Erythromycin

Authors: Latest update by A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, December 2017.


What is erythromycin?

Erythromycin is a macrolide antibiotic. Other macrolide antibiotics include azithromycin, clarithromycin, roxithromycin.

What is erythromycin used for?

Erythromycin is prescribed by dermatologists for a variety of skin conditions including:

Erythromycin is particularly useful in individuals allergic to penicillin and in children that are too young for a tetracycline.

It is active against many gram-positive organisms (including Staphylococcus aureus, Streptococcus pyogenes, corynebacteria and clostridia) and some gram-negative organisms (Neisseria gonorrhoeae,). It is also effective for mycoplasma infections, syphilis and chlamydia.

Increasing bacterial resistance to erythromycin is reported.  The prolonged use of erythromycin has been questioned in dermatology, because it can lead to bacterial resistance to the pathogenStaphylococcus aureus (see MRSA), as well as resistance to acne bacteria (C acnes).

How does erythromycin work in skin diseases?

  • Erythromycin has bacteriostatic effects and prevents the proliferation of bacteria.
  • It inhibits pro-inflammatory cytokines such as IL-8 and decreases neutrophil oxidative bursts.

How is erythromycin taken?

Oral erythromycin is best taken fasting or just before meals. It comes in a number of bases and formulations.

  • Base compound
  • Estolate salt
  • Ethyl succinate salt
  • Stearate salt

It is also available as a topical preparation for acne. To reduce antibiotic resistance, a non-antibiotic compound such as benzoyl peroxide or a topical retinoid should be applied when using topical erythromycin.

Side effects of erythromycin

Erythromycin is generally well tolerated. When essential, erythromycin can be used in pregnancy and during breast feeding.

The following side effects may arise.

  • Gastrointestinal disturbance: nausea, vomiting, abdominal pain, diarrhoea, loss of appetite
  • Liver reactions: more common in those with pre-existing liver disease and potentially serious. Signs are dark urine, light stools, yellow eyes and skin (jaundice)
  • Allergic rashes: hives, fixed drug eruption, Stevens-Johnson – toxic epidermal necrolysis and rarely, anaphylaxis
  • Hearing loss: more likely on high doses in those with kidney disease
  • Life threatening arrhythmias (irregularities of the heartbeat ) have been reported in those with an electrical dysfunction that results in a prolonged Q-T interval on electrocardiograph (ECG). This can be due to congenital or acquired heart conditions or electrolyte disturbance (low potassium or magnesium levels)

Drug interactions with erythromycin

Erythromycin has important interactions with other medications. Tell your doctor the names of all medications you are taking, whether prescribed or purchased without prescription.

  • Erythromycin should not be taken with terfenadine, astemisole or cisapride because it could result in dangerous irregularities of the heartbeat and sudden death. These drugs are no longer available in New Zealand.
  • Other drugs that can prolong the Q-T interval include amiodarone, risperidone, haloperidol, citalopram and ciprofloxacin.

Erythromycin can increase the concentration of the following medications resulting in potentially toxic levels.

  • Warfarin (additional prothrombin time blood tests are necessary)
  • Statins, particularly simvastatin and atorvastatin. Toxicity results in muscle pain and weakness, which may be serious. If long-term treatment with a statin and erythromycin is required, suitable alternatives are fluvastatin, pravastatin and rosuvastatin.
  • Caffeine
  • Theophylline 
  • Carbamazepine 
  • Ciclosporin 
  • Ergotamine (increases peripheral ischaemia)  
  • Digoxin 
  • Triazolam  
  • Midazolam  
  • Alfentanil 
  • Pimozide 
  • Bromocryptine 
  • Disopyramide 
  • Phenytoin  
  • Valproate  
  • Tacrolimus 
  • Quinidine 
New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

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Related information

 

References

  • Adler BL, Kornmehl H, Armstrong AW. Antibiotic Resistance in Acne Treatment. JAMA Dermatol 2017 Jun 21;[EPub Ahead of Print]. PubMed.

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