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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

ERYTHROMYCIN


Indication

  • primarily used in neonates for the treatment of Chlamydial infections (conjunctivitis, pneumonia)
  • erythromycin ophthalmic ointment is used for prophylaxis of neonatal gonococcal or chlamydial conjunctivitis

Pharmacology

  • erythromycin is a macrolide antibiotic which binds to 50 S ribosomal subunits, thereby inhibiting protein synthesis in susceptible organisms
  • erythromycin is active against Gram-positive cocci (staphylococci and streptococci) and Gram-positive bacilli (incl. Listeria monocytogenes) as well as some Gram-negative bacilli (incl. Legionella pneumophila)
  • erythromycin is also active against some strains of Chlamydia and Mycoplasma pneumonia
  • erythromycin is partly metabolized in the liver; it is mostly excreted unchanged in the bile

Side Effects

  • GI (vomiting, diarrhea, abdominal pain)
  • hypersensitivity (rash, fever, eosinophilia)
  • local reactions (pain, venous irritation, phlebitis) when given by IV route

Dose

  • give by slow IV infusion over 30 minutes, or orally

    < 7 days - 10 mg/kg q12h
       
    > 7 days - 10 mg/kg q8h

  • for Chlamydial conjunctivitis or pneumonia, therapy should be continued for at least 14 DAYS
  • topical therapy alone for conjunctivitis is NOT adequate, and is of no added benefit to systemic erythromycin
  • for prophylaxis of neonatal gonococcal or chlamydial conjunctivitis a ribbon of ointment, 0.5 to 1 cm in length, should be instilled into each conjunctival sac

Supplied

  • available as the lactobionate salt
  • 5 mg/mL syringe for IV use, prepared by the Pharmacy Department

TO PREPARE 5mg/mL STRENGTH

  • 500 mg vial; add 20 mL of sterile water for injection to produce a concentration of 25 mg/mL; add 2 mL of 25 mg/mL to 8 mL sterile water for injection to produce a final concentration of 5 mg/mL
  • Please Note: 5 mg/mL is the MAXIMUM recommended concentration
  • erythromycin estolate, 50 mg/mL, suspension

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Cloherty JP and Stark AR (eds): Manual of Neonatal Intensive Care, Little, Brown and Company, 1991.
  3. Nelson JD: Pocketbook of Pediatric Antimicrobial Therapy, 7th Edition, 1987, Williams and Wilkins, Baltimore.
  4. Health and Welfare Canada: 1988 Canadian guidelines for the treatment of sexually transmitted diseases in neonates, children, adolescents and adults, Canada Diseases Weekly Report, 1988 (Apr); 14S2 (supplement): 6.
  5. Anon: Morbidity and Mortality Weekly Report, 1985; 34 (No.4S): 77S-79S.
  6. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  7. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  8. Bhatt DR, Furman GI, Reber DJ et al: Neonatal Drug Formulary, 1990-1991, 2nd Edition, Fontana, California 92334.
  9. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.



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