on reproduction in female rats fed erythromycin base by oral gavage at 350 mg/kg/day (approximately twice the maximum recommended human dose on a body surface area) prior to and during mating, during gestation, and through weaning. No evidence of teratogenicity or embryotoxicity was observed when erythromycin base was given by oral gavage to pregnant rats and mice at 700 mg/kg/day and to pregnant rabbits at 125 mg/kg/day (approximately 1-3 times the maximum recommended human dose).

Erythromycin is excreted in human milk. Caution should be exercised when erythromycin is administered to a nursing woman.

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