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Why it's used

Erythromycin is used to treat certain bacterial infections which includes mild to moderate upper respiratory tract infections such as inflammation of the tonsil, throat, voice box, and cavities around the nasal passages, pus-filled pocket behind the tonsil, and secondary infections in influenza. It is also used to treat lower respiratory tract infections such as inflammation of the windpipe, severe inflammation of the lining of airways of the lungs (bronchitis), pneumonia, pneumonia of newborn baby, damaged airways of the lungs, pneumonia caused by Legionella bacteria. Also, it is used to treat ear infections such as infections of the middle ear infection, outer ear, and bone behind the ear, eye infections such as inflammation of the eyelid (blepharitis) and inflammation of the eye of the newborn (conjunctivitis of the newborn) and oral infections such as gum inflammation and painful gums infection. It is also used to treat skin and soft tissue infections such as boils and pus-filled skin bumps (carbuncles), skin infection around the toenails or fingernails (paronychia), pus-filled pockets under the skin, pus-filled bulging patch of the skin (pustular acne), red sores around mouth and nose, bacterial skin infection. Stomach and intestinal infections including infection of the large intestine, inflammation of the gallbladder, inflammation of the small intestine caused by bacteria and other infections such as bacterial infection, bone infection, urethra inflammation that not caused by gonorrheal infection, gonorrhea, first stage of the painless sores in or around the mouth, genitals, or anus (primary syphilis), long-term bacterial infection of the lymphatic system, serious infection of the throat and nose, prostate inflammation, fever caused by bacterial infection, pelvic inflammatory disease and infections of reproductive organs and the urinary system (urogenital infections) during pregnancy, and uncomplicated urethral, endocervical, or rectal infections are also treated by the Erythromycin. This medicine works by binding to specific cell site of the bacteria and stopping the protein synthesis. This medicine helps by stopping the growth of the bacteria. Erythromycin is also used to prevent pre- and post-operative trauma, whooping cough (pertussis), burns and complication of strep throat (rheumatic fever).
When not to use
Erythromycin will not work to treat viral infection.
Macrolide Antibacterial
Erythromycin is a prescription medicine that belongs to a class of medicines called Macrolide Antibacterial. Macrolide antibacterials are a class of antibiotics that are used to treat certain kinds of bacterial infections. They are commonly used to treat mild-to-moderate bacterial infections.

How to use

Read the directions on the product label, patient guide, or medicine guide provided by the medicine company or your pharmacist before starting to use Erythromycin. If you have any questions related to this medicine, ask your doctor or pharmacist. Use this medicine as recommended by your doctor.
Erythromycin is used with or without food.
The typical dose of Erythromycin is 333 mg every 8 hours or 500 mg every 12 hours (not more than 4000 mg per day). The usual dose for children is 30-50 mg/kg/day or 13.6-22.7 mg/lb/day in divided doses (not more than 4000 mg per day). The maximum adult dose of Erythromycin is 4000 mg in a day. This medicine is typically used for a period of 2 weeks for inflammation of the eye of the newborn, 3 weeks for pneumonia of newborn baby, 7 days for infections of reproductive organs and the urinary system during pregnancy, 10-15 days for first stage of the painless sores in or around the mouth, genitals, or anus, and 7 days for pelvic inflammatory disease. This medicine is not known to be habit-forming.
This medicine should be used on an as-needed basis. Erythromycin may be used for long-term for prevention of the respiratory tract infections in the children. You should continue to use this medicine as directed by the doctor even if you feel well.
Talk to your doctor if you develop new symptoms. Tell your doctor if watery and bloody stools with or without stomach cramps and fever, vomiting, and irritability with feeding.
The effectiveness of this medicine may reduce if it is used for long periods of time.
If you are giving Erythromycin to a child, be sure to use a product that is meant for children. Before giving this medicine to a child, use the child's weight or age to find the right dose from the product package. You can also read the dosage section of this page to know the correct dose for your child. Else, consult with your doctor and follow their recommendation.
If using the delayed-release form of this medicine, do not crush or chew the medicine, unless indicated on the package. Crushing or chewing of the medicine can result in unpleasant taste resulting in patients not following the medicine schedule. Crushing or chewing can also release all of the medicine at once, resulting in a decrease of effectiveness and a possible increase in side-effects.
If using the liquid form of this medicine, measure the dose using the provided measuring cup, spoon, or dropper. Before pouring the medicine into the measuring device, you should check the measurement markings carefully. Then, pour the dose amount into the device. After use, clean and store the measuring device in a safe place for your next use. You should not use a tablespoon or teaspoon as the dose measuring devices since it can result in an incorrect dose. If indicated on the product package, shake the medicine before use.
Your doctor may request that specific lab tests be performed before you start using Erythromycin. You may need to have Antibiotic Susceptibility test. Antibiotic susceptibility test is required to help in selecting an appropriate antibacterial drug for the treatment.
You should store Erythromycin below 30°C (86°F). Store the medicine away from the reach of children and pets.
Medicines may be prescribed for uses other than those listed in the medicine guide. Do not use Erythromycin for conditions for which it was not prescribed. Do not give Erythromycin to other people who might have the same conditions or symptoms that you have. Self-medication may harm them.

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How to take Erythromycin

Your dose may depend on several personal factors. You should consult with your doctor to find out the dose that is best for you. The dose of Erythromycin depends on the following factors:
  • patient's age
  • patient's weight
  • response to treatment

Erythromycin Dosage

Dosage for inflammation of the eye of the newborn (conjunctivitis of the newborn)

Children
  • Recommended: 50 mg/kg/day (22.7 mg/lb/day) for 2 weeks in 4 divided doses

Dosage for pneumonia in newborn baby

Children
  • Recommended: 50 mg/kg/day (22.7 mg/lb/day) for 3 weeks in 4 divided doses

Dosage for infections of the reproductive organs and the urinary system during pregnancy

Adult
  • Recommended: 500 mg four times a day or two 333 mg doses every 8 hours for 7 days on an empty stomach. If this regimen not tolerated, 500 mg every 12 hours or 333 mg dose every 8 hours or 250 mg four times a day for 14 days orally is recommended.

Dosage for uncomplicated urethral, endocervical or rectal infections and urethra inflammation not caused by gonorrheal infection (nongonococcal urethritis)

Adult (If tetracycline is not tolerated or recommended)
  • Recommended: 500 mg four times a day or two 333 mg doses every 8 hours for 7 days orally

Dosage for first stage of the painless sores in or around the mouth, genitals, or anus (primary syphilis)

Adult
  • Recommended: 3000-4000 mg in divided doses for 10-15 days

Dosage for pelvic inflammatory disease

Adult
  • Recommended: 500 mg injection into the vein every 6 hours for 3 days, then take 500 mg every 12 hours or 333 mg every 8 hours orally for 7 days

Dosage for infection of the large intestine (intestinal amebiasis)

Adult
  • Recommended: 500 mg every 12 hours, 333 mg every 8 hours or 250 mg every 6 hours orally for 10-14 days
Children
  • Recommended: 30-50 mg/kg/day (13.6-22.7 mg/lb/day) in divided doses for 10-14 days

Dosage for whooping cough (pertussis)

Adult
  • Recommended: 40-50 mg/kg/day (18.1-22.7 mg/lb/day) in divided doses for 5-14 days according to clinical studies

Dosage for pneumonia caused by Legionella bacteria (Legionnaire's disease)

Adult
  • Recommended: 1000-4000 mg daily in divided doses according to clinical studies

Dosage for upper respiratory tract infections such as inflammation of the tonsil and throat (tonsillitis and pharyngitis)

Children
  • Recommended: 30-50 mg/kg/day (13.6-22.7 mg/lb/day) in divided doses for 10 days
  • Maximum: 4000 mg/day

Dosage for prevention of upper respiratory tract infections (rheumatic fever)

Children
  • Recommended: 250 mg orally twice a day

Minimum Age

2 years

Dosage calculation for children

To calculate the dosage for children please use the weight based dose calculator to calculate the appropriate dosage as per the weight of your child.

Forms

Tablet
Strength: 200 mg, 250 mg, 333 mg, 400 mg, 500 mg, and 600 mg
Capsule
Strength: 250 mg
Delayed Release Capsule
Strength: 250 mg and 333 mg
Delayed Release Pellets Capsule
Strength: 250 mg
Gel
Strength: 20 mg/1000 mg
Granule for Suspension
Strength: 200 mg/5 ml
Injection, Powder, for Solution
Strength: 500 mg and 1000 mg

Missed Dose

Take the missed dose as soon as you remember. Skip the missed one if it's time for next dose. Avoid taking a double dose to make up for the missed dose.

Overdose

What to do if you overdose on Erythromycin?
In case of overdose, stop using this medicine and provide monitoring with supportive care to such patients. Stomach emptying should be performed by cleaning out the contents of the stomach.
Symptoms of an overdose of Erythromycin
If you use too much of this medicine, it could lead to dangerous levels of the medicine in your body. In such cases, symptoms of an overdose may include:
If you think you have overdosed on Erythromycin, call a poison control center immediately. You can look up the poison control center information from the Poison Center Finder at TabletWise.com.

Precautions while using Erythromycin

Before you use Erythromycin, tell your doctor if you are allergic to it or its ingredients. Your doctor may prescribe an alternative medicine and update your medical records to record this information.
Before you use Erythromycin, tell your doctor of your medical history including diarrhea associated with Clostridium difficile bacteria. The treatment with Erythromycin alter the microorganisms that live in the intestine resulting in the overgrowth of C.difficile bacteria. The incidence of mild to possibly fatal diarrhea associated with Clostridium difficile has been reported to occur within 2 months of the use of antibacterial agents.
The use of this medicine may change prolonged heartbeat (QT interval). A prolonged heartbeat (prolonged QT interval) has been seen in patients using Erythromycin.
The use of Erythromycin may change liver enzyme. An increase in the liver enzyme levels is seen in patients receiving Erythromycin.
Erythromycin should be used only when required in patients who are pregnant or planning to become pregnant. No adequate or well-controlled studies of Erythromycin have been performed in pregnant women. However, there have been some reports of heart abnormalities in patients using this medicine. Erythromycin crosses placenta with a low amount of Erythromycin in the blood of fetus. Also, there is a risk of obstruction in the opening between the stomach and small intestine of an infant (infantile hypertrophic pyloric stenosis) in the baby of pregnant women using Erythromycin. Consult with your doctor on the use of Erythromycin during breastfeeding. Erythromycin passes into breast milk. Such patients should take precaution while using this medicine due to the risk of obstruction in the opening between the stomach and small intestine in the infant (infantile hypertrophic pyloric stenosis).
Erythromycin can make you feel sleepy. Be careful, especially while driving, while using heavy machinery, or when doing any activity that needs you to be completely alert. The consumption of alcohol with Erythromycin can worsen the sleepiness. Erythromycin may cause seizures in some people. Hence, you should discuss with your doctor before performing any activities where a loss of consciousness may cause harm to you or others.
Older patients may have a higher incidence of side-effects when using Erythromycin. Elderly patients may see an increased risk of prolonged heartbeat (torsades de pointes).
Younger patients may have a higher incidence of side-effects with Erythromycin. Younger patients may see an increased risk of obstruction in the opening between the stomach and small intestine (infantile hypertrophic pyloric stenosis), vomiting, and irritability.
The long-term use of Erythromycin may cause overgrowth of nonsusceptible bacteria or fungi.

Erythromycin Side-effects

The following side-effects may commonly occur when using Erythromycin. If any of these side-effects worsen or last for a long time, you should consult with your doctor:
  • diarrhea
  • eating disorder (anorexia)
  • inflammation of the pancreas (pancreatitis)
  • nausea
  • stomach pain (abdominal pain)
  • upper stomach discomfort (upper abdominal discomfort)
  • vomiting
The following side-effects may commonly occur in older patients on the use of Erythromycin. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • prolonged heartbeat (torsades de pointes)
The following side-effects may commonly occur in children when using Erythromycin. Discuss with your doctor if any of these side-effects last for a long time or are severe:
  • irritability
  • obstruction in the opening between the stomach and small intestine (infantile hypertrophic pyloric stenosis)
  • vomiting
Rarely, the use of Erythromycin may cause the following side-effects:
  • chest pain
  • feeling sick
  • hives
  • itching of the skin
  • lack of energy
  • mild eruptions on the skin
  • palpitations
  • reversible hearing loss
  • ringing in the ear
  • vertigo
  • visual disturbance due to mitochondrial dysfunction (mitochondrial optic neuropathy)
The following severe side-effects may also occur when using Erythromycin:
  • Symptoms: an increased number of white blood cells (eosinophilia)
  • liver and bile disorders
    Symptoms: inflammation of the liver (hepatitis), liver dysfunction (hepatic dysfunction), abnormal liver function test, jaundice, inflammation of liver due to obstruction to bile flow (cholestatic hepatitis), abnormal enlargement of the liver (hepatomegaly), liver failure (hepatic failure), inflammation of the liver (hepatocellular hepatitis) increased liver enzyme values
  • heart disorders
    Symptoms: prolonged heartbeat (QT prolongation/torsades de pointes), increased heart rhythm caused by lower chambers of the heart, heart rhythm disorders, abnormal heartbeat caused by lower chambers of the heart increased heartbeat
  • stomach and intestinal disorders
    Symptoms: inflammation of the large intestine caused by a bacteria (pseudomembranous colitis), diarrhea, inflammation of the pancreas (pancreatitis), eating disorder (anorexia) obstruction in the opening between the stomach and small intestine of an infant (infantile hypertrophic pyloric stenosis)
  • allergic reaction
    Symptoms: fluid accumulation under the skin, skin rash accompanying fever (exanthema), drug-related skin reaction (acute generalized exanthematous pustulosis), redness of the skin (erythema multiforme), Stevens-Johnson syndrome, severe skin allergic reaction allergy (anaphylaxis)
  • nervous system disorders
  • Symptoms: deafness
  • Symptoms: hallucinations
  • kidney disorders
    Symptoms: swelling in between kidney tubules (interstitial nephritis)
Your doctor has prescribed this medicine because they judge that the benefit is greater than the risk posed by side-effects. Many people using this medicine do not have serious cases of side-effects. This page does not contain a complete list of all possible side-effects.
If you experience side-effects or notice other side-effects not listed above, contact your doctor for medical advice. You may also report side-effects to your local food and drug administration authority. You can look up the drug authority contact information from the Drug Authority Finder at TabletWise.com.

Warnings

Liver damage

Patients who use oral Erythromycin products are at an increased risk. These patients may suffer from liver dysfunction, including increased level of liver enzymes, and inflammation of the liver due to viruses (hepatocellular hepatitis) and inflammation of the liver due to decreased bile flow (cholestatic hepatitis), with or without jaundice. Such patients should be cautious while using Erythromycin as it eliminated mainly by the liver.

Syphilis in pregnancy

Newborn babies treated with Erythromycin during the pregnancy stage are at an increased risk. Newborn babies may develop a sexually transmitted infection (congenital syphilis). An appropriate penicillin treatment should be given to these patients.

Clostridium difficile associated diarrhea

Patients who are treated with Erythromycin are at an increased risk. These patients may suffer from mild diarrhea to the inflammation in the digestive tract that can be fatal (fatal colitis) caused by Clostridium difficile. Appropriate fluid and electrolyte management and protein supplementation should be given to the patient. Treatment of Clostridium difficile with antibiotics, and its surgical evaluation should be instituted.

Serious allergic reactions

Patients who use macrolide antibiotics including Erythromycin are at an increased risk. These patients may suffer from serious allergic reactions (including acute generalized exanthematous pustulosis). If this happens, stop using this medicine and appropriate treatment should be given.

Prolonged heartbeat (QT interval)

Patients who use medicines that can cause prolongation of heartbeat (QT interval) are at an increased risk when using this medicine. In these patients, Erythromycin should be used with caution.

Skeletal muscle weakness

Patients with skeletal muscle weakness are at an increased risk when using this medicine. It may increase the level of weakness in these patients.

Interference with urine tests

Patients who use Erythromycin are at an increased risk. This medicine may interfere with the fluorometric determination of catecholamine chemical in the urine.

Rhabdomyolysis

Seriously ill patients are at an increased risk when using Erythromycin in combination with statins. These patients may suffer from the breakdown of damaged skeletal muscle (rhabdomyolysis) with or without kidney dysfunction.

Infantile hypertrophic pyloric stenosis (IHPS)

Newborn babies are at an increased risk while on this drug therapy. They may suffer from obstruction in the opening between the stomach and small intestine of an infant (infantile hypertrophic pyloric stenosis) and develop symptoms like vomiting and irritability with feeding. The benefit of this drug therapy must outweigh against the risk of developing infantile hypertrophic pyloric stenosis. Parents should contact their doctor if irritability with feeding or vomiting occurs.

Interactions with Erythromycin

When two or more medicines are taken together, it can change how the medicines work and increase the risk of side-effects. In medical terms, this is called as a Drug Interaction.
Erythromycin interacts with digoxin, which is used to treat heart disorder. The use of Erythromycin with digoxin may cause an increased level of digoxin in the blood. The dosage adjustment should be done as necessary. The patients should be monitored carefully particularly when using Erythromycin together with medicine that prolongs the heartbeat.
There may be an interaction of Erythromycin with calcium channel blockers, which are used to treat high blood pressure. The use of Erythromycin with calcium channel blockers such as verapamil, may cause low blood pressure, slow heart rhythms, and excessive lactic acid accumulation in the body.
Erythromycin may interact with theophylline, which is used to treat lung diseases such as asthma. The use of Erythromycin with theophylline may cause an increased amount of theophylline in the blood. If this happens, the dose of theophylline should be reduced while receiving concurrent therapy with Erythromycin.
Your doctor's guidelines may need to be followed while taking this medicine along with drugs undergone breakdown and elimination by a liver enzyme (cytochrome P450). The use of Erythromycin with drugs metabolized by a liver enzyme (cytochrome P450) for example, alfentanil, acenocoumarol, bromocriptine, astemizole, carbamazepine, cyclosporin, cilostazol, disopyramide, dihydroergotamine, ergotamine, methylprednisolone, hexobarbitone, midazolam, omeprazole, quinidine, phenytoin, rifabutin, tacrolimus, sildenafil, terfenadine, domperidone, theophylline, triazolam, vinblastine, valproate, and antifungals e.g ketoconazole, fluconazole, and itraconazole may increase the level of these drugs in the blood. The dosage adjustment should be done as necessary. The patients should be monitored carefully particularly when using Erythromycin together with medicine that prolongs the heartbeat.
Special instructions need to be followed while taking this medicine along with anticoagulants, which are used to treat blood clots. When Erythromycin is used together with anticoagulants may increase the anticoagulant effects. This interaction is more noticeable in elderly patients.
Your doctor's guidelines may need to be followed while taking this medicine along with Sildenafil (Viagra), which is used to treat erectile dysfunction. When using Erythromycin together with sildenafil, an increase in the systemic exposure of sildenafil is seen. A reduction in the dose of sildenafil is recommended while using it together with Erythromycin.
Special instructions need to be followed while taking this medicine along with statins (HMG-CoA Reductase Inhibitors), which are used to reduce heart diseases. The use of Erythromycin with statins such as lovastatin and simvastatin, may increase the amount of statins in the body. It may also cause muscle injury and leakage of protein content into the blood (rhabdomyolysis) with or without kidney problems. Patients using Erythromycin with statins should be monitored for blood transaminase and creatine kinase enzymes levels.
Erythromycin interacts with CYP3A4 inducers. The use of Erythromycin with CYP3A4 inducers such as phenytoin, rifampicin, phenobarbital, carbamazepine, St John's Wort, may cause the breakdown and elimination of Erythromycin. This may result in a decrease in the effect of Erythromycin. The use of Erythromycin during or within two weeks after treatment with CYP3A4 inducers is not recommended.
There may be an interaction of Erythromycin with triazolobenzodiazepines, which are used to treat anxiety. The use of Erythromycin with benzodiazepines such as triazolam and alprazolam, may cause a decrease in the clearance of benzodiazepines. This may result in an increase in the effect of benzodiazepines in the body.
Erythromycin may interact with ergotamine or dihydroergotamine, which is used to treat migraines. The use of Erythromycin with ergotamine or dihydroergotamine may cause an increased level of ergots in the body which is associated with narrowing of blood vessels, severe blockage in the blood vessels in the brain and other body parts. The use of Erythromycin with ergotamine or dihydroergotamine is not recommended.
Your doctor's guidelines may need to be followed while taking this medicine along with cimetidine, which is used to treat heartburn and stomach ulcers. The use of cimetidine with Erythromycin may increase the amount of the Erythromycin in the blood by blocking its breakdown.
Special instructions need to be followed while taking this medicine along with protease inhibitors which are used to treat viral infections. The use of Erythromycin with protease inhibitors may block the breakdown of Erythromycin.
Erythromycin interacts with anti-bacterial agents, which are used to treat bacterial infections. The use of Erythromycin with other anti-bacterial agents such as penicillin, cephalosporin, clindamycin, chloramphenicol, lincomycin, streptomycin, colistin, and tetracyclines, may block the effects of other anti-bacterial agents.
There may be an interaction of Erythromycin with contraceptives, which are used for birth control. The use of contraceptive pills with Erythromycin may reduce the effects of contraceptive pills by decreasing the levels of steroid in the blood.
Erythromycin may interact with colchicine, which is used to treat gout. The use of colchicine with Erythromycin may cause an increase in the amount of colchicine in the blood. The use of recommended doses of Erythromycin and colchicine together can be possibly fatal. The starting and maximum dose of colchicine should be reduced when used with Erythromycin. These patients should be monitored for the symptoms of increasing levels of the colchicine in the blood.
This page does not contain all the possible interactions of Erythromycin. Share a list of all medicines that you use with your doctor and pharmacist. Do not start, stop, or change the dose of any medicines without the approval of your doctor.

Traveling With Medication

  • Ensure that you carry enough doses of each of your prescription medicines to last the entire trip. The best place to store your medicines is in the carry on baggage. However, while flying, if carrying liquid medicines, make sure you do not go over the limits imposed for carry-on liquids.
  • While traveling overseas, make sure that you can carry each of your prescription medicines legally to your destination country. One way to ensure this is by checking with your destination country's embassy or website.
  • Make sure that you carry each of your medicines in their original packaging, which should typically include your name and address, and the details of the prescribing doctor.
  • If your travel involves crossing time zones, and you are required to take your medicine as per a fixed schedule, make sure that you adjust for the change in time.

Expired Medication

Taking a single dose of expired Erythromycin is unlikely to cause a side-effect. However, please discuss with your doctor or pharmacist, if you feel unwell or sick. An expired medicine may become ineffective in treating your prescribed conditions. To be on the safe side, it is important not to use an expired drug. You are much safer by always keeping a fresh supply of unexpired medicines.

Safe Disposal of Medication

  • If there are disposal instructions on the package, please follow the instructions.
  • If there are medicine take-back programs in your country, you should contact the respective authority to arrange for the disposal of the medicine. For example, in the USA, the Drug Enforcement Administration regularly hosts National Prescription Drug Take-Back events.
  • If there are no take-back programs, mix the medicine with dirt and place them in a sealed plastic bag. Throw the plastic bag in your household trash. Separately, remove all personal information including the prescription label from the medicine packaging and then dispose off the container.
  • If specifically indicated on the medicine package that it needs to be flushed down the toilet when no longer needed, perform the required step.

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