Dosing and uses of Ery-Tab, PCE Dispertab (erythromycin base)
Adult dosage forms and strengths
tablet
- 250mg
- 500mg
tablet, delayed-release particles
- 250mg
- 333mg
- 500mg
PCE DispertaB
- 333mg
- 500mg
capsule, delayed release particles
- 250mg
Dose Range
Usual dosage range: 250-500 mg PO q6-12hr or 500 mg q12hr or 333 mg PO q8hr
Severe infections: Up to 4 g/day
Take on empty stomach if possible; PCE Dispertab may be taken with food; base has poorest absorption
Legionnaires Disease
1-4 g/day PO in divided doses for 21 days
Nongonococcal Urethritis
500 mg PO q6hr for 7 days
Bowel Preparation
1 g PO at 1:00, 2:00, and 11:00 PM on day before surgery in combination with PO neomycin and mechanical cleansing of large intestine
Lymphogranuloma Venereum
500 mg PO q6hr for 21 days
Pertussis
500 mg PO q6hr for 14 days
Gastroparesis (Off-label)
250-500 mg PO three times daily before meals
Granuloma Inguinale (Off-label)
500 mg PO four times daily for 21 days
Chancroid (Off-label)
500 mg PO three times daily for 7 days
Pediatric dosage forms and strengths
tablet
- 250mg
- 500mg
tablet, delayed-release particles
- 250mg
- 333mg
- 500mg
PCE DispertaB
- 333mg
- 500mg
Dose Range
Mild to moderate infection: 30-50 mg/kg/day PO divided q6-12hr; not to exceed 2 g/day
Severe infection: 15-50 mg/kg/day PO ; not to exceed 4 g/day
Chalmydial Infection
50 mg/kg/day PO divided q6hr for 14 days
Pertussis
40-50 mg/kg/day PO divided q6hr for 14 days; not to exceed 2 g/day
Streptococcal Pharyngitis, Tonsillitis
20 mg/kg/day PO divided q12hr
Bowel Preparation
20 mg/kg PO at 1:00, 2:00, and 11:00 PM on day before surgery in combination with PO neomycin and mechanical cleansing of large intestine
Dosing Considerations
Take on empty stomach if possible; PCE Dispertab may be taken with food; base has poorest absorption
Ery-Tab, PCE Dispertab (erythromycin base) adverse (side) effects
Frequency not defined
Abdominal pain
Anaphylaxis
Cholestatic hepatitis
Confusion
Diarrhea
Dyspepsia
Fever
Flatulence
Hallucinations
Hearing loss
Headache
Hypertrophic pyloric stenosis
Hypotension
Interstitial nephritis
Mild allergic reactions
Nausea
Nervous system effects, including seizures
Pain
Pruritus
Pseudomembranous colitis
QT prolongation
Rash
Skin eruptions
Tinnitus
Torsades de pointes
Urticaria
Ventricular arrhythmias
Ventricular tachycardia
Vertigo
Vomiting
Warnings
Contraindications
Documented hypersensitivity
Coadministration with astemizole, cisapride, lovastatin, simvastatin, or pimozide
Coadministration with ergotamine or dihydroergotamine (postmarketing reports of acute ergot toxicity characterized by vasospasm and ischemia of extremities and other tissues, including central nervous system [CNS])
Cautions
Risk of sudden death from cardiac causes when PO erythromycin used concomitantly with drugs that inhibit CYP3A4
Erythromycin is considered moderate inhibitor of CYP3A4; may increase toxicity of CYP3A4 substrates
Colchicine is substrate for both CYP3A4 and efflux transporter P-glycoprotein (P-gp); significant increase in colchicine plasma concentration is anticipated when drug is coadministered with moderate CYP3A4 inhibitors; reduce starting dose of colchicine, and lower maximum colchicine dose
Caution in liver disease; estolate formulation may cause cholestatic jaundice; gastrointestinal (GI) side effects are common; discontinue if nausea, vomiting, malaise, abdominal colic, or fever occurs
Caution in ventricular arrhythmias
Associated with QT prolongation and infrequent cases of arrhythmia
May increase liver function test values in pregnant women
GI effects: Abdominal pain and cramping; diarrhea; nausea and vomiting
Caution in hepatic impairment, history of hepatitis caused by macrolidide, cholestatic hepatitis
Overgrowth of nonsusceptible bacteria or fungi reported with prolonged use
Pregnancy and lactation
Pregnancy category: B
Lactation: Drug enters breast milk; use with caution (American Academy of Pediatrics committee states that drug is compatible with nursing)
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 Ery-Tab, PCE Dispertab (erythromycin base)
Mechanism of action
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest
Absorption
PO absorption is variable but better with salt forms than with base form
Peak plasma time: Base, 4 hr; ethylsuccinate, 0.5-2.5 hr; delayed with food because of differences in absorption
Distribution
Distribution: Crosses placenta; enters breast milk, relative diffusion from blood into CSF: minimal even with inflammation
Drug crosses placenta and enters breast milk; relative diffusion from blood into cerebrospinal fluid is minimal even with inflammation
Protein bound: 73-81%
Metabolism
Metabolized in liver by CYP3A4
Enzymes inhibited: CYP1A2, CYP3A4
Elimination
Half-life: 1.5-2 hr; 5-6hr (end stage renal disease)
Excretion: Feces (primarily), urine (2-15% as unchanged drug)
