Erythromycin Lactobionate

Erythromycin Lactobionate is a prescription medication used to treat the symptoms of Acute Pelvic Inflammatory Disease, Legionnaire Disease, and Streptococcal Infections. 

• Erythromycin Lactobionate is available under the following different brand names: Erythrocin Lactobionate

Common side effects of Erythromycin Lactobionate include:

• Severe stomach pain,
• Watery or bloody diarrhea (even if it occurs after the last dose),
• Liver problems, and
• Abnormal liver function tests

Serious side effects of Erythromycin Lactobionate 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 after the last dose),
• Headache with chest pain and severe dizziness,
• Fainting,
• Fast or pounding heartbeats,
• Seizure,
• Hearing problems (rare),
• 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, and
• Yellowing of the skin or eyes (jaundice)

Rare side effects of Erythromycin Lactobionate include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms include fast, irregular, or pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness, lightheadedness, or passing out.

This is not a complete list of side effects and other serious side effects or health problems that may occur because 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.

Adult and pediatric dosage

Injection

• 500 mg

General Dosing Recommendations

Adult and pediatric dosage

• 15-20 mg/kg/day Intravenous divided every 6 hours; infuse Intravenous over 1 hour  
• Up to 4 g/day may be administered for severe infections
• Geriatric: Increased risk for hearing loss in elderly patients with 4 g/day or more

Acute Pelvic Inflammatory Disease

Adult dosage

• 500 mg Intravenous every 6 hours for 3 days; followed by 500 mg orally every12 hours

Legionnaire Disease

Adult dosage

• 1-4 g Intravenous in divided doses

Streptococcal Infections

Adult dosage

• 250 mg orally every 12 hours

Usual Dosage Range, Infants & Children

Pediatric dosage

• 15-20 mg/kg/day Intravenous divided every 6 hours; infuse Intravenous over 1 hour  
• Higher doses may be administered for severe infection; not to exceed 4 g/day

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”

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 Lactobionate has severe interactions with the following drugs:
  • arsenic trioxide
  • dihydroergotamine
  • dihydroergotamine intranasal
  • disopyramide
  • elagolix
  • flibanserin
  • fluconazole
  • ibutilide
  • indapamide
  • lefamulin
  • lomitapide
  • lonafarnib
  • lovastatin
  • pentamidine
  • pimozide
  • procainamide
  • quinidine
  • saquinavir
  • simvastatin
  • sotalol
• Erythromycin Lactobionate has serious interactions with at least 275 other drugs.
• Erythromycin Lactobionate has serious interactions with at least 280 other drugs.
• Erythromycin Lactobionate has serious 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 healthcare professional or doctor for additional medical advice, or if you have health questions or concerns.

Contraindications

• Coadministration with terfenadine
• Coadministration with HMG-CoA reductase inhibitors that are extensively metabolized by CYP3A4 (lovastatin or simvastatin)
• Co-administration of erythromycin with ergotamine or dihydroergotamine

Effects of drug abuse

• None

Short-Term Effects

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

Long-Term Effects

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

Cautions

• 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 the 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 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 post-marketing 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 hypokalemia 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 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
  • 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
  • Increased anticoagulant effects, which may be more pronounced in the elderly when erythromycin and oral anticoagulants (. g, 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

Pregnancy and Lactation

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