Home Drug Guide Erythromycin Lactobionate

Drug Guide

Generic Name

Erythromycin Lactobionate

Brand Names Erythrocin, Erythromycin

Classification

Therapeutic: Antibiotic, Macrolide

Pharmacological: Protein synthesis inhibitor (Macrolide)

FDA Approved Indications

  • Respiratory tract infections
  • Skin and soft tissue infections
  • Whooping cough
  • Diphtheria prophylaxis
  • Syphilis
  • Other bacterial infections sensitive to erythromycin

Mechanism of Action

Erythromycin binds to the 50S ribosomal subunit of susceptible bacteria, inhibiting protein synthesis by preventing translocation of peptides, thus exerting its antibacterial effects.

Dosage and Administration

Adult: Typically 250-500 mg every 6-12 hours orally or IV, dose varies based on infection severity and site

Pediatric: 10-50 mg/kg/day divided into 2-4 doses, depending on age and infection

Geriatric: Adjust based on renal and hepatic function, monitor for QT prolongation

Renal Impairment: Use cautiously, dosage adjustments may be necessary depending on severity of impairment

Hepatic Impairment: Adjust dose; contraindicated in severe hepatic impairment

Pharmacokinetics

Absorption: Orally well-absorbed; bioavailability approximately 35-50%

Distribution: Widely distributed, including to CSF with meningeal inflammation

Metabolism: Metabolized in the liver, partly via CYP3A4

Excretion: Excreted mainly in bile and feces, some renal elimination

Half Life: 1.5-2 hours

Contraindications

  • Known hypersensitivity to erythromycin or other macrolides
  • History of cholestatic jaundice or hepatic dysfunction associated with erythromycin use

Precautions

  • Use with caution in patients with QT prolongation, electrolyte abnormalities, cardiac arrhythmias; monitor ECG during therapy
  • Potential drug interactions due to CYP3A4 metabolism

Adverse Reactions - Common

  • Nausea (Common)
  • Vomiting (Common)
  • Diarrhea (Common)
  • Abdominal pain (Common)

Adverse Reactions - Serious

  • QT prolongation and arrhythmias (including torsades de pointes) (Serious but rare)
  • Hepatotoxicity (Rare)
  • Ototoxicity (Rare)
  • Anaphylaxis (Rare)

Drug-Drug Interactions

  • Clarithromycin, Kabicid, other CYP3A4 inhibitors - increase erythromycin levels and toxicity
  • Statins – increased risk of rhabdomyolysis

Drug-Food Interactions

  • Grapefruit juice – may increase plasma erythromycin levels

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor for signs of superinfection, hepatic function, cardiac status (ECG in at-risk patients)

Diagnoses:

  • Risk for allergic reaction
  • Potential for impaired hepatic function
  • Risk for cardiac arrhythmias

Implementation: Administer with food to reduce GI irritation; IV infusion over 20-60 minutes; monitor therapeutic response and side effects

Evaluation: Assess for resolution of infection signs and symptoms, monitor for adverse reactions

Patient/Family Teaching

  • Complete full course of therapy
  • Report any signs of allergic reactions or severe diarrhea
  • Be aware of potential interactions with other medications
  • Take erythromycin on an empty stomach if directed, with water

Special Considerations

Black Box Warnings:

  • Potential for QT prolongation and arrhythmias, especially in patients with existing risk factors

Genetic Factors: None well-established

Lab Test Interference: Can cause false tests for urinary catecholamines and serum bilirubin

Overdose Management

Signs/Symptoms: Nausea, vomiting, stomach pain, diarrhea, hearing loss, and possible cardiac arrhythmias

Treatment: Supportive care; activated charcoal if recent ingestion; cardiac monitoring; magnesium sulfate for torsades de pointes; hemodialysis is generally ineffective due to extensive tissue distribution

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F), away from moisture and light

Stability: Stable for 24 months under proper storage conditions

This guide is for educational purposes only and is not intended for clinical use.