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Dose and administration
IV infusion by syringe pump over 60 minutes.
|Preterm infants||10 mg/kg/dose 6 hourly|
|Term infants||12.5 mg/kg/dose 6 hourly|
- Suspected/proven infection with Mycoplasma pneumoniae, Ureaplasma urealyticum, and Chlamydia trachomatis.
- As a substitute for penicillin in situations of significant hypersensitivity to penicillin.
- Treatment for and prophylaxis against Bordetella pertussis.
- Known hypersensitivity to erythromycin
- Administration to patients already taking cisapride is contraindicated.
- If allergic reactions, from skin eruptions to anaphylaxis, occur discontinue erythromycin immediately.
- Prolonged use may result in superinfection. This may be accompanied by Clostridium difficile - associated diarrhoea which may range from mild diarrhoea to fatal pseudomembranous colitis. Discontinue erythromycin immediately and avoid co-administration of drugs which delay peristalsis eg. opiates.
- Prolongation of QT interval and development of ventricular arrhythmias can occur and may be associated with too rapid administration.
- Liver disease. Caution in infants with jaundice, liver dysfunction, and biliary tract disease.
- Caution in preterm infants, especially extreme immaturity
- Avoid concomitant use with cisapride
- Erythromycin may increase the effects of digoxin, midazolam, corticosteroids, fentanyl, milrinone, phenytoin, rifampicin, caffeine citrate, theophylline.
- Erythromycin may decrease the effect of: BCG
Bacteriostatic antibiotic which suppresses bacterial protein synthesis. The antibacterial spectrum is similar to penicillin but extended to include Mycoplasma pneumoniae, Ureaplasma urealyticum and Chlamydia trachomatis.
Vd 45% of body weight in adults. Antibacterial levels are achievable in all tissues except brain and CSF. Highly bound (64-98%) to human plasma protein. Hepatic excretion into bile as active compound. Only 5-15% of administered dose excreted in the active form in the urine. Plasma half life equals 2-4 hours.
Possible adverse effects
- Allergic reactions, cardiotoxicity , including prolongation of QT interval, ventricular arrhythmias. See "warnings"
- More common reactions are thrombophlebitis, venous irritation, and gastrointestinal eg. vomiting, diarrhoea. These can be avoided by administering slowly as a diluted solution.
- Other reactions that may occur are: bradycardia, hypotension, ototoxicity, hepatic impairment, hypertrophic pyloric stenosis.
- Monitor LFTs, B.P., heart rate.
- Hepatic dysfunction, use cautiously.
- I.V. push is not recommended due to local irritation and cardiovascular effects. See "warnings"
- At low doses erythromycin may inhibit the effect of penicillin, but at high doses may act synergistically.
Management of IV Erythromycin administration
- White powder for reconstitution containing erythromycin lactobionate equivalent to 1 gram per vial of erythromycin. There may be other vial strengths available.
- Stable in solution at pH 6.5 - 7.5.
- Osmolality ~300 mOsmol/Kg in sodium chloride 0.9%.
- For IV administration only. DO NOT administer IM.
Erythromycin is charted on the prescription chart in mg/dose.
Slow IV Infusion3
Reconstitute with Water for Injection to 50 mg/ml. Do NOT use sodium chloride 0.9% or glucose 5% to reconstitute as precipitation may occur at this concentration.
|Erythromycin 1 gram|
|Water to be added|| 20 ml
|1 gram in 20.0 ml|
- Shake vigorously. For peripheral administration, immediately prior to use further dilute to 5 mg/mL with sodium chloride 0.9%. For central line administration may be diluted to 10 mg/mL.
- Administer by slow IV infusion over 60 minutes using a syringe pump.
- Incompatible with ceftazidime. Unstable in acidic solutions.
- Do NOT mix with any other drugs, IV solutions, blood or blood products. Is incompatible with many substances.
- Flush line with sodiuim chloride 0.9% before and after infusion of erythromycin.
- Monitor vital signs especially heart rate for arrhythmias
- Observe for signs of adverse effects eg. diarrhoea, vomiting, allergic reactions.
- Observe IV site closely for extravasation during infusion of drug.
- Observe for signs of renal, hepatic and haematological dysfunction during prolonged therapy.
- Observe for signs of super infection including fungal infection.
- Store at room temperature <25°C until reconstituted.
- Solution should be used immediately after reconstitution. Not suitable for storage when used in the neonatal unit.
- Phelps SJ, Hak EB, Crill CM, editors. Teddy bear book: Pediatric injectable drugs. 8th ed. Bethesda, MD: American Society of Heath-System Pharmacists; 2007.
- Hey, E, editor. Neonatal formulary. 5th ed. Oxford: Blackwell Publishing; 2007
- Martin, J, Managing editor. BNF for children 2010-2011. London: BMJ Group, Pharmaceutical Press & RCPCH Publications Ltd; 2010.
- Trissel LA. Handbook on Injectable Drugs. American Society of Health-System Pharmacists (ASHP) 16th Edition.
- Young TE, Mangum B, editors. Neofax: A manual of drugs used in neonatal care. 18th ed. Raleigh, North Carolina, USA: Acorn Publishing; 2005.
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- Date last published: 30 November 2011
- Document type: Drug Dosage Guideline
- Services responsible: ADHB Pharmacy, Neonatology
- Editor: Sarah Bellhouse
- Review frequency: 2 years