erythromycin
Regulatory sources consulted
Approved indications
- Infections caused by susceptible organisms, including respiratory, skin, dental, and Chlamydia infections, when an oral macrolide is indicated.
Contraindications
Absolute
- Hypersensitivity to erythromycin or macrolides; prolonged QT, ventricular arrhythmia, or uncorrected electrolyte abnormalities; and treatment with astemizole, terfenadine, cisapride, pimozide, ergotamine/dihydroergotamine, lovastatin, simvastatin, or lomitapide.
Clinical warnings
- It may prolong QT and cause torsades de pointes; avoid with prolonged QT, hypokalemia or hypomagnesemia, significant bradycardia, and other QT-prolonging drugs. — CIMA/AEMPS, ficha técnica 39690
- Major warning · It may cause cholestatic hepatitis, hepatic necrosis, or liver failure; discontinue if signs of hepatic dysfunction develop. — CIMA/AEMPS, ficha técnica 39690
- Major warning · Clostridioides difficile-associated diarrhea and colitis may occur during or after treatment; assess significant diarrhea and discontinue if confirmed. — CIMA/AEMPS, ficha técnica 39690
Drug interactions
- ModerateSimvastatin and lovastatin
Mechanism: CYP3A4 inhibition markedly increases exposure and the risk of myopathy and rhabdomyolysis.
Recommendation: Stop these statins during treatment; use a non-CYP3A4-dependent alternative.
CIMA/AEMPS, ficha técnica 39690
- ModerateErgot alkaloids
Mechanism: It may cause acute ergotism by increasing exposure.
Recommendation: Do not coadminister.
CIMA/AEMPS, ficha técnica 39690
- ModerateQT-prolonging drugs
Mechanism: Effects on repolarization are additive.
Recommendation: Avoid the combination, especially with pimozide, cisapride, or class IA/III antiarrhythmics.
CIMA/AEMPS, ficha técnica 39690
- ModerateLomitapide
Mechanism: CYP3A4 inhibition markedly increases lomitapide exposure.
Recommendation: Do not coadminister.
CIMA/AEMPS, ficha técnica 39690
Adverse events
Common (≥1%)
Nausea, abdominal pain, diarrhea, and vomiting
Rare but serious
Anaphylaxis, severe hepatotoxicity, ventricular arrhythmia, and severe skin reactions
Pregnancy and lactation
Use during pregnancy only if needed. It passes into milk; weigh the benefit of breastfeeding against the risk of diarrhea or sensitization in the infant.
Recent literature (PubMed)
Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. The objective of this study was to provide evidence-based recommendations for the management of acne. A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Analysis is based on the best available evidence at the time of the systematic review. These guidelines provide evidence-based recommendations for the management of acne vulgaris.
Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy. This sheet is about exposure to erythromycin during pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. Roxithromycin is not approved for marketing in the United States by the U.S. Food and Drug Administration, but is available in other countries. Because of the low levels of roxithromycin in breastmilk, it would not be expected to cause adverse effects in breastfed infants. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash). Unconfirmed epidemiologic evidence indicates that the risk of infantile hypertrophic pyloric stenosis might be increased by maternal use of macrolide ant