Erythromycin Ethyl Succinate

Erythromycin Ethyl Succinate is a prescription medication used for treating different types of bacterial infections. 

• Erythromycin Ethyl Succinate is available under the following different brand names: E.E.S., EryPed.

Adult and pediatric dosage 

Tablet

• 400mg

Oral suspension

• 200mg/5mL
• 400mg/5mL

General Dosing Recommendations

Adult dosage

• 400 mg orally every 6 hours
• May increase up to 4 g/day depending on infection severity

Pediatric dosage

Neonates

• Children below 1.2 kg: 20 mg/kg/day orally divided every 12 hours  
• 1.2 kg or more, 0-7 days old: 20 mg/kg/day orally divided every 12 hours
• Children above1.2 kg or more, 7 days or older: 30 mg/kg/day orally divided every 8 hours
• Chlamydial conjunctivitis and pneumonia: 50 mg/kg/day orally divided every 6 hours for 14days

Children

• Mild-to-moderate infections: 30-50 mg/kg/day orally divided every 6-12 hours
• Severe infection: 60-100 mg/kg/day orally divided every 6-12 hours

Intestinal amebiasis

Adult dosage

• 400 mg orally every 6 hours for 10-14 days

Legionnaire Disease

Adult dosage

• 400-1000 mg orally every 6 hours for 21 days

Pertussis

Adult dosage

• 40-50 mg/kg/day orally in divided doses for 5 to 14 days

Streptococcal infections

Adult dosage

• 400 mg orally divided every 12 hours for 10 days

Primary syphilis

Adult dosage

• 48-64 g orally in divided doses for 10-15 days

Urethritis

Adult dosage

• 800 mg orally every 8 hours for 7 days

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

Common side effects of Erythromycin Ethyl Succinate include:

• nausea,
• vomiting,
• abdominal pain,
• stomach cramping,
• loss of appetite,
• diarrhea,
• dizziness,
• headache,
• feeling tired,
• vaginal itching or discharge, or
• mild itching or skin rash.

Serious side effects of Erythromycin Ethyl Succinate include:

• hives,
• difficulty breathing,
• swelling of the face, lips, tongue, or throat,
• fever,
• sore throat,
• burning eyes,
• skin pain,
• red or purple skin rash with blistering and peeling,
• severe stomach pain,
• watery or bloody diarrhea (even if it occurs months after the last dose),
• headache with chest pain and severe dizziness,
• fainting,
• fast or pounding heartbeats,
• seizure,
• hearing problems,
• severe pain in the upper stomach spreading to the back,
• nausea,
• vomiting,
• loss of appetite,
• stomach pain (upper right side),
• tiredness,
• easy bruising,
• unusual bleeding,
• dark urine,
• clay-colored stools,
• yellowing of the skin or eyes (jaundice), and
• vomiting or irritableness with feeding (babies)

Rare side effects of Erythromycin Ethyl Succinate include:

• none 

This is not a complete list of side effects and other serious side effects or health problems that may occur as a result of the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may report side effects or health problems to FDA at 1-800-FDA-1088.

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Erythromycin Ethyl Succinate has severe interactions with the following drugs:
  • arsenic trioxide
  • dihydroergotamine
  • dihydroergotamine intranasal
  • disopyramide
  • elagolix
  • flibanserin
  • fluconazole
  • ibutilide
  • indapamide
  • cefazolinin
  • lomitapide
  • lonafarnib
  • lovastatin
  • pentamidine
  • pimozide
  • procainamide
  • quinidine
  • saquinavir
  • simvastatin
  • sotalol
• Erythromycin Ethyl Succinate has serious interactions with at least 266 other drugs
• Erythromycin Ethyl Succinate has moderate interactions with at least 277 other drugs
• Erythromycin Ethyl Succinate has minor interactions with at least 40 other drugs

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this product, tell your doctor or pharmacist about all your products. Keep a list of all your medications with you and share this information with your doctor and pharmacist. Check with your health care professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Documented hypersensitivity
• Coadministration with terfenadine, cisapride, astemizole, pimozide
• Coadministration with HMG-CoA reductase inhibitors that are extensively metabolized by CYP3A4 (lovastatin or simvastatin)
• Co-administration with ergotamine or dihydroergotamine

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Erythromycin Ethyl Succinate?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Erythromycin Ethyl Succinate?”

Cautions

• Caution in liver disease; estolate formulation may cause cholestatic jaundice; GI side effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur
• Hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice reported in patients receiving oral erythromycin products
• Prescribing therapy in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of development of drug-resistant bacteria
• Since erythromycin is principally excreted by the liver, caution should be exercised when erythromycin is administered to patients with impaired hepatic function
• Exacerbation of symptoms of myasthenia gravis and new onset of symptoms of myasthenic syndrome were reported in patients receiving erythromycin therapy
• Infantile hypertrophic pyloric stenosis (IHPS) in infants following erythromycin therapy was reported; a possible dose-response effect was reported; since erythromycin may be used in the treatment of conditions in infants which are associated with significant mortality or morbidity (such as pertussis or neonatal Chlamydia trachomatis infections), the benefit of therapy needs to be weighed against the potential risk of developing IHPS; parents should be informed to contact their physician if vomiting or irritability with feeding occurs
• Prolonged or repeated use of erythromycin may result in an overgrowth of no susceptible bacteria or fungi; if superinfection occurs, erythromycin should be discontinued, and appropriate therapy instituted
• When indicated, incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy; observational studies in humans have reported cardiovascular malformations after exposure to drug products containing erythromycin during early pregnancy
• QT Prolongation
  • Therapy has been associated with prolongation of QT interval and infrequent cases of arrhythmia; elderly patients may be more susceptible to drug-associated effects on QT interval
  • Cases of torsades de pointes spontaneously reported during postmarketing surveillance in patients receiving erythromycin; fatalities reported
  • Therapy should be avoided in patients with known prolongation of QT interval, patients with ongoing proarrhythmic conditions such as uncorrected hypokalaemia or hypomagnesemia, clinically significant bradycardia, and patients receiving Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents
• Syphilis in pregnancy
  • There have been reports suggesting erythromycin does not reach the fetus in adequate concentration to prevent congenital syphilis; infants born to women treated during pregnancy with oral erythromycin for early syphilis should be treated with an appropriate penicillin regimen
• Clostridium difficile associated diarrhea
  • Clostridium difficile associated diarrhea (CDAD) is reported with the use of nearly all antibacterial agents, including erythromycin, and may range in severity from mild diarrhea to fatal colitis
  • Treatment with antibacterial agents alters the normal flora of the colon leading to the overgrowth of C. difficile; C. difficile produces toxins A and B which contribute to the development of CDAD
  • Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy
  • CDAD must be considered in all patients who present with diarrhea following antibiotic use; careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents
  • If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued; appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated
• Drug interaction overview
  • Increased anticoagulant effects, which may be more pronounced in the elderly when erythromycin and oral anticoagulants (eg, warfarin) are used concomitantly, reported
  • Colchicine is a substrate for both CYP3A4 and the efflux transporter P-glycoprotein (P-GP); erythromycin is considered a moderate inhibitor of CYP3A4; a significant increase in colchicine plasma concentration is anticipated when co-administered with moderate CYP3A4 inhibitors such as erythromycin; if coadministration of colchicine and erythromycin is necessary, may need to reduce the starting dose of colchicine, and maximum colchicine dose lowered; monitor patients for clinical symptoms of colchicine toxicity
  • Erythromycin may increase systemic exposure (AUC) of sildenafil; consider reduction of sildenafil dosage
  • Erythromycin may decrease the clearance of triazolam, midazolam, and related benzodiazepines, increasing their effect
  • Post-marketing reports indicate that co-administration with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by vasospasm and ischemia of the central nervous system, extremities, and other tissues
  • There have been post-marketing reports of cardiac arrhythmias, ventricular tachycardia, ventricular fibrillation, and torsades de pointes, caused by coadministration of drugs that result in QT prolongation; fatalities reported

Pregnancy & Lactation

• May be acceptable during pregnancy
• Lactation
  • Distributed in breast milk, use with caution; AAP categorizes it as compatible with breastfeeding