Erythromycin

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Definition
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Mixture of structurally very similar compounds which are formed by the bacterium Saccharopolyspora erythraea and which is used as a medicinal substance because of its antibiotic effect. e

The main component of the substance mixture is erythromycin A. Other ingredients are erythromycin B (5%) and, in a significantly smaller amount, erythromycin C. Chemically, erythromycin can be described as a glycoside; pharmacologically, erythromycin belongs to the macrolide antibiotics.

Half-life
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1,6 h

Spectrum of action
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Bacillus anthracis, Bacterioides ureolyticus, Bordetella, Borrelia, Campylobacter, Chlamydia, Clostridium spp. difficile), Corynebacterium diphtheriae, Entamoeba histolytica, Eikenella corrodens, Erysipelothrix rusiopathiae, Gardnerella vaginalis, Haemophilus ducreyi, Helicobacter pylori, Legionella pneumophilia, Listeria monocytogenes, Mobiluncus spp, Moraxella catarrhalis, Mycoplasma pneumoniae, Neisseria, Peptostreptococcus spp., Prevotella spp., Propionibacterium acnes, Rochalimaea spp., Staphylococcus spp., Streptococcus spp., Treponema pallidum.

Notice!

Cross-resistance to other macrolide antibiotics, including clindamycin!

Indication
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Tonsillitis, pharyngitis, otitis media, whooping cough, pneumonia, skin infections, syphilis, gonorrhoea, molle ulcer, diphtheria. Replacement preparation for penicillin allergy; topical, among other things for the treatment of acne papulopustulosa and for Crédé's prophylaxis.

Limited indication
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In case of systemic application: liver dysfunction, pregnancy, lactation, myasthenia gravis.

Pregnancy/nursing period
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Erythromycin orally justified only during pregnancy. Careful benefit-risk assessment. Substance passes into breast milk.

Dosage and method of use
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  • Systemic:
    • Pat. > 14 y.: 1.5-2 g/day p.o. or i.v.
    • Children/teenagers 8-14 years: 30 mg/kg bw/day p.o. in 4 ED or 20-30 mg/kg bw i.v.
  • Topical:
    • Eye ointment: Apply 0.5 cm ointment every 2 hours into the conjunctival sac.
    • Solution/Gel/Ointment/Cream: After thorough skin cleansing, apply thinly to the affected skin areas twice a day.

Notice! Use for max. 10-12 weeks due to development of resistance. Do not use together with alcoholic benzoyl peroxide solutions.

Standard concentration
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  • 1% as eye ointment.
  • 0.5-, 1-, 2- or 4% in solutions, gels, ointments and creams.

Undesirable effects
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  • The most common adverse events in systemic erythromycin application are gastrointestinal side effects such as gastrointestinal cramps, nausea, vomiting, diarrhea. Furthermore: allergic reactions, reversible intrahepatic cholestasis.
  • With top. Appl. Erythema, peeling, burning, scaling, contact dermatitis, pruritus.

Notice. In case of persistent diarrhea and colics think of pseudomembranous colitis!

Interactions
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s. Table 1.

Contraindication
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Hypersensitivity.

Recipe(s)
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In magistral prescriptions, standardized formulations such as those found in the NRF as"Hydrophilic Erythromycin Cream" (NRF11.77) are recommended.

Further erythromycin-containing formulations are:

Preparations
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Aknemycin (as ointment or solution); Erythrocin i.v.; Erythrocin Neo; Paediathrocin; Aknemycin; Ecolicin eye ointment; Ecolicin eye drops; Sanasepton gel 2%/-4%; Inderm gel 2%/-4%.

Erythromycin 500 Ratiopharm®

Note(s)
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Erythromycin has an extremely stable behaviour in the alkaline range. The optimum stability should always be artificially adjusted to a pH between 8.0-8.5. In acidic conditions it is destroyed within 1-3 hours! The combination with the acid labile Clotrimazol is possible. On the other hand, the combination of erythromycin with different glucocorticoids (stability optimums are often in the acidic range) is not very useful, as instabilities often occur due to different pH values (e.g. with a prednicarbate/erythromycin mixture). An exception is triamcinolone acetonide, which has its pH optimum at pH 7. At pH 7, 4 times the amount of eRythromycin in a formulation is required for the same efficacy.

Literature
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  1. Garcia-Lechuz JM et al (2007) Spanish Pneumococcal Study Network. Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness. Eur J Clin Microbiol Infect Dis 26: 247-253
  2. Wolff G (2009) Formulation tip: Many active ingredients - higher compatibility risk. Dermatologist 60: 534-535
  3. Wolff G (2013) Formulation tip: Individual formulations with ready-to-use dermatics. Dermatologist 64: 882-883

Tables
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Significant interactions of erythromycin

Anticoagulants, oral

Bleeding tendency ↑

Carbamazepine

Carbamazepine levels ↑

Ciclosporin

Ciclosporin levels ↑

Digoxin

Digoxin level ↑

Dihydroergotamine

Vasoconstriction ↑

Lincomycine

mutual effect ↓

Theophylline

Theophylline levels ↑

Authors

Last updated on: 29.10.2020