Each tablet contains : Erythromycin Ethylsuccinate equivalent to Erythromycin 400mg
Presentation : Orange color,
18.8mm elongated tablet.
Indicated in the treatment of
infections caused by susceptible strains of designated organisms in the
diseases listed below : upper and lower respiratory tract infections that
caused by Streptococcus pyogenes and Streptococcus pneumoniae. Pertussis (
whooping cough ) caused by Bordetella pertussis. Skin and soft tissue
infections caused by Streptococcus pyogenes and Streptococcus aureus. Otitis
media, erythrasma, listeriosis, dipheteria, primary syphilis in patients
allergy to penicillin, prophylaxis of endocarditis.
Mechanisms of action :
Erythromycin and other macrolides
bind reversibly to the 50S subunit of the ribosome, resulting blockage of
the transpeptidation or translocation reactions, inhibition of protein
synthesis, and hence inhibition of cell growth. Its action is predominantly
bacteriostatic, but high concentrations are slowly bactericidal against the
ore sensitive strains. because of the ready penetration of macrolides into
white blood cells and macrophages there has been some interest in their
potential synergy with host defence mechanism in vivo. Its actions are
increased at moderately alkaline pH ( up to about 8.5 ), particularly in
Gram-negative species, probably because of the improved cellular penetration
of the nonionised form of the drug.
Erythromycin has a broad spectrum
activity. The pathogenic organisms which are usually sensitive to
Erythromycin include :
a) Gram-positive cocci :
Streptococcus pneumoniae, Strep pyogenes, Staphylococcus
b) Gram-positive organisms :
Bacillus anthracis, Corynebacterium diphtheriae etc.
c) Gram-negative cocci :
Neisseria meningitidis, N. gonnorrhoeae, Moraxela catarrhalis.
d) Gram-negative organisms :
Bordetella spp., Pasteurella, Haeemophilus ducreyi. Among
the gram-negative anarobes more than half of all strains of Bacteroides
fragilis and many Fusobacterium strains are resistant.
Fungi, yeast, and viruses are
resistant to erythromycin.
Erythromycin is a macrolide
antibiotic with a broad and essentially bacteriostatic action against many
Gram-positive and to a lesser extent some Gram-negative bacteria, as well as
other organisms including mycoplasmas, spirochaetes, chlamydiae, and
rickettsiae. Peak plasma concentration of erythromycin generally occurs
between 1 and 4 hours after administration. Higher peak concentraions may be
achieved on repeated administration four times daily. Erythromycin is widely
distributed throughout body tissues and fluids, although it does not cross
the blood-brain barrier well and concentrations in cerebrospinal fluid are
low. Relatively high concentrations are found in the liver and spleen.
Erythromycin crosses the placenta : foetal plasma concentrations are
variously stated to be 5 to 20% of those in the mother. It is distributed
into breast milk. Erythromycin is excreted in high concentrations in the
bile and 2 to 5% of an oral dose is excreted in the urine. The half-life of
erythromycin is usually reported to be roughly in the range 1.5 to 2.5
hours, although this may be somewhat longer in patients with renal
Dosage and administration :
Adults : 400mg ( 1 tablet ), 6
hourly or 800mg ( 2 tablets ), 12 hourly. Dosage may be increased up to 4g
per day according to the severity of the infection.
Contraindicated in patients with
known hypersensitivity to erythromycin, liver disease and hepatic
Side effects :
such as : abdominal discomfort and cramp, nausea, vomiting and diarrhoea;
pseudomembranous colitis, hepatotoxicity, ototoxicity. Allergic reactions
ranging from urticaria to anaphylaxis have occurred. Rarely, erhthromycin
has been associated with the production of ventricular arrythmias, including
ventricular tachycardia. Other side effects that have been reported in
patients receiving erythromycin include agranulocytosis, central
neurotoxicity including psychotic reactions and nightmares, myasthenia-like
syndrome and pancreatitis.
Since the erythromycin is
principally excreted by the liver, caution should be exercised when
administered to patients with impaired hepatic function. There have been
reports that erythromycin may aggravate the weakness of patients with
myasthenia gravis. Prolonged or repeated use of erythromycin may result in
an overgrowth of nonsusceptible bacteria or fungi. Caution should be also
taken when administered to patients with a history of arrhythmias.
Pseudomembranous colitis has been reported under the usage of erythromycin,
and may range in severity from mild to life threatening side effects.
Therefore, it is important to consider this diagnosis in patients who
present with diarrhoea subsequent to the administration of erythromycin.
Rhabdomyolysis with or without renal impairment has been reported in
seriously ill patients receiving erythromycin concomitantly with lovastatin.
Therefore, patient treated with this combination should be carefully
monitored for creatine kinase and serum transaminase levels.
Pregnancy and lactation :
Erythromycin should be used
during pregnancy only if clearly needed. Erythromycin is excreted in human
milk. Caution should be exercised when it is administered to nursing women.
Drug interactions :
Erythromycin should be given with
caution if other hepatotoxic or ototoxic drugs are given concomitantly.
Cimetidine might increase the risk of toxicity. The use of erythromycin in
patients concurrently taking drugs metabolized by the cytochrome P450 system
may be associated with elevation in serum levels of other drugs, such as :
carbamazepine, cyclosporine, phenytoin, alfentanil, cisapride, lovastatin,
bromocriptine, valproate, terfenadine and astimazole. Toxicity of
theophylline, digoxin, ergotamine and midazolam may occur when administered
concurrently with erythromycin due to the increase of the serum level and
decrease of clearance of the particular drug.
Overdosage and treatment :
In case of overdosage,
erythromycin should be discontinued. Overdosage should be handled with the
prompt elimination of unabsorbed drug and all other appropriate measures
should be instituted.
Erythromycin is not removed by
perintoneal dialysis or hemodialysis.
Keep container well closed. Store
below 28°C. Protect from light