Dosing and uses of E.E.S., EryPed (erythromycin ethylsuccinate)
Adult dosage forms and strengths
tablet
- 400mg
oral suspension
- 200mg/5mL
- 400mg/5mL
General Dosing Recommendations
400 mg PO q6hr
May increase up to 4 g/day depending on infection severity
Intestinal amebiasis
400 mg PO q6hr for 10-14 days
Legionnaire Disease
400-1000 mg PO q6hr for 21 days
Pertusis
40-50 mg/kg/day PO in divided doses for 5 to 14 days
Streptococcal infections
400 mg PO divided q12hr for 10 days
Primary syphilis
48-64 g PO individed doses for 10-15 days
Urethritis
Urethritis caused by C trachomatis or U urealyticum
800 mg PO q8hr for 7 days
Administration
May take with food
Renal Impairment
Dose adjustment not necessary
Hepatic Impairment
Use caution
Other Indications and Uses
Group A beta-hemolytic strep, Actinobacillus actinomycetemcomitans, Actinomyces israelii, Actinomyces naeslundii, Actinomyces odontolyticus, Afipia felis, Arachnia propionica, Arcanobacterium (Corynebacterium) haemolyticum, Bacillus anthracis, Bartonella henselae, Bartonella quintana, Bordetella pertussis, Borrelia burgdorferi, Borrelia recurrentis, C. diphtheriae, C. trachomatis, Klebsiella granulomatis, Campylobacter jejuni, Capnocytophaga ochracea, Chlamydia pneumonia (TWAR agent), Chlamydia psittaci, Chlamydia trachomatis, Chryseobacterium meningosepticum, Corynebacterium jeikeium (CDC group JK), Corynebacterium minutissimum, Corynebacterium ulcerans, Coxiella burnetii, E. histolytica, Erysipelothrix rhusiopathiae, H. ducreyi, H. influenzae, Kingella sp., Lactobacillus sp, Legionella pneumophilia, Leptospira interrogans, Leptotrichia buccalis, Leuconostoc species, Listeria, Mycobacterium chelonae, Mycobacterium fortuitum, M. catarrhalis, Mycoplasma pneumoniae, N. gonorrhoeae, Rhodococcus equi, S. aureus, S. pyogenes (group A beta-hemolytic streptococci), S. pneumoniae, Spirillum minus, Streptobacillus moniliformis, Streptococcus (Group C, G), Streptococcus agalactiae (Group B), Streptococcus bovis (Group D), Streptococcus intermedius group (S. anginosus, S intermedius, S. constellatus), Streptococcus pneumoniae (PCN sensitive, MIC <0.1 mcg/mL), Streptococcus pyogenes (Group A), Treponema pallidum, U. urealyticum, Ureaplasma urealyticum, Vibrio cholerae, Viridans streptococci
Off-label: Campylobacter jejuni, Calymmatobacterium granulomatis, Haemophilus ducreyi, prophylaxis in colorectal surgery, anthrax, tetanus, Lyme disease
First line: Afipia felis, Arcanobacterium (Corynebacterium) haemolyticum, Bartonella henselae, Bartonella quintana, Campylobacter jejuni, Capnocytophaga ochracea, Chlamydia pneumonia, Corynebacterium minutissimum, Corynebacterium ulcerans, Haemophilus ducreyi, Mycobacterium fortuitum, Ureaplasma urealyticum (others eg, Haemophilus ducreyi not unanimous)
Pediatric dosage forms and strengths
tablet
- 400mg
oral suspension
- 200mg/5mL
- 400mg/5mL
General Dosing Recommendations
Neonates
- <1.2 kg: 20 mg/kg/day PO divided q12hr
- 1.2 kg or more, 0-7 days old: 20 mg/kg/day PO divided q12hr
- ≥1.2 kg or more, 7 days or older: 30 mg/kg/day PO divided q8hr
- Chlamydial conjunctivitis and pneumonia: 50 mg/kg/day PO divided q6hr for 14days
Children
- Mild-to-moderate infections: 30-50 mg/kg/day PO divided q6-12hr
- Severe infection: 60-100 mg/kg/day PO divided q6-12hr
E.E.S., EryPed (erythromycin ethylsuccinate) adverse (side) effects
1-10%
Abdominal pain (8%)
Headache (8%)
Nausea (8%)
Diarrhea (7%)
Rash (3%)
Vomiting (3%)
Dyspepsia (2%)
Flatulence (2%)
Pain (2%)
Pruritus (1%)
Pseudomembranous colitis
Hypertrophic pyloric stenosis
Anaphylaxis
Fever
Mild allergic reactions
Urticaria
Skin eruptions
Tinnitus
<1%
Cholestatic hepatitis
Confusion
Hallucinations
Hearing loss
Hypotension
Nervous system effects including seizures
Torsade de pointes
Ventricular tachycardia
Vertigo
Postmarketing reports
Interstitial nephritis
Warnings
Contraindications
Documented hypersensitivity
Hepatic impairment
History of hepatitis caused by macrolide
Cholestatic hepatitis
Coadministration with terfenadine (discontinued), astemizole (discontinued), cisapride, or pimozide
Coadministration with ergotamine or dihydroergotamine (postmarketing reports of acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system)
Cautions
Risk of sudden death due to cardiac causes with concomitant use of oral erythromycin with drugs that inhibit CYP3A4
Erythromycin is considered a moderate inhibitor of CYP3A4; may increase toxicity of CYP3A4 substrates
Colchicine is a substrate for both CYP3A4 and the efflux transporter P-glycoprotein (P-gp); significant increase in colchicine plasma concentration is anticipated when coadministered with moderate CYP3A4 inhibitors; reduce the starting dose of colchicine and lower maximum colchicine dose
Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Associated with QT prolongation and infrequent cases of arrhythmia
May increase LFTs in pregnant women
GI effects: abdominal pain and cramping; diarrhea; nausea and vomiting
Hepatic impairment
Overgrowth of nonsusceptible bacteria or fungi
Pregnancy and lactation
Pregnancy category: B
Lactation: distributed in breast milk, use with caution; AAP categorizes as compatible with breastfeeding
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of E.E.S., EryPed (erythromycin ethylsuccinate)
Mechanism of action
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest
Absorption
Oral: Variable but better with salt forms than with base form; 18-45%; ethylsuccinate may be better absorbed with food
Peak Plasma Time: 4 hr (base); 0.5-2.5 hr (ethylsuccinate); delayed with food due to differences in absorption
Distribution
Protein Bound: 75-80%
Crosses placenta; enters breast milk
Relative diffusion from blood into CSF: minimal even with inflammation
Metabolism
Via P450 enzyme CYP3A4
Enzymes inhibited: CYP1A2, CYP3A4
Elimination
Half-life elimination: 1.4 hr
Excretion: primarily feces; urine (2-15% as unchanged drug)
