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Macrolide·Infectious Diseases - Macrolides
Penicillin-allergic patients with susceptible infections
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Max Dose
4 g/day
Half-life
1.5 h
High risk: GI Upset
SEVERE
Prokinetic
OFF-LABEL
Avoid / Cautions
Concurrent use of potent CYP3A4 substrates (Colchicine, Statins). Baseline QTc > 500 ms. Pregnancy Category A, BUT associated with Infantile Hypertrophic Pyloric Stenosis if given to neonates in the first 2 weeks of life.
Overview
The original macrolide antibiotic. Due to its short half-life, severe GI toxicity, and massive drug interactions, it is largely obsolete as an antibiotic. Now heavily utilized as an IV prokinetic to force gastric emptying.
Clinical Focus
Like Clarithromycin, it is a potent CYP3A4 inhibitor. Causes agonizing stomach cramps by massively stimulating gut motilin receptors.
Bottom Line
Erythromycin is a macrolide useful for respiratory infections and as a prokinetic agent, but causes significant GI disturbance and has extensive CYP3A4 drug interactions.
Brand Names
Eryc, EES
Oral Routes
Capsules/Tablets (250 mg, 400 mg).
Parenteral
Vials (1 g powder) for IV infusion.
Prescribing & PBS
Unrestricted General Benefit (S4).
Primary
Penicillin-allergic patients with susceptible infections.
Off-Label
Gastroparesis, clearing blood from the stomach prior to an urgent endoscopy for a GI bleed.
Clinical Place
Almost entirely replaced by Azithromycin and Clarithromycin for infections. Survives in hospitals entirely as a GI motility agent.
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