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 – 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.

Instructions for use ERYTHROMYCIN

Before using erythromycin, a detailed history should be obtained from the patient regarding hypersensitivity reactions to erythromycin, other macrolides, or other allergens. If a patient develops a hypersensitivity reaction due to the use of erythromycin, the drug should be stopped immediately and symptomatic treatment should be initiated.

Erythromycin should be administered with caution to patients with impaired liver function or concomitantly taking drugs that may have hepatotoxic effects. During long-term treatment with erythromycin, liver function tests are indicated.

Erythromycin prescribed to pregnant women with syphilis does not reach therapeutic concentrations in the fetus, so immediately after birth it is recommended to prescribe penicillin to a child whose mother took erythromycin orally.

Erythromycin used in patients suffering from myasthenia gravis may increase symptoms of the disease.

Broad-spectrum antibiotics (for example, macrolides, semisynthetic penicillins, cephalosporins) can sometimes cause pseudomembranous colitis. Suppression of normal bacterial flora in the intestine promotes the development of Clostridium difficile, the toxins of which cause the clinical symptoms of pseudomembranous colitis. Therefore, patients who experience diarrhea during antibiotic treatment or immediately after its discontinuation should consult a doctor and not self-medicate. If the diagnosis of pseudomembranous colitis is confirmed, erythromycin should be immediately discontinued and appropriate treatment initiated. In milder cases, it is usually sufficient to discontinue the drug; in more severe cases, it is necessary to prescribe metronidazole or vancomycin orally. Taking drugs that inhibit intestinal motility or other drugs that have a fastening effect is contraindicated.

Long-term use of antibiotics can lead to an overgrowth of resistant bacteria and fungi. If new fungal or bacterial infections occur during treatment with erythromycin, the antibiotic should be stopped immediately and appropriate treatment should be initiated.

In seriously ill patients taking; concomitantly erythromycin and lovastatin, cases of rhabdomyolysis have been observed.

Erythromycin may distort the result of determining the level of catecholamines in urine, carried out using the fluorometric method.

Impact on the ability to drive vehicles and maintain moving mechanical devices

There is no data on the effect of the drug on the ability to drive vehicles and operate mechanical devices.