Names and pronunciation
AKne-Mycin, Erygel
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Drug reference
AKne-Mycin, Erygel
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Func. class.: Antiinfective
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Chem. class.: Macrolide
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Do not confuse: erythromycin/azithromycin
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ACTION: Binds to 50S ribosomal sub- units of susceptible bacteria and sup- presses protein synthesis
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USES: Mild to moderate respira- tory tract, skin, soft tissue infections caused by Bordetella pertussis, Borrelia burgdorferi, Chlamydia trachomatis; Corynebacterium diphtheriae, Haemophilus influen- zae (when used with sulfonamides); Legionella pneumophila, Legion- naire’s disease, Listeria monocyto- genes; Mycoplasma pneumoniae, Streptococcus pneumoniae, syphilis: Treponema pallidum; Staphylococ- cus sp.
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Unlabeled uses: Bartonellosis, burn wound infection, chancroid, cholera, diabetic gastroparesis, endocarditis prophylaxis, gastroenteritis, granu- loma inguinale, Lyme disease, tetanus E
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CONTRAINDICATIONS: Hyper- sensitivity, preexisting hepatic disease (estolate) Precautions: Pregnancy, breastfeeding, geriatric patients, hepatic disease, GI dis- ease, QT prolongation, seizure disorder, myasthenia gravis
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SIDE EFFECTS CNS: Seizures CV: Dysrhythmias, QT prolongation GI: Nausea, vomiting, diarrhea, hepato- toxicity, abdominal pain, stomatitis, heartburn, anorexia, CDAD, esophagitis GU: Vaginitis, moniliasis INTEG: Rash, urticaria, pruritus, throm- bophlebitis, injection site reactions (IV site) SYST: Anaphylaxis
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INTERACTIONS • Serious dysrhythmias—diltiaZEM, itra- conazole, ketoconazole, nefazodone, pimozide, protease inhibitors, verapamil; do not use together Increase: QT prolongation—products that increase QT prolongation Increase: action, toxicity of alfent- anil, ALPRAZolam, bromocriptine, busPIRone, carBAMazepine, cilo- stazol, clindamycin, cloZAPine, cycloSPORINE, diazePAM, digoxin, disopyramide, ergots, felodipine, HMG-CoA reductase inhibitors, ibru- tinib methylPREDNISolone, mid- azolam, quiNIDine, rifabutin, silden afil, tacrolimus, tadalafil, theophylline, triazolam, vardenafil, vinBLAStine, warfarin Decrease: erythromycin effect—rifabu- tin, rifAMPin, rifapentine Drug/Lab Test Increase: AST/ALT Decrease: folate assay False increase: 17-OHCS/17-KS Drug/Food Decrease: erythromycin metabo- lism—grapefruit juice; avoid using together
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DOSAGE AND ROUTES Most infections • Adults PO (base, stearate): 250 mg q6hr or 333 mg q8hr or 500 mg q12hr; (ethylsuccinate) 400 mg q6hr or 800 mg q12hr: IV 250 mg-500 mg q6hr • Child >1 mo: PO (base, ethylsucci- nate) 30-50 mg/kg/day divided q6-8hr, max 2 g/day (base), max 3.2 g/day (ethylsuccinate); 30-50 mg/kg/day di- vided q6hr, max 2 g/day (stearate); IV 15-50 mg/kg/day divided q6hr, max 4 g/ day • Neonates: PO (ethylsuccinate) 20- 50 mg/kg/day divided q6-8hr
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Available forms: Base: enteric-coated tablets 250, 333, 500 mg; film-coated tablets 250, 500 mg; enteric-coated cap- sules 250, 333 mg; stearate: film-coated tablets 250 mg; ethylsuccinate: granules for oral suspension 200, 400 mg/5 mL; powder for injection 500 mg, 1 g (lacto- bionate), 1 g (as gluceptate)
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Administer: • Do not break, crush, or chew time- released capsule or tablet; chew only chewable tablets; enteric-coated tablets may be given with food • Do not give by IM or IV push • Oral product with full glass of water; do not give with fruit juice • Give 1 hr prior to or 2 hr after meals • Store at room temperature; store sus- pension in refrigerator • Adequate intake of fluids (2 L) during diarrhea episodes IV route • After reconstituting 500 mg or less/10 mL sterile water without preserva- tives, dilute further in 100-250 mL of 0.9% NaCl, LR, Normosol-R; may be further diluted to 1 mg/mL and given as contin- uous infusion; run 1 g or less/100 mL over 1/2-1 hr; continuous infusion over 6 hr, may require buffers to neutralize pH if di- lution is <250 mL, use infusion pump Lactobionate Y-site compatibilities: Acyclovir, alfent- anil, amikacin, aminocaproic acid, aminophylline, amiodarone, anidulafun- gin, argatroban, atenolol, atosiban, atra- curium, atropine, azaTHIOprine, benz- tropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorpha- nol, calcium chloride/gluconate, CAR- BOplatin, caspofungin, cefotaxime, cef- TRIAXone, cefuroxime, chlorproMAZINE, cimetidine, CISplatin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cyt arabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, doxapram, DOXOrubicin, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, famotidine, fenoldo- pam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, gati- floxacin, gemcitabine, gentamicin, glyco- pyrrolate, granisetron, hydrocortisone, HYDROmorphone, hydrOXYzine, IDAru- bicin, ifosfamide, imipenem-cilastatin, insulin (regular), irinotecan, isoproter- enol, labetalol, levofloxacin, lidocaine, LORazepam, LR, mannitol, mechloretha- mine, meperidine, methicillin, metho- trexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, miconazole, mid- azolam, milrinone, mitoXANtrone, mor- phine, multiple vitamins injection, myco- phenolate, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCAR- dipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxacillin, oxali- platin, oxytocin, PACLitaxel, palonose- tron, pamidronate, pancuronium, papav- erine, pentamidine, pentazocine, perphenazine, phenylephrine, phytona- dione, piperacillin, piperacillin-tazobac- tam, polymyxin B, procainamide, prochlorperazine, promethazine, pro- pranolol, protamine, pyridoxine, quiNI- Dine, ranitidine, Ringer’s, ritodrine, sodium acetate/bicarbonate, succinyl- choline, SUFentanil, tacrolimus, temocil- lin, teniposide, theophylline, thiamine, thiotepa, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vin- CRIStine, vinorelbine, vitamin B complex/C, voriconazole, zidovudine, zoledronic acid
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Assess: • Infection: temperature, characteristics of wounds, urine, stools, sputum, WBCs at baseline and periodically • I&O ratio; report hematuria, oliguria in renal disease • Hepatic studies: AST, ALT if patient is receiving long-term therapy • Hearing at baseline and after treat- ment • Renal studies: urinalysis, protein, blood • C&S prior to product therapy; prod- uct may be given as soon as culture is taken; C&S may be repeated after treat- ment • CDAD: diarrhea with blood, mucus; abdominal pain, fever; product should be discontinued immediately, notify pre- scriber • Anaphylaxis: generalized hives, itch- ing, flushing, swelling of lips, tongue, throat, wheezing; have emergency equip- ment nearby • QT prolongation: may occur (IV >15 mg/min); those with electrolyte imbalances, congenital QT prolonga- tion, elderly at greater risk; correct electrolyte imbalances prior to treat- ment, ECG • Pregnancy/breastfeeding: use only if clearly needed; use other form of eryth- romycin, avoid estolate salt; use caution in breastfeeding, product appears in breast milk
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Evaluate: • Therapeutic response: decreased symptoms of infection
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To notify nurse of diarrhea stools, dark urine, pale stools, jaundice of eyes or E skin, severe abdominal pain • To take at evenly spaced intervals; to complete dosage regimen; to take with- out food • To avoid use with other products un- less approved by prescriber TREATMENT OF HYPERSEN- SITIVITY: Withdraw product; maintain airway; administer EPINEPHrine, ami nophylline, O2, IV corticosteroids
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PHARMACOKINETICS Peak 1-4 hr (base); 1/2-21/2 hr (ethylsuc- cinate); half-life 1-2 hr, neonates 2 hr; metabolized in liver; excreted in bile, feces; protein binding 75%-90%; inhibi- tor of CYP3A4 and P-glycoprotein
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• Child >1 mo: PO (base, ethylsucci- nate) 30-50 mg/kg/day divided q6-8hr, max 2 g/day (base), max 3.2 g/day (ethylsuccinate); 30-50 mg/kg/day di- vided q6hr, max 2 g/day (stearate); IV 15-50 mg/kg/day divided q6hr, max 4 g/ day
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