Erythromycin

Erythromycin is a Macrolide Antibiotic belonging to antimicrobial agent.

Erythromycin is a macrolide antibiotic used to treat and prevent a variety of bacterial infections.

Erythromycin variable and unreliable due to instability in gastric acid. The Time to peak plasma concentration is approximately 1-4 hours. Erythromycin widely distributed throughout the body tissues and fluids; diffused into CSF (minimal). Erythromycin crosses the placenta and enters breast milk. The volume of distribution is about 0.64 L/kg. Plasma protein binding is about 70-75% (as the base), 95% (as the propionate ester). Erythromycin partly metabolized in the liver via N-demethylation by CYP3A4 into inactive, unidentified metabolites. Mainly via faeces; urine (2-15% as unchanged drug). The elimination half-life is about 1.5-2.5 hours.

Erythromycin shows common side effects like Upset stomach, diarrhea, vomiting, stomach pain, loss of appetite.

Erythromycin is available in the form of Oral Tablet, Oral capsule, Oral suspension, Ophthalmic ointment, and Injectable solution.

Erythromycin is available in India, US, China, Japan, Singapore, France, Spain, Italy, Malaysia, Russia, and Australia.

Erythromycin belongs to the antimicrobial agent acts as a Macrolide Antibiotic.

To replicate, bacteria require a specific process of protein synthesis, enabled by ribosomal proteins. Erythromycin acts by inhibition of protein synthesis by binding to the 23S ribosomal RNA molecule in the 50S subunit of ribosomes in susceptible bacterial organisms. It stops bacterial protein synthesis by inhibiting the transpeptidation/translocation step of protein synthesis and by inhibiting the assembly of the 50S ribosomal subunit. This results in the control of various bacterial infections. The strong affinity of macrolides, including erythromycin, for bacterial ribosomes, supports their broad‐spectrum antibacterial activities.

The Data of onset and duration of action of Erythromycin is not clinically established.

The Tmax of Erythromycin is approximately 1-4 hours.

Erythromycin is available in the form of Oral Tablet, Oral capsule, Oral suspension, Ophthalmic ointment, and Injectable solution.

Erythromycin Tablet and Capsule are taken orally, usually once daily or in divided dose.

Erythromycin Injectable solution is given via intravenous route.

Erythromycin Ophthalmic ointment: Instill ~1 cm ribbon into affected eye(s) 4 times daily for 7 days.

Erythromycin is a macrolide antibiotic used to treat bacterial infections of the lungs, skin, bones, stomach, and intestine. It can be also used with other antibiotics to treat certain infections caused by sexually transmitted organisms like Chlamydia trachomatis, Neisseria gonorrhoeae, etc. The topical forms of erythromycin are used to treat acne or pimples. This medicine kills or stops the growth of bacteria causing the infection. It is not effective against infections caused by viruses.

Erythromycin is a Macrolide Antibiotic belonging to antimicrobial agent.

Erythromycin inhibits protein synthesis by binding to the 50S ribosomal subunit of susceptible organisms resulting in blockage of transpeptidation.

Erythromycin is approved for use in the following clinical indications

Adult indication

• Legionnaire disease
• Pertussis
• Rheumatic fever, secondary prophylaxis
• Ocular infections, superficial

Although not approved, there have been certain off-label indications. These include

• Sexually transmitted infections
• Acne vulgaris, inflammatory, moderate to severe
• Bartonella spp. Infection
• Chronic obstructive pulmonary disease, prevention of exacerbations
• Endoscopy/esophagogastroduodenoscopy, adjunctive prokinetic agent
• Gastroparesis
• Surgical prophylaxis

Pediatric indication

• Acne, moderate to severe; treatment
• Bartonella spp. Infections
• Catheter; exit-site or tunnel infection
• Chancroid
• Chlamydia trachomatis infection
• Gastroparesis or prokinetic agent for GI motility
• Impetigo
• Lyme disease, erythema migrans
• Pertussis; treatment or postexposure prophylaxis
• Pneumococcal prophylaxis in patients with sickle cell disease
• Pneumonia, atypical, community-acquired
• Surgical prophylaxis; colorectal
• Blepharitis
• Conjunctivitis

Adult Dose

• Legionnaire disease

IV: 1 to 4 g/day in divided doses.

Oral: 1.6 to 4 g (ethyl succinate) daily or 1 to 4 g (base or stearate) daily in divided doses.

• Pertussis

Oral: 500 mg (base) every 6 hours for 14 days.

• Rheumatic fever, secondary prophylaxis

Oral: 250 mg (base or stearate) or 400 mg (ethyl succinate) twice daily.

• Ocular infections, superficial

Blepharitis: Instill ~1 cm ribbon into affected eye(s) one or more times daily or at bedtime.

Conjunctivitis: Instill ~1 cm ribbon into affected eye(s) 4 times daily for 7 days.

• Sexually transmitted infections

Chancroid (off-label use)

Oral: 500 mg (base) 3 times daily for 7 days.

Granuloma inguinale (donovanosis) (alternative agent) (off-label use)

Oral: 500 mg (base) 4 times daily for >3 weeks and until resolution of lesions.

Lymphogranuloma venereum (alternative agent) (off-label use)

Oral: 500 mg (base) 4 times daily for 21 days

• Acne vulgaris, inflammatory, moderate to severe

Oral: 250 to 500 mg (base) twice daily. Treatment should ideally be limited to 3 to 4 months to minimize the risk of resistance.

• Bartonella spp. Infection

Patients with HIV

• Bacillary angiomatosis, cat scratch disease, peliosis hepatis, bacteremia, and osteomyelitis

Oral, IV: 500 mg every 6 hours.

• Other severe infections (excluding CNS infections or endocarditis)

Oral, IV: 500 mg every 6 hours in combination with rifampin; IV therapy may be needed initially.

• Suppressive therapy

Oral: 500 mg every 6 hours. Continue until patient has received ≥3 months of therapy and CD4 count is >200 cells/mm³ for ≥6 months; some experts discontinue therapy only if Bartonella titers have also decreased 4-fold.

Patients without HIV

• Bacillary angiomatosis (BA), peliosis hepatitis (PH)

Oral: 500 mg (base) 4 times daily for 3 months (BA) or 4 months.

• Chronic obstructive pulmonary disease, prevention of exacerbations

Oral: 200 to 400 mg/day (formulation not specified) (Suzuki 2001) or 250 mg (stearate) twice daily.

• Endoscopy/esophagogastroduodenoscopy, adjunctive prokinetic agent

IV: 250 mg as a single dose infused over 20 to 30 minutes; perform endoscopy 20 to 90 minutes after infusion is complete.

• Gastroparesis

IV: 3 mg/kg administered over 45 minutes every 8 hours.

Oral: Patients refractory/intolerant to other prokinetic agents (eg, metoclopramide, domperidone): 250 to 500 mg (base) 3 times daily before meals. Limit duration of therapy, tachyphylaxis may occur after 4 weeks

• Surgical prophylaxis

Oral: 1 g erythromycin base per dose at 1 PM, 2 PM, and 11 PM on the day before 8 AM surgery combined with mechanical cleansing of the large intestine, oral neomycin. Perioperative IV antibiotics are also given on the day of surgery.

Pediatric Dose

• Acne, moderate to severe; treatment

Oral: 250 to 500 mg 1 to 2 times daily; maximum daily dose: 50 mg/kg/day. Treatment should ideally be limited to 3 to 4 months to minimize development of resistance; some experts suggest discontinuation or tapering within 1 to 2 months once new lesions have stopped emerging; consistent follow-up and reevaluation is recommended for patients who require a longer course.

• Bartonella spp. Infections

Treatment (bacillary angiomatosis, peliosis hepatitis)

Infants, Children, and Adolescents: Oral: Ethyl succinate: 10 mg/kg/dose every 6 hours; maximum dose: 500 mg/dose.

Suppressive therapy for patients with HIV who experience a relapse after receiving a ≥3-month course of primary treatment

Adolescents: Oral: 500 mg every 6 hours. Continue until patient has received at least 3 to 4 months of therapy and CD4 count is >200 cells/mm³ for ≥6 months; some experts discontinue therapy only if Bartonella titers have also decreased 4-fold.

• Catheter; exit-site or tunnel infection

Infants, Children, and Adolescents: Oral: Base: 30 to 50 mg/kg/day divided every 6 to 8 hours; maximum dose: 500 mg/dose. Exit-site infection should be treated for ≥2 weeks and for at least 7 days after complete resolution, or for ≥3 weeks for Staphylococcus aureus; tunnel infection should be treated for 2 to 4 weeks.

• Chancroid

Children ≥45 kg and Adolescents: Base: Oral: 500 mg every 8 hours for 7 days.

• Chlamydia trachomatis infection

Infants and Children weighing <45 kg: Oral: Base, ethyl succinate: 12.5 mg/kg/dose every 6 hours for 14 days; maximum dose: 500 mg/dose. In infants with pneumonia, a second course may be necessary due to efficacy of ~80%.

Adolescents: Lymphogranuloma venereum: Oral: Base: 500 mg 4 times daily for 21 days.

• Gastroparesis or prokinetic agent for GI motility

Infants, Children, and Adolescents:

Response determination during gastric emptying study

IV: 2.8 mg/kg infused over 20 minutes; maximum dose: 250 mg/dose.

Treatment

Oral: 3 mg/kg/dose 4 times daily; may increase as needed to effect up to 10 mg/kg/dose; maximum dose: 250 mg/dose.

• Impetigo

Infants, Children, and Adolescents: Oral: Base, ethylsuccinate: 40 mg/kg/day divided every 6 to 8 hours for 7 days; maximum dose (base): 250 mg/dose; maximum dose (ethylsuccinate): 400 mg/dose.

• Lyme disease, erythema migrans

Infants, Children, and Adolescents: Oral: 12.5 mg/kg/dose every 6 hours for 14 to 21 days; maximum dose: 500 mg/dose.

• Pertussis; treatment or postexposure prophylaxis

Infants <6 months: Oral: 10 to 12.5 mg/kg/dose every 6 hours for 14 days; maximum dose: 500 mg/dose.

Infants ≥6 months and Children: Oral: 10 to 12.5 mg/kg/dose every 6 hours for 7 to 14 days; maximum dose: 500 mg/dose.

Adolescents: Oral: 500 mg every 6 hours for 7 to 14 days.

• Pneumococcal prophylaxis in patients with sickle cell disease

Infants ≥4 months and Children <3 years: Oral: 125 mg twice daily.

Children 3 to <5 years: Oral: 250 mg twice daily.

• Pneumonia, atypical, community-acquired

Infants >3 months, Children, and Adolescents

Mild infection or step-down therapy: Oral: 10 mg/kg/dose every 6 hours; maximum dose: 500 mg/dose.

Moderate to severe infection: IV: Lactobionate: 5 mg/kg/dose every 6 hours; maximum dose: 1,000 mg/dose.

• Surgical prophylaxis; colorectal

Children and Adolescents: Oral: Base: 20 mg/kg/dose for 3 doses; administer at 1 PM, 2 PM, and 11 PM on the day before surgery, in combination with mechanical cleansing of the large intestine and oral neomycin; maximum dose: 1,000 mg/dose; perioperative IV antibiotics should also be administered on the day of surgery.

• Blepharitis

Ophthalmic: Instill ~1 cm ribbon into affected eye(s) 1 or more times daily or at bedtime.

• Conjunctivitis

Ophthalmic: Instill ~1 cm ribbon into affected eye(s) 4 times daily for 7 days.

Erythromycin is available in various strengths as 333mg, 250mg, 500mg (1 ea.), 600mg, 1000mg (1 ea.) and 5mg/g (1g, 3.5g).

Erythromycin is available in the form of Oral Tablet, Oral capsule, Oral suspension, Ophthalmic ointment, and Injectable solution.

Avoid consumption of grapefruit products.

Erythromycin is contraindicated in patients with

• Erythromycin is contraindicated in patients with known hypersensitivity to this antibiotic.
• Erythromycin is contraindicated in patients taking terfenadine, astemizole, pimozide, or cisapride.

• Altered cardiac conduction

Macrolides have been associated with rare QTc prolongation and ventricular arrhythmias, including torsade de pointes; use with caution in patients at risk of prolonged cardiac repolarization; avoid use in patients with prolonged QT interval, uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or concurrent use of Class IA (eg, quinidine, procainamide) or Class III (eg, amiodarone, dofetilide, sotalol) antiarrhythmic agents.

• Superinfection

Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months post antibiotic treatment.

Erythromycin is excreted in human milk. Caution should be exercised when erythromycin is administered to a nursing woman.

There is no evidence of teratogenicity or any other adverse effect on reproduction in female rats fed erythromycin base (up to 0.25 percent of diet) prior to and during mating, during gestation, and through weaning of two successive litters. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Avoid consumption of grapefruit products.

Common

● Fungal or bacterial superinfection (e.g. C. difficile-associated diarrhoea [CDAD]), myasthenia gravis; infantile hypertrophic pyloric stenosis; hepatotoxicity, Eosinophilia, Chest pain, palpitations, Deafness, tinnitus, Mitochondrial optic neuropathy, Nausea, vomiting, abdominal pain, diarrhoea, pancreatitis, Fever, malaise, Cholestatic hepatitis, jaundice, hepatic dysfunction, hepatomegaly, hepatic failure, hepatocellular hepatitis, Allergic reactions, anaphylaxis, Increased liver enzymes, Anorexia, Convulsions, vertigo, Hallucinations, confusion, Interstitial nephritis, Pruritus, urticaria, exanthema, angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme, burning, peeling, drying, reddening, oiliness and pruritus at the application site, Hypotension.

• Abemaciclib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Abemaciclib. Management: Monitor for increased abemaciclib toxicities if combined with moderate CYP3A4 inhibitors. Consider reducing the abemaciclib dose in 50 mg decrements if necessary.
• Acalabrutinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Acalabrutinib. Management: Reduce acalabrutinib dose to 100 mg once daily with concurrent use of a moderate CYP3A4 inhibitor. Monitor patient closely for both acalabrutinib response and evidence of adverse effects with any concurrent use.
• Afatinib: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Afatinib. Management: If combined, administer the P-gp inhibitor simultaneously with, or after, the dose of afatinib. Monitor closely for signs and symptoms of afatinib toxicity and if the combination is not tolerated, reduce the afatinib dose by 10 mg.
• Alfentanil: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Alfentanil. Management: If use of alfentanil and moderate CYP3A4 inhibitors is necessary, consider dosage reduction of alfentanil until stable drug effects are achieved. Frequently monitor patients for respiratory depression and sedation when these agents are combined.
• Alfuzosin: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Alfuzosin.
• Aliskiren: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Aliskiren.
• Alitretinoin (Systemic): CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Alitretinoin (Systemic).
• Alprazolam: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Alprazolam. Management: Consider alternatives to this combination when possible. If combined, consider an alprazolam dose reduction and monitor for increased alprazolam effects and toxicities (eg, sedation, lethargy).
• Amiodarone: May enhance the QTc-prolonging effect of Erythromycin (Systemic). Erythromycin (Systemic) may enhance the QTc-prolonging effect of Amiodarone. Erythromycin (Systemic) may increase the serum concentration of Amiodarone.
• Amisulpride (Oral): May enhance the QTc-prolonging effect of QT-prolonging Agents (Moderate Risk).
• Amlodipine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Amlodipine.
• Apixaban: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase the serum concentration of Apixaban.
• Aprepitant: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Aprepitant.
• Aripiprazole: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Aripiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy, indication, or dosage form. Consult full interaction monograph for specific recommendations.
• Avanafil: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Avanafil. Management: The maximum avanafil dose is 50 mg per 24-hour period when used together with a moderate CYP3A4 inhibitor. Patients receiving such a combination should also be monitored more closely for evidence of adverse effects (eg, hypotension, syncope, priapism).
• Avapritinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Avapritinib. Management: Avoid use of moderate CYP3A4 inhibitors with avapritinib. If this combination cannot be avoided, reduce the avapritinib dose to 100 mg daily for the treatment of GIST or to 50 mg daily for the treatment of advanced systemic mastocytosis.
• Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy.
• Benzhydrocodone: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Benzhydrocodone. Specifically, the concentration of hydrocodone may be increased.
• Berotralstat: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Berotralstat. Management: Decrease the berotralstat dose to 110 mg daily when combined with P-glycoprotein (P-gp) inhibitors.
• Brexpiprazole: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Brexpiprazole. Management: The brexpiprazole dose should be reduced to 25% of usual if used together with both a moderate CYP3A4 inhibitor and a strong or moderate CYP2D6 inhibitor, or if a moderate CYP3A4 inhibitor is used in a CYP2D6 poor metabolizer.
• Brigatinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Brigatinib. Management: Avoid concurrent use of brigatinib with moderate CYP3A4 inhibitors when possible. If such a combination cannot be avoided, reduce the dose of brigatinib by approximately 40% (ie, from 180 mg to 120 mg, from 120 mg to 90 mg, or from 90 mg to 60 mg).
• Bromocriptine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Bromocriptine. Management: The bromocriptine dose should not exceed 1.6 mg daily with use of a moderate CYP3A4 inhibitor. The Cycloset brand specifically recommends this dose limitation, but other bromocriptine products do not make such specific recommendations.
• Budesonide (Systemic): CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Budesonide (Systemic). Management: Avoid the concomitant use of CYP3A4 inhibitors and oral budesonide. If patients receive both budesonide and CYP3A4 inhibitors, they should be closely monitored for signs and symptoms of corticosteroid excess.
• Buspirone: Erythromycin (Systemic) may increase the serum concentration of Buspirone. Management: Limit the buspirone dose to 2.5 mg twice daily and monitor for increased buspirone effects/toxicities if combined with erythromycin. Dose adjustments of buspirone or erythromycin should be based on clinical assessments.
• Calcium Channel Blockers (Nondihydropyridine): Erythromycin (Systemic) may increase the serum concentration of Calcium Channel Blockers (Nondihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may increase the serum concentration of Erythromycin (Systemic).
• Cannabis: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be increased.
• Cariprazine: CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Cariprazine. Specifically, concentrations of didesmethylcariprazine (DDCAR), the primary active metabolite of cariprazine, may increase. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cariprazine.
• Ceritinib: May enhance the QTc-prolonging effect of Erythromycin (Systemic). Ceritinib may increase the serum concentration of Erythromycin (Systemic). Erythromycin (Systemic) may increase the serum concentration of Ceritinib. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Cilostazol: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cilostazol. Management: Decrease the dose of cilostazol to 50 mg twice daily when combined with moderate CYP3A4 inhibitors.
• Cisapride: May enhance the QTc-prolonging effect of Erythromycin (Systemic). Erythromycin (Systemic) may enhance the QTc-prolonging effect of Cisapride. Erythromycin (Systemic) may increase the serum concentration of Cisapride.
• Citalopram: May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Citalopram.
• Clindamycin (Topical): Erythromycin (Systemic) may diminish the therapeutic effect of Clindamycin (Topical). Management: Consider avoiding the concomitant use of systemic erythromycin and topical clindamycin when treating acne vulgaris. This recommendation does not appear to apply to intravaginal use of clindamycin for the treatment of bacterial vaginosis.
• Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).
• Clopidogrel: Erythromycin (Systemic) may diminish the antiplatelet effect of Clopidogrel.
• Cobicistat: May increase the serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination when cobicistat is combined with atazanavir or darunavir. If combined, monitor for increased erythromycin and cobicistat effects/toxicities.
• Cobimetinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Cobimetinib. Management: Avoid this combination when possible. If concurrent short term (14 days or less) use cannot be avoided, reduce the cobimetinib dose from 60 mg to 20 mg daily. Avoid concomitant use in patients already receiving reduced cobimetinib doses.
• Colchicine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Colchicine. Management: Reduce colchicine dose as directed when using with a moderate CYP3A4 inhibitor and increase monitoring for colchicine-related toxicity. See interaction monograph for details. Use extra caution in patients with impaired renal and/or hepatic function.
• Colchicine: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Colchicine. Colchicine distribution into certain tissues (e.g., brain) may also be increased. Management: Colchicine is contraindicated in patients with impaired renal or hepatic function who are also receiving a P-gp inhibitor. In those with normal renal and hepatic function, reduce colchicine dose as directed. See interaction monograph for details.
• Crizotinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Crizotinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Crizotinib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• CYP3A4 Inhibitors (Strong): May increase the serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination when possible. If combined, monitor for increased erythromycin effects and toxicities, including QTc interval prolongation.
• Dabrafenib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Dabrafenib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Dabrafenib. Management: Monitor for QTc interval prolongation, ventricular arrhythmias, and dabrafenib adverse effects when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Dapoxetine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Dapoxetine. Management: The dose of dapoxetine should be limited to 30 mg per day when used together with a moderate inhibitor of CYP3A4.
• Daridorexant: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Daridorexant. Management: Limit the daridorexant dose to 25 mg, no more than once per night, when combined with moderate CYP3A4 inhibitorsDarifenacin: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Darifenacin.
• Domperidone: May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Domperidone.
• Edoxaban: Erythromycin (Systemic) may increase the serum concentration of Edoxaban. Management: In patients treated for DVT/PE, reduce the edoxaban dose to 30 mg daily when combined with erythromycin. No dose adjustment is recommended for patients treated for atrial fibrillation. Monitor for increased edoxaban toxicities (ie, bleeding) when combined.
• Elexacaftor, Tezacaftor, and Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Elexacaftor, Tezacaftor, and Ivacaftor. Management: When combined with moderate CYP3A4 inhibitors, two elexacaftor/tezacaftor/ivacaftor (100 mg/50 mg/75 mg) tablets should be given in the morning, every other day. Ivacaftor (150 mg) should be given in the morning, every other day on alternate days.
• Eliglustat: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Eliglustat. Management: Reduce eliglustat dose to 84 mg daily in CYP2D6 EMs when used with moderate CYP3A4 inhibitors. Avoid use of moderate CYP3A4 inhibitors in CYP2D6 IMs or PMs. Use in CYP2D6 EMs or IMs also taking strong or moderate CYP2D6 inhibitors is contraindicated.
• Encorafenib: May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Encorafenib. Management: Avoid use of encorafenib and moderate CYP3A4 inhibitors when possible. If combined, decrease encorafenib dose from 450 mg to 225 mg; 300 mg to 150 mg; and 225 mg or 150 mg to 75 mg. Monitor closely for QT interval prolongation.
• Fexinidazole: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Fexinidazole. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may decrease serum concentrations of the active metabolite(s) of Fexinidazole. Management: Consider alternatives to this combination. If combined, monitor for QT interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QT prolongation may be at even higher risk. Also monitor for reduced fexinidazole efficacy.
• Flibanserin: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Flibanserin. Management: Use of flibanserin with moderate CYP3A4 inhibitors is contraindicated. If starting flibanserin, start 2 weeks after the last dose of the CYP3A4 inhibitor. If starting a CYP3A4 inhibitor, start 2 days after the last dose of flibanserin.
• Fluorouracil Products: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Fluorouracil Products. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Guanfacine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Guanfacine. Management: Reduce the extended-release guanfacine dose 50% when combined with a moderate CYP3A4 inhibitor. Monitor for increased guanfacine toxicities when these agents are combined.
• Haloperidol: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Ibrutinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ibrutinib. Management: When treating B-cell malignancies, decrease ibrutinib to 280 mg daily when combined with moderate CYP3A4 inhibitors. When treating graft versus host disease, monitor patients closely and reduce the ibrutinib dose as needed based on adverse reactions.
• Infigratinib: CYP3A4 Inhibitors (Moderate) may decrease serum concentrations of the active metabolite(s) of Infigratinib. CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Infigratinib. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Infigratinib.
• Irinotecan Products: CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, the serum concentration of SN-38 may be increased. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Irinotecan Products.
• Isavuconazonium Sulfate: CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Isavuconazonium Sulfate. Specifically, CYP3A4 Inhibitors (Moderate) may increase isavuconazole serum concentrations.
• Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ivacaftor. Management: Ivacaftor dose reductions may be required; consult full drug interaction monograph content for age- and weight-specific dosage recommendations.
• Ivosidenib: May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Ivosidenib. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Lefamulin: May enhance the QTc-prolonging effect of QT-prolonging CYP3A4 Substrates. Management: Do not use lefamulin tablets with QT-prolonging CYP3A4 substrates. Lefamulin prescribing information lists this combination as contraindicated.
• Levoketoconazole: QT-prolonging CYP3A4 Substrates may enhance the QTc-prolonging effect of Levoketoconazole. Levoketoconazole may increase the serum concentration of QT-prolonging CYP3A4 Substrates.
• Lidocaine (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Lidocaine (Systemic). Specifically, concentrations of monoethylglycinexylidide (MEGX) may be increased. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Lidocaine (Systemic).
• Lurasidone: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Lurasidone. Management: US labeling recommends reducing lurasidone dose by 50% with a moderate CYP3A4 inhibitor and initiating 20 mg/day, max 80 mg/day. Some non-US labels recommend initiating lurasidone 20 mg/day, max 40 mg/day. Avoid concurrent use of grapefruit products.
• Lurbinectedin: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Lurbinectedin. Management: Avoid concomitant use of lurbinectedin and moderate CYP3A4 inhibitors when possible. If combined, consider a lurbinectedin dose reduction as clinically indicated.
• Mavacamten: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Mavacamten. Management: Start mavacamten at 5 mg/day if stable on a moderate CYP3A4 inhibitor. For those stable on mavacamten who are initiating a moderate CYP3A4 inhibitor, reduce mavacamten dose by one dose level.
• Mequitazine: Erythromycin (Systemic) may enhance the arrhythmogenic effect of Mequitazine. Management: Concurrent administration of intravenous erythromycin with mequitazine is contraindicated.
• Methadone: May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Methadone. Management: Consider alternatives to this drug combination. If combined, monitor for increased methadone toxicities (eg, respiratory depression, QTc interval prolongation). Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Midazolam: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Midazolam. Management: Avoid concomitant use of nasal midazolam and moderate CYP3A4 inhibitors. Consider alternatives to use with oral midazolam whenever possible and consider using lower midazolam doses. Monitor patients for sedation and respiratory depression if combined.
• Mitapivat: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Mitapivat. Management: When coadministered with moderate CYP3A4 inhibitors, doses of mitapivat should not exceed 20 mg twice daily. Additionally, patients should be monitored for changes in hemoglobin response and increased mitapivat adverse effects.
• Mobocertinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Mobocertinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentrations of the active metabolite(s) of Mobocertinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Mobocertinib. Management: Avoid use of QT prolonging moderate CYP3A4 inhibitors with mobocertinib when possible. If combined, the mobocertinib dose should be reduced by approximately 50% (ie, from 160 mg to 80 mg, 120 mg to 40 mg, or 80 mg to 40 mg). Monitor QTc interval closely.
• Naloxegol: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Naloxegol. Management: The use of naloxegol and moderate CYP3A4 inhibitors should be avoided. If concurrent use is unavoidable, reduce naloxegol dose to 12.5 mg once daily and monitor for signs of opiate withdrawal (eg, hyperhidrosis, chills, diarrhea, anxiety, irritability).
• Olaparib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Olaparib. Management: Avoid use of moderate CYP3A4 inhibitors with olaparib, if possible. If such concurrent use cannot be avoided, the dose of olaparib tablets should be reduced to 150 mg twice daily and the dose of olaparib capsules should be reduced to 200 mg twice daily.
• Ondansetron: May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Paclitaxel (Protein Bound): CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Paclitaxel (Protein Bound).
• Pazopanib: Erythromycin (Systemic) may enhance the QTc-prolonging effect of Pazopanib. Erythromycin (Systemic) may increase the serum concentration of Pazopanib.
• Pemigtanib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Pemigatinib. Management: If combined use cannot be avoided, reduce the pemigatinib dose from 13.5 mg daily to 9 mg daily, or from 9 mg daily to 4.5 mg daily. Resume prior pemigatinib dose after stopping the moderate inhibitor once 3 half-lives of the inhibitor have passed.
• Pentamidine (Systemic): May enhance the QTc-prolonging effect of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Pexidartinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Pexidartinib. Management: Avoid use of pexidartinib with moderate CYP3A4 inhibitors if possible. If combined, the pexidartinib dose should be reduced. Decrease 800 mg or 600 mg daily doses to 200 mg twice daily. Decrease doses of 400 mg per day to 200 mg once daily.
• Pitavastatin: Erythromycin (Systemic) may increase the serum concentration of Pitavastatin. Management: Limit pitavastatin to a maximum of 1 mg/day when used in combination with erythromycin. If this combination is used, monitor patients more closely for evidence of pitavastatin toxicity.
• Pravastatin: Erythromycin (Systemic) may increase the serum concentration of Pravastatin. Management: Limit pravastatin dose to a maximum of 40 mg/day when used in combination with erythromycin. If this combination is used, monitor patients more closely for evidence of pravastatin toxicity.
• Quetiapine: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Quetiapine. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Quetiapine. Management: Monitor for increased quetiapine toxicities including QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Ranolazine: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Ranolazine. Management: Limit the ranolazine dose to a maximum of 500 mg twice daily in patients concurrently receiving moderate CYP3A4 inhibitors. Monitor for increased ranolazine effects and toxicities during concomitant use.
• Regorafenib: CYP3A4 Inhibitors (Moderate) may decrease serum concentrations of the active metabolite(s) of Regorafenib. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Regorafenib.
• Relugolix: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Relugolix. Management: Avoid coadministration of relugolix with oral P-gp inhibitors whenever possible. If combined, take relugolix at least 6 hours prior to the P-gp inhibitor and monitor patients more frequently for adverse reactions.
• Relugolix, Estradiol, and Norethindrone: P-glycoprotein/ABCB1 Inhibitors may increase the serum concentration of Relugolix, Estradiol, and Norethindrone. Management: Avoid use of relugolix/estradiol/norethindrone with P-glycoprotein (P-gp) inhibitors. If concomitant use is unavoidable, relugolix/estradiol/norethindrone should be administered at least 6 hours before the P-gp inhibitor.
• Rilpivirine: Macrolide Antibiotics may increase the serum concentration of Rilpivirine. Management: Consider the use of azithromycin or another non-macrolide alternative when appropriate to avoid this potential interaction.
• Rimegepant: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Rimegepant. Management: If taking Rimegepant for the acute treatment of migraine, avoid a second dose of Rimegepant within 48 hours when used concomitantly with moderate CYP3A4 inhibitors. No dose adjustment needed if using rimegepant for prevention of episodic migraine.
• Risperidone: May enhance the QTc-prolonging effect of Erythromycin (Systemic). Erythromycin (Systemic) may increase the serum concentration of RisperiDONE. Management: Monitor for increased risperidone toxicities, including QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Rivaroxaban: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase the serum concentration of Rivaroxaban. Management: No action is needed in patients with normal renal function. Do not use this combination in patients with estimated creatinine clearance 15 to 80 mL/min unless prospective benefits outweigh the risks.
• Selpercatinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Selpercatinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Selpercatinib. Management: Avoid combination if possible. If use is necessary, reduce selpercatinib dose as follows: from 120mg twice/day to 80mg twice/day, or from 160mg twice/day to 120mg twice/day. Monitor QT interval more closely for QTc interval prolongation and arrhythmias.
• Selumetinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Selumetinib. Management: Avoid concomitant use when possible. If combined, selumetinib dose reductions are recommended and vary based on body surface area and selumetinib dose. For details, see the full drug interaction monograph or selumetinib prescribing information.
• Sildenafil: Erythromycin (Systemic) may increase the serum concentration of Sildenafil. Management: For pulmonary arterial hypertension, no dose adjustment required. For erectile dysfunction, consider using a lower starting dose of 25 mg in patients who are also taking erythromycin. Monitor patients for sildenafil toxicities when combined.
• Simeprevir: Erythromycin (Systemic) may increase the serum concentration of Simeprevir. Simeprevir may increase the serum concentration of Erythromycin (Systemic).
• Sirolimus (Conventional): Erythromycin (Systemic) may increase the serum concentration of Sirolimus (Conventional). Sirolimus (Conventional) may increase the serum concentration of Erythromycin (Systemic). Management: Monitor for increased serum concentrations of sirolimus if combined with erythromycin. Lower initial sirolimus doses or sirolimus dose reductions will likely be required.
• Sonidegib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Sonidegib. Management: Avoid concomitant use of sonidegib and moderate CYP3A4 inhibitors when possible. When concomitant use cannot be avoided, limit CYP3A4 inhibitor use to less than 14 days and monitor for sonidegib toxicity (particularly musculoskeletal adverse reactions).
• Sunitinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may enhance the QTc-prolonging effect of Sunitinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase the serum concentration of Sunitinib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk.
• Suvorexant: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Suvorexant. Management: The recommended dose of suvorexant is 5 mg daily in patients receiving a moderate CYP3A4 inhibitor. The dose can be increased to 10 mg daily (maximum dose) if necessary for efficacy.
• Tazemetostat: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Tazemetostat. Management: Avoid when possible. If combined, reduce tazemetostat dose from 800 mg twice daily to 400 mg twice daily, from 600 mg twice daily to 400 mg in AM and 200 mg in PM, or from 400 mg twice daily to 200 mg twice daily.
• Temsirolimus: CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Temsirolimus. Specifically, concentrations of sirolimus may be increased.
• Terfenadine: May enhance the QTc-prolonging effect of Erythromycin (Systemic). Erythromycin (Systemic) may enhance the QTc-prolonging effect of Terfenadine. Erythromycin (Systemic) may increase the serum concentration of Terfenadine.
• Tezacaftor and Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Tezacaftor and Ivacaftor. Management: If combined with moderate CYP3A4 inhibitors, give tezacaftor/ivacaftor in the morning, every other day; give ivacaftor in the morning, every other day on alternate days. Tezacaftor/ivacaftor dose depends on age and weight; see full Lexi-Interact monograph.
• Theophylline Derivatives: Erythromycin (Systemic) may increase the serum concentration of Theophylline Derivatives. Theophylline Derivatives may decrease the serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination. If combined, monitor for increased serum concentrations/toxic effects of theophylline derivatives. Theophylline derivative dose reductions may be needed. Also monitor for reduced erythromycin efficacy.
• Tolvaptan: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Tolvaptan. Management: Avoid this combination with Samsca brand of tolvaptan. Reduce dose for Jynarque brand: 90 mg AM and 30 mg PM, reduce to 45 mg AM and 15 mg PM; 60 mg AM and 30 mg PM, reduce to 30 mg AM and 15 mg PM; 45 mg AM and 15 mg PM, reduce to 15 mg AM and PM.
• Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose.
• Vardenafil: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Vardenafil. Management: Limit Levitra (vardenafil) dose to a single 5 mg dose within a 24-hour period if combined with moderate CYP3A4 inhibitors. Avoid concomitant use of Staxyn (vardenafil) and moderate CYP3A4 inhibitors. Combined use is contraindicated outside of the US.
• Venetoclax: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Venetoclax. Management: Reduce the venetoclax dose by at least 50% in patients requiring concomitant treatment with moderate CYP3A4 inhibitors. Resume the previous venetoclax dose 2 to 3 days after discontinuation of moderate CYP3A4 inhibitors.
• Vinflunine: CYP3A4 Inhibitors (Moderate) may increase serum concentrations of the active metabolite(s) of Vinflunine. CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Vinflunine.
• Vitamin K Antagonists (eg, warfarin): Macrolide Antibiotics may increase the serum concentration of Vitamin K Antagonists.
• Zanubrutinib: CYP3A4 Inhibitors (Moderate) may increase the serum concentration of Zanubrutinib. Management: Decrease the zanubrutinib dose to 80 mg twice daily during coadministration with a moderate CYP3A4 inhibitor. Further dose adjustments may be required for zanubrutinib toxicities, refer to prescribing information for details.

The common side effects of Erythromycin include the following

Common side effects

● Upset stomach, diarrhea, vomiting, stomach pain, loss of appetite.

Rare side effects

● Rash, itching, Hives, difficulty breathing or swallowing, Wheezing, yellowing of the skin or eyes, dark urine, pale stools, unusual tiredness, pain in the upper right part of the stomach, Seizures, fast, pounding, or irregular heartbeat, severe diarrhea (watery or bloody stools) that may occur with or without fever and stomach cramps (may occur up to 2 months or more after your treatment).

• Pregnancy

Pregnancy Category B

There is no evidence of teratogenicity or any other adverse effect on reproduction in female rats fed erythromycin base (up to 0.25 percent of diet) prior to and during mating, during gestation, and through weaning of two successive litters. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

• Nursing Mothers

Erythromycin is excreted in human milk. Caution should be exercised when erythromycin is administered to a nursing woman.

• Pediatric Use

Erythromycin is available in an IV formulation as the lactobionate salt, and orally as base, ethyl succinate salt, or stearate salt. In adults, 400 mg erythromycin ethyl succinate produces the same concentrations as 250 mg of erythromycin base or stearate; however, in pediatric patients, weight-based dosing is typically used interchangeably.

• Geriatric Use

Elderly patients, particularly those with reduced renal or hepatic function, may be at increased risk for developing erythromycin-induced hearing loss.

Pharmacodynamic

Macrolides, such as erythromycin, stop bacterial growth by inhibiting protein synthesis and translation, treating bacterial infections. Erythromycin does not exert effects on nucleic acid synthesis. This drug has been shown to be active against most strains of the following microorganisms, effectively treating both in vitro and clinical infections. Despite this, it is important to perform bacterial susceptibility testing before administering this antibiotic, as resistance is a common issue that may affect treatment.

Pharmacokinetics

• Absorption

Erythromycin variable and unreliable due to instability in gastric acid. The Time to peak plasma concentration is approximately 1-4 hours.

• Distribution

Erythromycin widely distributed throughout the body tissues and fluids; diffused into CSF (minimal). Erythromycin crosses the placenta and enters breast milk. The volume of distribution is about 0.64 L/kg. Plasma protein binding is about 70-75% (as the base), 95% (as the propionate ester).

• Metabolism and Excretion

Erythromycin partly metabolized in the liver via N-demethylation by CYP3A4 into inactive, unidentified metabolites. Mainly via faeces; urine (2-15% as unchanged drug). The elimination half-life is about 1.5-2.5 hours.

1. Curry JI, Lander TD, Stringer MD. Erythromycin as a prokinetic agent in infants and children. Alimentary pharmacology & therapeutics. 2001 May 15;15(5):595-603.
2. Tunevall G, Hedenius P. Laboratory and Clinical Studies with Erythromycin. Antibiotics & Chemotherapy. 1954;4(6):678-83.
3. WASHINGTON II JA, WILSON WR. Erythromycin: a microbial and clinical perspective after 30 years of clinical use (first of two parts). InMayo Clinic Proceedings 1985 Mar 1 (Vol. 60, No. 3, pp. 189-203). Elsevier.

• https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/050207s074,050611s036lbl.pdf
• https://reference.medscape.com/drug/erythromycin-stearate-999598
• https://www.mims.com/india/drug/info/erythromycin?type=full&mtype=generic
• https://www.rxlist.com/erythromycin-drug.htm#overdosage
• https://medlineplus.gov/druginfo/meds/a682381.html#side-effects
• https://www.drugs.com/dosage/erythromycin.html
• https://go.drugbank.com/drugs/DB00199
• https://www.practo.com/medicine-info/erythromycin-103-api
• https://www.uptodate.com/contents/erythromycin-systemic-drug-information#F8086405
• https://www.uptodate.com/contents/erythromycin-ophthalmic-drug-information#F8086400