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|Erythro

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; Erythromycin Gluceptate; Erythromycin Lactobionate; Erythromycin Stearate
• Bowel preparation, preoperative, adjunct—Erythromycin Base

Description

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

These medicines may also be used to treat Legionnaires" disease and for other 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 the following 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 will do. This is a decision you and your doctor will make. For erythromycins, the following should be considered:

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

Pregnancy—Erythromycin estolate has caused side effects involving the liver in some pregnant women. However, none of the erythromycins has been shown 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, in effective doses, has not been shown to cause different side effects or problems in children than it does in adults.

Older adults—This medicine has been tested and has not been shown to cause different side effects or problems in older people than it does in younger adults. However, older adults may be at increased risk of hearing loss, especially if they are taking high doses of erythromycin and/or have kidney or liver disease.

Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking or receiving erythromycins, it is especially important that your health care professional 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 with erythromycins, especially erythromycin estolate, may increase the chance of liver 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 medicines with 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 terfenadine with 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 erythromycin may increase the side effects of carbamazepine or increase the chance of liver problems

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

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

Other medical problems—The presence of other medical problems may affect the use of erythromycins. Make sure you tell your doctor if you have any other medical problems, especially:

• Heart disease—High doses of erythromycin may increase the chance of 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 empty stomach (at least 1 hour before or 2 hours after meals). If stomach upset occurs, these medicines may be taken with food. If you have questions about the erythromycin medicine you are taking, check with your health care professional.

For patients taking the oral liquid form of this medicine:

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

For patients taking the chewable tablet form of 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 of this medicine:

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

To help clear up your infection completely, keep taking this medicine for the full time of treatment , even if you begin to feel better after a few days. If you have a ""strep"" infection, you should keep taking this medicine for at least 10 days. This is especially important in ""strep"" infections. Serious heart problems could develop 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 spaced about 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, check with your health care professional.

Dosing—The dose of erythromycin will be different for different patients. Follow your doctor"s orders or the directions on the label . The following information includes only the 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 you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which 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 four times a day.
    • Children—Dose is based on body weight. The usual dose is 7.5 to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight four times a day, or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weight two times a day.
  • For prevention of heart infections:
    • Adults and teenagers—Take 1 gram two hours before your dental appointment or surgery, then 500 mg six hours after taking the first dose.
    • Children—Dose is based on body weight. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight two hours before the dental appointment or surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hours after taking the first dose.

• For erythromycin estolate
• For oral dosage forms (capsules, oral suspension, tablets):
  • For treatment of infections:
    • Adults and teenagers—250 to 500 milligrams (mg) two to four times a day.
    • Children—Dose is based on body weight. The usual dose is 7.5 to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight four times a day, or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weight two times a day.
  • For prevention of heart infections:
    • Adults and teenagers—Take 1 gram two hours before your dental appointment or surgery, then 500 mg six hours after taking the first dose.
    • Children—Dose is based on body weight. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight two hours before the dental appointment or surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hours after 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 four times a day.
    • Children—Dose is based on body weight. The usual dose is 7.5 to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight four times a day, or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weight two times a day.
  • For prevention of heart infections:
    • Adults and teenagers—Take 1.6 grams two hours before your dental appointment or surgery, then 800 mg six hours after taking the first dose.
    • Children—Dose is based on body weight. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight two hours before the dental appointment or surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hours after taking the first dose.

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

• For erythromycin lactobionate
• For injection dosage forms:
  • For treatment of infections:
    • Adults and teenagers—250 to 500 milligrams (mg) injected into a vein every six hours; or 3.75 to 5 mg per kilogram (kg) (1.7 to 2.3 mg per pound) of body weight injected into a vein every six hours.
    • Children—Dose is based on body weight. The usual dose is 3.75 to 5 mg per kg (1.7 to 2.3 mg per pound) of body weight injected into a vein every 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 four times a day.
    • Children—Dose is based on body weight. The usual dose is 7.5 to 12.5 mg per kilogram (kg) (3.4 to 5.6 mg per pound) of body weight four times a day; or 15 to 25 mg per kg (6.8 to 11.4 mg per pound) of body weight two times a day.
  • For prevention of heart infections:
    • Adults and teenagers—Take 1 gram two hours before your dental appointment or surgery, then 500 mg six hours after taking the first dose.
    • Children—Dose is based on body weight. The usual dose is 20 mg per kg (9.1 mg per pound) of body weight two hours before the dental appointment or surgery, then 10 mg per kg (4.5 mg per pound) of body weight six hours after taking the first dose.

Missed dose—If you miss a dose of this medicine, take it as soon as possible. This will help to keep a constant amount of medicine in the blood. However, if it is almost time for your next dose, skip the missed dose 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 cause the medicine to break down.
• Store the oral liquid form of some erythromycins in the refrigerator because heat will cause this medicine to break down. However, keep the medicine from freezing. Follow the directions on the label.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Precautions While Using This Medicine

If your symptoms do not improve within a few days, or if they become worse, check with your doctor.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause 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 of the following side effects occur:

Other side effects may occur that usually do not need medical attention. These side effects may 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 are bothersome:

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

Additional Information

Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although these uses are not included in product labeling, erythromycins are used in certain patients with the following medical conditions:

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

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

Revised: 08/14/1997

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