Erythromycin is produced by a strain of Saccharopolyspora erythraea (formerly Streptomyces erythraeus) and belongs to the macrolide group of antibiotics. It is basic and readily forms salts with acids. The base, the stearate salt, and the esters are poorly soluble in water. Erythromycin ethylsuccinate is an ester of erythromycin suitable for oral administration.
To reduce the development of drug-resistant
bacteria and maintain the effectiveness of E.E.S. and other antibacterial
drugs, E.E.S. should be used only to treat or prevent infections that
are proven or strongly suspected to be caused by susceptible bacteria.
When culture and susceptibility information are available, they should
be considered in selecting or modifying antibacterial therapy. In
the absence of such data, local epidemiology and susceptibility patterns
may contribute to the empiric selection of therapy.
E.E.S. is indicated in the treatment of infections
caused by susceptible strains of the designated organisms in the diseases
tract infections of mild to moderate degree caused by Streptococcus
pyogenes , Streptococcus pneumoniae, or Haemophilus influenzae (when used concomitantly with adequate
doses of sulfonamides, since many strains of H. influenzae are not susceptible to the erythromycin concentrations ordinarily
achieved). (See appropriate sulfonamide labeling for prescribing
tract infections of mild to moderate severity caused by Streptococcus
pneumoniae or Streptococcus pyogenes.
Listeriosis caused by Listeria
(whooping cough) caused by Bordetella pertussis.
Erythromycin is effective in eliminating the organism from the nasopharynx
of infected individuals rendering them noninfectious. Some clinical
studies suggest that erythromycin may be helpful in the prophylaxis
of pertussis in exposed susceptible individuals.
Respiratory tract infections due to Mycoplasma
skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus (resistant staphylococci may emerge during treatment).
Diphtheria: Infections due to Corynebacterium diphtheriae, as an adjunct to antitoxin,
to prevent establishment of carriers and to eradicate the organism
the treatment of infections due to Corynebacterium minutissimum.
Intestinal amebiasis caused
by Entamoeba histolytica (oral erythromycins only).
Extraenteric amebiasis requires treatment with other agents.
Acute pelvic inflammatory disease caused
by Neisseria gonorrhoeae: As an alternative drug
in treatment of acute pelvic inflammatory disease caused by N. gonorrhoeae in female patients with a history of sensitivity
to penicillin. Patients should have a serologic test for syphilis
before receiving erythromycin as treatment of gonorrhea and a follow-up
serologic test for syphilis after 3 months.
Syphilis caused by Treponema pallidum: Erythromycin is an alternate choice of treatment for primary syphilis
in patients allergic to the penicillins. In treatment of primary
syphilis, spinal fluid examinations should be done before treatment
and as part of follow-up after therapy.
Erythromycins are indicated for the treatment of the
following infections caused by Chlamydia trachomatis: conjunctivitis of the newborn, pneumonia of infancy, and urogenital
infections during pregnancy. When tetracyclines are contraindicated
or not tolerated, erythromycin is indicated for the treatment of uncomplicated
urethral, endocervical, or rectal infections in adults due to Chlamydia trachomatis.
When tetracyclines are contraindicated or not tolerated, erythromycin
is indicated for the treatment of nongonococcal urethritis caused
by Ureaplasma urealyticum.
Legionnaires' Disease caused by Legionella
pneumophila. Although no controlled clinical efficacy studies
have been conducted, in vitro and limited preliminary
clinical data suggest that erythromycin may be effective in treating
Prevention of InitialAttacks of Rheumatic Fever
Penicillin is considered by the American Heart Association to be
the drug of choice in the prevention of initial attacks of rheumatic
fever (treatment of Streptococcus pyogenes infections
of the upper respiratory tract, e.g., tonsillitis or pharyngitis).
Erythromycin is indicated for the treatment of penicillin-allergic
patients.4 The therapeutic dose should
be administered for 10 days.
Prevention of RecurrentAttacks of Rheumatic Fever
Penicillin or sulfonamides are considered by the American Heart Association
to be the drugs of choice in the prevention of recurrent attacks of
rheumatic fever. In patients who are allergic to penicillin and sulfonamides,
oral erythromycin is recommended by the American Heart Association
in the long-term prophylaxis of streptococcal pharyngitis (for the
prevention of recurrent attacks of rheumatic fever).4