Home Drug Guide Erythromycin Ethylsuccinate

Drug Guide

Generic Name

Erythromycin Ethylsuccinate

Brand Names E.e.s., Eryped, E.e.s. 200, E.e.s. 400, Wyamycin E, E-mycin E, Pediamycin, Pediamycin 400

Classification

Therapeutic: Antibiotic, Macrolide

Pharmacological: Macrolide Antibiotic

FDA Approved Indications

Bacterial infections caused by susceptible organisms, including respiratory tract infections, skin infections, and sexually transmitted infections

Mechanism of Action

Erythromycin binds to the 50S ribosomal subunit, inhibiting protein synthesis in susceptible bacteria, leading to bacteriostatic activity.

Dosage and Administration

Adult: Dosing varies by infection; typically 400 mg every 8-12 hours. Adjust based on infection severity and site.

Pediatric: Dosing is usually 30-50 mg/kg/day divided into 2-4 doses, depending on infection and weight.

Geriatric: Use with caution; consider renal and hepatic function. Adjust dose as needed.

Renal Impairment: Adjust dose based on severity of impairment.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Inadequate oral absorption; requires suspension or enteric-coated formulations.

Distribution: Widely distributed, including into most body tissues and fluids.

Metabolism: Minimal hepatic metabolism; some initial metabolism in the liver.

Excretion: Primarily in bile; small amount in urine.

Half Life: Approximately 1.5 to 2 hours.

Contraindications

Hypersensitivity to erythromycin or other macrolides.
History of cholestatic jaundice or liver dysfunction related to prior erythromycin therapy.

Precautions

Use cautiously in patients with hepatic impairment, arrhythmias (e.g., QT prolongation), or concurrent use of QT-prolonging drugs.
Monitor for hepatic toxicity and cardiac arrhythmias.

Adverse Reactions - Common

Gastrointestinal upset (nausea, vomiting, diarrhea) (Common)
Abdominal pain (Common)

Adverse Reactions - Serious

QT prolongation, ventricular arrhythmias (Serious but rare)
Ototoxicity (reversible) (Rare)
Hepatotoxicity (Rare)

Drug-Drug Interactions

Erythromycin inhibits CYP3A4 enzymes, increasing levels of drugs metabolized by this pathway (e.g., statins, certain benzodiazepines).

Drug-Food Interactions

Grapefruit juice may increase erythromycin levels.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of hepatotoxicity, cardiac arrhythmias, and gastrointestinal disturbances.

Diagnoses:

Risk for infection related to bacterial pathogen.
Impaired hepatic function.

Implementation: Administer with food to decrease gastrointestinal irritation if tolerated. Monitor ECG in patients at risk of QT prolongation. Adjust doses for hepatic impairment.

Evaluation: Resolution of infection signs, tolerable side effect profile, stable liver function tests.

Patient/Family Teaching

Complete full course of therapy.
Report symptoms of liver problems (yellowing skin/eyes, dark urine), persistent nausea, or irregular heartbeat.
Inform about potential drug interactions, including with herbal supplements.

Special Considerations

Black Box Warnings:

Potential for serious cardiac arrhythmias, including QT prolongation, especially in those with underlying risk factors.

Genetic Factors: Consideration of CYP3A4 interactions and genetic predispositions to QT prolongation.

Lab Test Interference: May interfere with certain blood tests, including liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, abdominal pain, and diarrhea; possible ototoxicity and cardiac arrhythmias.

Treatment: Supportive care, activated charcoal if ingestion is recent, and cardiac monitoring. No specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable when stored properly, avoid moisture and excessive heat.