Dosing and uses of Erythrocin Lactobionate (erythromycin lactobionate)
Adult dosage forms and strengths
injection
- 500mg
- 1g
General Dosing Recommendations
15-20 mg/kg/day IV divided q6hr; infuse IV over 1 hr
Up to 4 g/day may be administered for severe infections
Geriatric: Increased risk for hearing loss in elderly patients with 4 g/day or more
Acute Pelvic Inflammatory Disease
500 mg IV q6hr for 3 days; follow by 500 mg PO q12hr
Legionaire Disease
1-4 g IV in divided doses
Streptococcal Infections
250 mg PO q12hr
Renal Impairment
CrCl <10 mL/min: Administer 50-75% of usual dose
Other Indications & 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
injection
- 500mg
- 1g
Usual Dosage Range, Infants & Children
15-20 mg/kg/day IV divided q6hr; infuse IV over 1 hr
Higher doses may be administered for severe infection; not to exceed 4 g/day
Renal Impairment
CrCl <10 mL/min: Administer 50-75% of usual dose
Erythrocin Lactobionate (erythromycin lactobionate) 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
QT prolongation
Venous irritation
Ventricular arrhythmias
<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 w/ 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; discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
Ventricular arrhythmias
Associated with QT prolongation and infrequent cases of arrhythmia
May increase LFTs in pregnant women
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 Erythrocin Lactobionate (erythromycin lactobionate)
Mechanism of action
Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest
Absorption
Peak Plasma Time: 2 hr (base)
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: 1.4 hr
Excretion: primarily feces; urine (2-15% as unchanged drug)
Administration
IV Compatibilities
Solution: 0.9% NaCL
Additive: Ampicillin, cimetidine, diphenhydramine, hydrocortisone, lidocaine, penicillin G potassium, pentobarbital, KCl, prochlorperazine, ranitidine, Na bicarb, verapamiL
Y-site (partial list): Acyclovir, amiodarone, diltiazem, esmolol, heparin, hydromorphone, labetalol, lorazepam, meperidine, morphine, tacrolimus, aminB/C, zidovudine
IV Incompatibilities
Solution (usually 10-15% decomposition): D5/LR, D5/NS, D5W (?), Normosol M, Normosol R, LR, Ringer's
Additive: Aminophylline, ascorbic acid (may be conc-dependent), heparin, vitamin B/C
Syringe: Ampicillin, heparin
Not spec: Carbenicillin, cefazolin, epinephrine, tetracycline
IV Preparation
Infusion: Reconstitute 250 or 500 mg vials with 10 mL SWI without preservatives; 1 g vials with 20 mL
Intermittent infusion: Dilute 250-500 mg in 100-250 mL D5W or 0.9% NaCL
Continuous infusion: Final concentration of 1 g/L
IV Administration
Intermittent Infusion: Over 20-60 min
Continuous Infusion: Over 6-24 hr
Storage
Store at controlled room temperature
