What is the indication for Erythromycin (Erythromycin)

From the Guidelines

Erythromycin is an appropriate antibiotic for certain conditions, and its use should be guided by the most recent and highest quality evidence, prioritizing morbidity, mortality, and quality of life as outcomes. For the treatment of chlamydial conjunctivitis, erythromycin base or ethylsuccinate can be prescribed at 50 mg/kg body weight/day orally divided into four doses a day for 14 days 1. In the context of community-acquired pneumonia, erythromycin may be considered for certain cases, particularly those involving atypical bacteria such as Mycoplasma pneumoniae or Chlamydophila pneumoniae, where oral erythromycin (40 mg/kg/day in 4 doses) is an alternative therapy 1. It's crucial to note that erythromycin has significant drug interactions through CYP3A4 inhibition, so a medication review is essential before prescribing. Common side effects include gastrointestinal disturbances like nausea, vomiting, and abdominal pain. Additionally, there is an association between oral erythromycin and infantile hypertrophic pyloric stenosis in infants aged less than 6 weeks, so infants treated with erythromycin should be followed for signs and symptoms of this condition 1. The choice of erythromycin should be based on the specific clinical scenario, local resistance patterns, and patient factors, always prioritizing the most effective treatment with the least risk of adverse effects and promoting the best possible outcomes in terms of morbidity, mortality, and quality of life. Some key points to consider when prescribing erythromycin include:

• Dosage and duration of treatment vary depending on the condition being treated
• Potential drug interactions, particularly through CYP3A4 inhibition
• Monitoring for side effects, including gastrointestinal disturbances and, in infants, signs of infantile hypertrophic pyloric stenosis
• Consideration of local resistance patterns and patient-specific factors to guide antibiotic choice.

From the FDA Drug Label

Erythromycin tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the diseases listed below: Upper respiratory tract infections of mild to moderate degree caused by Streptococcus pyogenes; Streptococcus pneumoniae; Haemophilus influenzae Lower respiratory tract infections of mild to moderate severity caused by Streptococcus pyogenes or Streptococcus pneumoniae. Listeriosis caused by Listeria monocytogenes. Respiratory tract infections due to Mycoplasma pneumoniae Skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus Pertussis (whooping cough) caused by Bordetella pertussis. Diphtheria: Infections due to Corynebacterium diphtheriae, as an adjunct to antitoxin, to prevent establishment of carriers and to eradicate the organism in carriers. Erythrasma: In the treatment of infections due to Corynebacterium minutissimum Intestinal amebiasis caused by Entamoeba histolytica (oral erythromycins only). Extraenteric amebiasis requires treatment with other agents. Acute pelvic inflammatory disease caused by Neisseria gonorrhoeae: Erythrocin® Lactobionate-I. V. (erythromycin lactobionate for injection, USP) followed by erythromycin base orally, as an alternative drug in treatment of acute pelvic inflammatory disease caused by N. gonorrhoeae in female patients with a history of sensitivity to penicillin Erythromycins tablets are indicated for treatment of the following infections caused by Chlamydia trachomatis: conjunctivitis of the newborn, pneumonia of infancy, and urogenital infections during pregnancy When tetracyclines are contraindicated or not tolerated, erythromycin tablets are indicated for the treatment of uncomplicated urethral, endocervical, or rectal infections in adults due to Chlamydia trachomatis. When tetracyclines are contraindicated or not tolerated, erythromycin tablets are indicated for the treatment of nongonococcal urethritis caused by Ureaplasma urealyticum Primary syphilis caused by Treponema pallidum. Erythromycin (oral forms only) is an alternative choice of treatment for primary syphilis in patients allergic to the penicillins. In treatment of primary syphilis, spinal fluid should be examined before treatment and as part of the follow-up after therapy. Legionnaires’ Disease caused by Legionella pneumophila Although no controlled clinical efficacy studies have been conducted, in vitro and limited preliminary clinical data suggest that erythromycin may be effective in treating Legionnaires’ Disease

The indications for erythromycin include:

• Upper respiratory tract infections
• Lower respiratory tract infections
• Listeriosis
• Respiratory tract infections due to Mycoplasma pneumoniae
• Skin and skin structure infections
• Pertussis
• Diphtheria
• Erythrasma
• Intestinal amebiasis
• Acute pelvic inflammatory disease
• Infections caused by Chlamydia trachomatis
• Nongonococcal urethritis
• Primary syphilis
• Legionnaires’ Disease 2

From the Research

Erythromycin for State

• Erythromycin is a macrolide antibiotic that has been used to treat various infections, including respiratory tract and skin infections 3, 4, 5, 6, 7.
• The newer macrolides, such as azithromycin and clarithromycin, have several advantages over erythromycin, including improved oral bioavailability, longer half-life, and fewer gastrointestinal adverse effects 4, 5, 6, 7.
• Azithromycin and clarithromycin have enhanced antimicrobial activity compared to erythromycin, and are effective against a broader range of pathogens, including Mycobacterium avium complex (MAC), Haemophilus influenzae, and Chlamydia trachomatis 3, 4, 5, 6, 7.
• The clinical efficacy of azithromycin and clarithromycin has been similar to erythromycin for the treatment of upper and lower respiratory tract and skin and soft tissue infections 4, 6, 7.
• New therapeutic roles for azithromycin and clarithromycin include the use of azithromycin for C. trachomatis infections and the inclusion of clarithromycin or azithromycin as part of therapeutic regimens for disseminated MAC infections in HIV-infected patients 4, 5, 7.

Comparison of Macrolides

• Azithromycin has a larger volume of distribution and a longer tissue half-life compared to erythromycin and clarithromycin, allowing for shorter treatment regimens and improved patient compliance 3, 6.
• Clarithromycin has a longer serum half-life and better tissue penetration than erythromycin, allowing for twice-daily dosing for most common infections 3, 6.
• The cost of azithromycin and clarithromycin is substantially higher than that of erythromycin, although the convenience of single-dose azithromycin may be appealing for certain infections 5.

Safety and Efficacy

• Azithromycin and clarithromycin are generally well-tolerated, with fewer gastrointestinal adverse effects compared to erythromycin 4, 6, 7.
• The emergence of macrolide resistance is a concern, particularly with Streptococcus pneumoniae, group A streptococci, and Haemophilus influenzae 4.
• Analysis of safety data indicates differences among the macrolides in terms of drug interactions and use in pregnancy, with azithromycin and erythromycin being pregnancy category B drugs, and clarithromycin being a category C drug 6.