(1997; 132 pages) [French] [Spanish]
Cream or solution, 2%
Capsule or tablet, 250 mg (as stearate or ethyl succinate)
Erythromycin is a macrolide antibiotic produced by Streptomyces erythreus. It has selective bacteriostatic activity against both streptococci and staphylococci, Propionibacterium acnes and some Gram-positive bacilli.
Because erythromycin is inactivated by gastric juices, oral formulations are protected by enteric coating. The drug diffuses rapidly into all tissues except the brain and cerebrospinal fluid. It readily crosses the placental barrier, and low concentrations have been reported in fetal plasma. The plasma half-life is approximately 90 minutes. Erythromycin is partially demethylated in the liver and excreted largely via the bile and faeces.
• mild to moderate inflammatory acne
• severe impetigo unresponsive to topical antibiotics
• erysipelas and cellulitis
• moderate to severe acne in patients in whom tetracyclines are contraindicated or ineffective
• yaws in children under 8 years of age, in whom tetracyclines are contraindicated.
Dosage and administration
Erythromycin tablets should not be broken in half before administration.
Mild to moderate inflammatory acne:
A thin layer of cream or solution should be applied to affected areas twice daily for 8-12 weeks.
Severe impetigo, folliculitis, erysipelas, cellulitis and moderate to severe acne:
Adults: 250 mg four times daily for 7-10 days. Patients with acne should receive 250 mg four times daily for 6-8 weeks followed by 250 mg twice daily until improvement occurs. Treatment may need to be continued for up to 6 months.
Children: 30 mg/kg daily in four divided doses for 7-10 days.
Yaws in children under 8 years:
30 mg/kg in four divided doses for 7-10 days.
Known hypersensitivity to erythromycin.
Hepatic function should be monitored in patients with a previous history of liver disease.
Use in pregnancy
Erythromycin has not been shown to be mutagenic, teratogenic or embryotoxic; it can be used during pregnancy.
Nausea, vomiting and diarrhoea can occur.
Cholestatic hepatitis, which may present with symptoms suggestive of acute cholecystitis, occasionally complicates prolonged courses of treatment. Symptoms resolve rapidly when the drug is withdrawn.
Anaphylaxis and other hypersensitivity reactions are rare.
Erythromycin, chloramphenicol and clindamycin have a similar bacteriostatic action and tend to be mutually antagonistic when administered together. Erythromycin decreases the rate of metabolism of carbamazepine and warfarin in the liver to a degree that can warrant readjustment of dosage. Erythromycin may diminish the action of oral contraceptives. Convulsions have recently been reported to occur when erythromycin is given together with a non-steroidal anti-inflammatory agent.
Erythromycin and other macrolide antibiotics should not be given with the non-sedating antihistamines astemizole and terfenadine, as cardiac arrhythmias such as prolonged Q-T intervals and ventricular arrhythmias (including ventricular fibrillation) have been reported in association with these drug combinations.
Symptoms of overdosage include severe nausea, vomiting, diarrhoea and hearing loss. Induction of emesis or gastric lavage may be of value if undertaken within a few hours of ingestion.
Preparations should be stored in tightly closed containers. Tablets and capsules should be protected from light.