Erythromycin

A mixture of structurally very similar compounds produced by the bacterium Saccharopolyspora erythraea and used as a drug due to its antibiotic effect.

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

Notice!

Tonsillitis, pharyngitis, otitis media, whooping cough, pneumonia, skin infections, syphilis, gonorrhea, ulcus molle, diphtheria. Substitute preparation for penicillin allergy; topically for the treatment of acne papulopustulosa and for Crédé's prophylaxis.

• Systemic:
  • Pat. > 14 yrs.: 1.5-2 g/day p.o. or i.v.
  • Children/adolescents 8-14 yrs: 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 into the conjunctival sac every 2 hours.
  • Solution/gel/ointment/cream: After thorough skin cleansing, apply a thin layer twice a day to the affected skin areas.

Note! Do not use for more than 10-12 weeks due to the development of resistance. Do not use together with alcoholic benzoyl peroxide solutions.

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

• 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!

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:

• Erythromycin-containing solution
• Tinted Erythromycin Cream

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®

Erythromycin has an extremely stable behavior 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 hydrolytically inactivated within 1-3 hours! Combination with the acid-labile clotrimazole is possible. In contrast, the combination of erythromycin with various glucocorticoids (stability optima 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 optimum pH at pH 7. At pH 7, 4 times the amount of erythromycin is required in a formulation for the same efficacy.

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

Significant interactions of erythromycin