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Drug dosage identifier

Erythromycin Lactobionate

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Dose and administration

IV infusion by syringe pump over 60 minutes.

  Dose
Preterm infants 10 mg/kg/dose 6 hourly
Term infants 12.5 mg/kg/dose 6 hourly

Indications

  • 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.

Contraindications

  • Known hypersensitivity to erythromycin
  • Administration to patients already taking cisapride is contraindicated.

Warnings1:

  • 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.

Precautions

  • Liver disease. Caution in infants with jaundice, liver dysfunction, and biliary tract disease.
  • Caution in preterm infants, especially extreme immaturity

Drug interactions

  • 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

Clinical pharmacology

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.

Special considerations

  • 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

Description4

  • 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.

Prescription

Erythromycin is charted on the prescription chart in mg/dose.

Administration

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.

Nursing considerations

  • 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.

Storage

  • 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.

References

  1. Phelps SJ, Hak EB, Crill CM, editors. Teddy bear book: Pediatric injectable drugs. 8th ed. Bethesda, MD: American Society of Heath-System Pharmacists; 2007.
  2. Hey, E, editor. Neonatal formulary. 5th ed. Oxford: Blackwell Publishing; 2007
  3. Martin, J, Managing editor. BNF for children 2010-2011. London: BMJ Group, Pharmaceutical Press & RCPCH Publications Ltd; 2010.
  4. Trissel LA. Handbook on Injectable Drugs. American Society of Health-System Pharmacists (ASHP) 16th Edition.
  5. 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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Document Control

  • Date last published: 30 November 2011
  • Document type: Drug Dosage Guideline
  • Services responsible: ADHB Pharmacy, Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years