Erythromycin
Reduces the bactericidal effect (antagonism) of beta-lactam antibiotics (penicillins, cephalosporins, carbapenems), lincomycin, clindamycin, chloramphenicol, streptomycin, tetracyclines, colistin.
Increases the concentration of theophylline in the blood: a reduction in the dose of geophylline may be required.
At the same time, the concentration of erythromycin may decrease, which may lead to subtherapeutic concentrations of erythromycin and a decrease in its effect.
Increases the nephrotoxicity of cyclosporine (especially in patients with concomitant renal failure).
Reduces the clearance of triazolam and midazolam, and therefore may enhance the pharmacological effects of benzodiazepines.
Slows down the elimination (increases the effect) of methylprednisolone, felodigment and coumarin anticoagulants.
When used together with lovastatin and other HMB-CoA reductase inhibitors, the risk of developing rhabdomyolysis increases.
Increases the bioavailability of digoxin.
Reduces the effectiveness of hormonal contraception.
Medicines that block tubular secretion prolong T1/2 of erythromycin.
Since erythromycin is an isoenzyme inhibitor and a CYP3A substrate, when taken simultaneously with drugs that are metabolized in the liver (acenocoumarol, astemizole, cilostazol, cyclosporine, dihydroergotamine, ergotamine, omeprazole, quinidine, rifabutin, tacrolimus, terfenadine, vinblastine, carbamazepine, valproic acid, hexobarbital, phenytoin, alfentanil, disopyramide, lovastatin, bromocriptine, antifungals such as fluconazole, ketoconazole and itraconazole), the plasma concentrations of these drugs may increase.
Drugs that are inducers of CYP3A4 isoenzymes (such as rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) can induce the metabolism of erythromycin, which can lead to subtherapeutic concentrations of erythromycin and a decrease in its effect. The interaction persists for 2 weeks after discontinuation of treatment with CYP3A4 inducers.
Erythromycin alters the metabolism of mizolastine.
When used together with pimozide, arrhythmia (ventricular fibrillation and flutter), ventricular tachycardia of the “pirouette” type, cardiac arrest, and even death may develop.
Protease inhibitors inhibit the metabolism of erythromycin; monitoring of the concentration of erythromycin in blood plasma is necessary.
When used simultaneously with terfenadine or astemizole, arrhythmia may develop (ventricular fibrillation and flutter, ventricular tachycardia, even death), with dihydroergotamine or dihydrogenated ergot alkaloids - vasoconstriction to spasm, dysesthesia.
Concomitant use of erythromycin with sildenafil may lead to a moderate increase in the maximum concentration of sildenafil in the blood.
An increase in the level of cisapride can lead to a prolongation of the QTc interval, and the development of arrhythmia (ventricular fibrillation and flutter), ventricular tachycardia of the “pirouette” type is possible.
When taken together with verapamil and other slow calcium channel blockers, hypotension, bradyarrhythmia and lactic acidosis are observed.
Cimetidine inhibits the metabolism of erythromycin, which may lead to increased plasma concentrations of erythromycin.
Erythromycin reduces the clearance of zopiclone and thus may increase the pharmacodynamic effects of this drug.
Concomitant use of erythromycin increases the toxicity of colchicine.
Erythromycin – granules, lyophilisate, powder, suppositories
Orally (tablets, capsules, oral suspension, granules or powder for the preparation of oral suspension), intravenously (lyophilisate for the preparation of solution for injection), rectally (suppositories).
IV slowly (over 3-5 minutes) or drip. All doses of the drug are given based on calculations based on the basis.
A single dose for adults and adolescents over 14 years of age is 0.25-0.5 g, daily - 1-2 g. The interval between administration is 6 hours. In case of severe infections, the daily dose can be increased to 4 g. For intravenous jet administration, the drug is dissolved in water for injection or 0.9% NaCl solution at the rate of 5 mg per 1 ml of solvent.
For intravenous drip administration, the drug is dissolved in a 0.9% NaCl solution or a 5% dextrose solution to a concentration of 1 mg/ml and administered at a rate of 60-80 drops/min. It is administered intravenously for 5-6 days (until a clear therapeutic effect occurs), followed by a transition to oral administration. With good tolerability and the absence of phlebitis and periphlebitis, the course of intravenous administration can be extended to 2 weeks (no more).
Orally (the regimen for taking the drug and eating is determined by the dosage form and its resistance to the effects of gastric juice), the average daily dose for adults is 1-2 g in 2-4 doses, the maximum daily dose is 4 g. Children from 4 months to 18 years depending on age, body weight and severity of infection - 30-50 mg/kg/day in 2-4 doses; for children in the first 3 months of life - 20-40 mg/kg/day. In case of severe infections, the dose may be doubled.
For the treatment of diphtheria carriage - 0.25 g 2 times a day.
The course dose for the treatment of primary syphilis is 30-40 g, the duration of treatment is 10-15 days.
For amoebic dysentery, adults - 0.25 g 4 times a day, children - 30-50 mg/kg/day; Course duration is 10-14 days.
For legionellosis - 0.5-1 g 4 times a day for 14 days.
For gonorrhea - 0.5 g every 6 hours for 3 days, then 0.25 g every 6 hours for 7 days.
For gastroparesis - orally (for the treatment of gastroparesis, a drug for intravenous use is more preferable), 0.15-0.25 g 30 minutes before meals 3 times a day.
For preoperative bowel preparation to prevent infectious complications - orally, 1 g 19 hours, 18 hours and 9 hours before surgery (3 g in total).
For the prevention of streptococcal infections (for tonsillitis, pharyngitis) adults - 20-50 mg/kg/day, children - 20-30 mg/kg/day, course duration - at least 10 days.
For the prevention of septic endocarditis in patients with heart defects - 1 g for adults and 20 mg/kg for children, 1 hour before a treatment or diagnostic procedure, then 0.5 g for adults and 10 mg/kg for children, again after 6 h.
For whooping cough - 40-50 mg/kg/day for 5-14 days.
For conjunctivitis of newborns - 50 mg/kg/day suspension in 4 divided doses for at least 2 weeks.
For pneumonia in children - 50 mg/kg/day suspension in 4 divided doses for at least 3 weeks.
For genitourinary infections during pregnancy - 0.5 g 4 times a day for at least 7 days or (if this dose is poorly tolerated) 0.25 g 4 times a day for at least 14 days.
In adults, with uncomplicated chlamydia and intolerance to tetracyclines - 0.5 g 4 times a day for at least 7 days.
Rectally: children aged 1 to 3 years - 0.4 g / day, from 3 to 6 years - 0.5-0.75 g / day, 6-8 years - up to 1 g / day. The daily dose is divided into 4-6 parts and administered every 4-6 hours.
Erythromycin-LekT
Inside (the regimen for taking the drug and eating is determined by the dosage form and its resistance to the effects of gastric juice). Take the tablet 1-2 hours before meals or 2-3 hours after meals. The tablet must not be split or chewed.
A single dose for adults is 250-500 mg. The average daily dose for adults is 1-2 g in 2-4 doses, the maximum daily dose is 4 g.
Children over 14 years old, depending on age, body weight and severity of infection - 30-50 mg/kg/day in 2-4 doses. In case of severe infections, the dose may be doubled.
For the treatment of diphtheria carriage - 0.25 g 2 times a day.
The course dose for the treatment of primary syphilis is 30-40 g, the duration of treatment is 10-15 days.
For amoebic dysentery in adults - 0.25 g 4 times a day, course duration - 10-14 days.
For legionellosis - 0.5-1 g 4 times a day for 14 days.
For gonorrhea - 0.5 g every 6 hours for 3 days, then 0.25 g every 6 hours for 7 days.
For gastroparesis - orally (for the treatment of gastroparesis, erythromycin for intravenous use is more preferable) 0.15-0.25 g 30 minutes before meals 3 times a day.
For scarlet fever - in usual doses, the course of treatment is at least 10 days.
For listeriosis - 250-500 mg 4 times a day for at least 7 days, etiotropic therapy is carried out until the 6-7th day of normal temperature, and for severe forms - until the 14-21st day.
For erythrasma - 250 mg 4 times a day for 5-7 days simultaneously with external agents.
For preoperative bowel preparation to prevent infectious complications - orally, 1 g 19 hours, 18 hours and 9 hours before surgery (3 g in total).
For the prevention of streptococcal infections (for tonsillitis, pharyngitis) adults - 20-50 mg/kg/day, children over 14 years old - 20-30 mg/kg/day, course duration - at least 10 days.
For the prevention of septic endocarditis in patients with heart defects - 1 g for adults and 20 mg/kg for children over 14 years old, 1 hour before the treatment or diagnostic procedure, then 0.5 g for adults and 10 mg/kg for children, again after 6 hours.
For whooping cough - 40-50 mg/kg/day for 5-14 days.
For genitourinary infections during pregnancy - 0.5 g 4 times a day for at least 7 days or (if this dose is poorly tolerated) 0.25 g 4 times a day for at least 14 days.
In adults, with uncomplicated chlamydia and intolerance to tetracyclines - 0.5 g 4 times a day for at least 7 days.
Erythromycin 100 mg No. 10 tablet p.o. solution/intestinal
Instructions for the use of the drug for specialists ERYTHROMYCIN Trade name Erythromycin International nonproprietary name Erythromycin Dosage form Enteric-coated tablets, 0.1 and 0.25 g Composition One tablet contains the active substance - erythromycin 0.1170 g and 0.2924 g, equivalent to 0 , 1 g and 0.25 g of pure substance, excipients: potato starch, polyvinylpyrrolidone, Tween-80, calcium stearate, shell composition: acetylphthalylcellulose, castor oil, titanium dioxide. Description Biconvex tablets, white or white with a grayish tint. Pharmacotherapeutic group Antimicrobial drugs for systemic use. Macrolides ATC code J01FA01 Pharmacological properties Pharmacokinetics Erythromycin is well absorbed when taken orally. Oral enteric-coated base forms of erythromycin have no effect on food intake. Bioavailability - 30-65%. The maximum concentration (Cmax) is achieved after oral administration after 2-4 hours. The affinity for blood plasma proteins is high, binding by 70 - 80%. It is distributed unevenly in the body. It accumulates in large quantities in the liver, spleen, and kidneys. In bile and urine, the concentration is tens of times higher than the concentration in plasma. Penetrates well into the tissues of the lungs, lymph nodes, middle ear exudate, prostate secretions, sperm, pleural cavity, ascitic and synovial fluid. The milk of lactating women contains 50% of the plasma concentration. It penetrates poorly through the blood-brain barrier into the cerebrospinal fluid (its concentration is 10% of the drug content in plasma). During inflammatory processes in the meninges, their permeability to erythromycin increases slightly. It penetrates the placental barrier and enters the blood of the fetus, where its content reaches 5-20% of the content in the mother's plasma. Metabolized in the liver (more than 90%), partially with the formation of inactive metabolites. The half-life (T1/2) is 1.4-2 hours, with anuria - 4-6 hours. Excretion with bile - 20-30% unchanged, by the kidneys (unchanged) - 2-5%. Pharmacodynamics Bacteriostatic antibiotic from the macrolide group. However, in high doses it has a bactericidal effect against sensitive microorganisms. Erythromycin reversibly binds to bacterial ribosomes, thereby inhibiting protein synthesis. The spectrum of action includes gram-positive (Staphylococcus spp., producing and not producing penicillinase); Streptococcus spp. (including Streptococcus pneumoniae) and gram-negative microorganisms (Neisseria gonorrhoeae, Haemophilus influenzae, Bordetella pertussis, Brucella spp., Legionella spp.), e, Bacillus anthracis, Corynebacterium diphtheriae Mycoplasma spp., Chlamydia spp., Treponema spp., Ricketsia spp. Gram-negative bacilli are resistant: Escherichia coli, Pseudomonas aeruginosa, as well as Shigella spp., Salmonella spp. etc. Indications for use - diphtheria (including bacterial carriage), whooping cough (including prevention), trachoma, brucellosis, Legionnaires' disease, erythrasma, listeriosis, scarlet fever, amoebic dysentery - primary syphilis (in patients with allergies to penicillins), uncomplicated chlamydia in adults (with localization in the lower genitourinary tract and rectum), gonorrhea - genitourinary infections in pregnant women caused by Chlamydia trachomatis - conjunctivitis of newborns - tonsillitis, otitis, sinusitis - cholecystitis - tracheitis, bronchitis, pneumonia, pneumonia in children - pustular skin diseases, incl. juvenile acne, infected wounds, bedsores, stage II-III burns, trophic ulcers - infections of the mucous membrane of the eyes - prevention of exacerbations of streptococcal infections in patients with rheumatism - preoperative bowel preparation, dental interventions, endoscopy - prevention of infectious complications in patients with heart defects. Method of administration and dosage: Orally 1-1.5 hours before meals. A single dose for adults and adolescents over 14 years of age is 0.25-0.5 g. The average daily dose for adults is 1-2 g in 2-4 doses, the maximum daily dose is 4 g. Children from 4 months. up to 14 years, depending on age, body weight and severity of infection, 30-50 mg/kg/day in 4 doses (less often in 2 doses with an interval of 12 hours); children of the first 3 months. life 20-40 mg/kg/day. In case of severe infections, the dose may be doubled. For the treatment of diphtheria carriage, 0.25 g 2 times a day. The course dose for the treatment of primary syphilis is 30-40 g, the duration of treatment is 10-15 days. For amoebic dysentery, adults - 0.25 g 4 times a day, children - 30-50 mg/kg/day for 10-14 days. For gonorrhea, 0.5 g every 6 hours for 3 days, then 0.25 g every 6 hours for 7 days. For adults, for the prevention of streptococcal infections (tonsillitis, pharyngitis) 20-50 mg/kg/day, for children – 20-30 mg/kg/day, course duration is at least 10 days. For preoperative bowel preparation to prevent infectious complications, 1 g orally 19 hours, 18 hours and 9 hours before surgery (3 g in total). For the prevention of septic endocarditis in patients with heart defects, 1 g for adults and 20 mg/kg for children, 1 hour before a treatment or diagnostic procedure, then 0.5 g for adults and 10 mg/kg for children, again after 6 hours. For whooping cough – 40-50 mg/kg/day for 5-14 days. Adults with uncomplicated chlamydia and intolerance to tetracyclines - 0.5 g 4 times a day for at least 7 days. Side effects - liver dysfunction, abdominal pain, cholestatic jaundice, pseudomembranous enterocolitis, nausea, vomiting, gastralgia, tenesmus, diarrhea, pancreatitis, dysbiosis — increased activity of “liver” transaminases — hearing loss and/or tinnitus — urticaria, other forms of rash, eosinophilia, anaphylactic shock — tachycardia, atrial fibrillation and/or flutter (in patients with a long QT interval on the ECG) — oral candidiasis . Contraindications - hypersensitivity to the drug - liver disease - simultaneous use of terfenadine or astemizole. Drug interactions Drugs that block tubular secretion prolong T1/2 of erythromycin. Incompatible with lincomycin, clindamycin and chloramphenicol (antagonism). Reduces the bactericidal effect of beta-lactam antibiotics (penicillins, cephalosporins, carbopenems). Increases theophylline content. When taken simultaneously with drugs that are metabolized in the liver (carbamazepine, valproic acid, hexobarbital, phenytoin, alfentanil, disopyramide, lovastatin, bromocriptine), the concentration of these drugs in plasma may increase (it is an inhibitor of microsomal liver enzymes). Increases the nephrotoxicity of cyclosporine (especially in patients with concomitant renal failure). Reduces the clearance of triozolam and midazolam, and therefore may enhance the pharmacological effects of benzodiazepines. When taken simultaneously with terfenadine or astemizole, there is a possibility of developing arrhythmia; with dihydroergotamine or non-hydrogenated ergot alkaloids, vasoconstriction to spasm and dysesthesia. Slows down the elimination (increases the effect) of methylprednisolone, felodipine and coumarin anticoagulants. When co-administered with lovastatin, rhabdomyolysis increases. Increases the bioavailability of digoxin. Reduces the effectiveness of hormonal contraception. Special instructions During long-term therapy, it is necessary to monitor laboratory parameters of liver function. Symptoms of cholestatic jaundice may develop several days after the start of therapy, but the risk of development increases after 7-14 days of continuous therapy. The likelihood of developing an ototoxic effect is higher in patients with renal or renal insufficiency. Some resistant strains of Haemophilus influenzae are sensitive to concomitant administration of erythromycin and sulfonamides. May interfere with the determination of catecholamines in urine and the activity of “liver” transaminases in the blood (colorimetric determination using definylhydrazine). Do not drink milk or dairy products. Drugs that increase the acidity of gastric juice and acidic drinks inactivate erythromycin (with the exception of the dosage form in capsule form). Pregnancy and lactation When using erythromycin during pregnancy, the expected benefit to the mother and the potential risk to the fetus should be assessed. If it is necessary to use it during lactation, the issue of stopping breastfeeding should be decided. Effect on the ability to drive transport and potentially dangerous mechanisms The drug does not affect the ability to drive transport and potentially dangerous mechanisms. Overdose Symptoms: nausea, diarrhea, stomach discomfort; mild acute pancreatitis; dizziness (especially in patients with liver or kidney failure). Treatment: activated carbon, careful monitoring of the state of the respiratory system (if necessary, artificial ventilation), acid-base balance and electrolyte metabolism. Gastric lavage is effective when taking a dose five times higher than the average therapeutic dose. Hemodialysis, peritoneal dialysis, forced diuresis are ineffective. Release form and packaging Enteric-coated tablets of 0.1 and 0.25 g, No. 10 in orange glass jars. Each jar, along with instructions for use, is placed in a cardboard box. Storage conditions Store in a dry place, at a temperature not exceeding +25 °C. Keep out of the reach of children! Shelf life: 2 years After the expiration date, the drug should not be used. Conditions for dispensing from pharmacies By prescription, Russia 440033, Penza, st. Friendship, 4.
