Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (158 page)
(e-rith′roe-mye′sin)
Ilotycin, Romycin
Func. class.:
Ophthalmic anti-infective
Chem. class.:
Macrolide
Inhibits protein synthesis, thereby decreasing bacterial replication
Conjunctivitis, eye infections, prevention of ophthalmic neonatorum
Hypersensitivity to this product or macrolides
Precautions:
Pregnancy (B), breastfeeding
Calculator
• Adult/adolescent/child:
Apply 1 cm of ointment directly to the eye up to 6 times a day ×7–10 days depending on severity of infection
Neonate:
Ointment
Apply 1 cm ribbon to lower conjunctival sac of each eye once after birth
•
Apply ribbon of ointment directly to the eye; for ophthalmic use only
EENT:
Hypersensitivity, irritation, redness
Unknown
•
Allergic reaction:
Assess for hypersensitivity, discontinue product
•
Decreased ophthalmic infection
•
Apply ribbon of ointment directly to the eye; for ophthalmic use only
Canada only Side effects:
italics
= common;
bold
= life-threatening 
Nurse Alert
(eh-rith-roh-my′sin)
Apo-Erythro
, Ery-Tab, Novo-Rythro Encap, PCE
ethylsuccinate (Rx)
Apo-Erythro-Es, E.E.S., Ery Ped, Novo-Rythro
lactobionate (Rx)
Erythrocin
Apo-Erythro-S, Erythrocin, My-E, Novo-Rythro
Func. class.:
Antiinfective
Chem. class.:
Macrolide
Do not confuse:
erythromycin
/azithromycin
Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Infections caused by
Neisseria gonorrhoeae;
mild to moderate respiratory tract, skin, soft-tissue infections caused by
Bordetella pertussis, Borrelia burgdorferi, Chlamydia trachomatis; Corynebacterium diphtheriae, Haemophilus influenzae
(when used with sulfonamides);
Legionella pneumophila
, Legionnaire’s disease,
Listeria monocytogenes; Mycoplasma pneumoniae, Streptococcus pneumoniae
, syphilis:
Treponema pallidum; Staphylococcus
sp.
Unlabeled uses:
Bartonellosis, burn wound infection, chancroid, cholera, diabetic gastroparesis, endocarditis, prophylaxis, gastroenteritis, granuloma inguinale, Lyme disease, tetanus
Hypersensitivity, preexisting hepatic disease (estolate)
Precautions:
Pregnancy (B), breastfeeding, geriatric patients, hepatic disease, GI disease, QT prolongation, seizure disorder, myasthenia gravis
Calculator
• Adult:
PO
250 mg qid
• Adult:
PO
250–500 mg (of base, estolate, or stearate) every 6 hr or 400–800 mg (ethylsuccinate) every 6 hr;
IV
15-20 mg/kg/day in divided doses every 4–6 hr, max 4 g/day
• Adolescent/child/infant:
PO
20–50 mg/kg/day divided every 6 hr, max adult doses;
IV
15–20 mg/kg/day in divided doses every 4–6 hr, or as a continuous inf, max dose 4 g/day
• Neonate
>
7 days,
≥
1200 g:
PO
30 mg/kg/day in divided doses every 8 hr
• Neonates
>
7 days,
<
1200 g:
PO
20 mg/kg/day in divided doses every 12 hr
• Neonates
≤
7 days:
PO
20 mg/kg/day in divided doses every 12 hr
Chlamydia trachomatis
• Infant/neonate:
PO
CDC recommends 50 mg/kg/day in 4 divided doses × 14 days (erythromycin base or ethylsuccinate)
Mycoplasma pneumoniae
pneumonia
• Adult:
PO
250–500 mg tid
• Adult/adolescent/child/infant:
IV
15–20 mg/kg/day, given in divided doses every 4–6 hr, or as a continuous inf, max dose 4 g/day; replace by oral dosage as soon as possible
Legionella pneumophila
)
• Adult:
PO/IV
0.5–1 g every 6 hr × 21 days
β
-hemolytic streptococcal (GAS) pharyngitis (primary rheumatic fever prophylaxis)
• Adult:
PO
250–500 mg (base, estolate, or stearate) every 6 hr or 400–800 mg (ethylsuccinate) every 6 hr × 10 days
• Adolescent/child/infant:
PO
20–50 mg/kg/day, divided every 6 hr × 10 days, max adult dose
• Adult/adolescent/child:
PO
250 mg bid in patients allergic to penicillin and sulfADIAZINE for 10 yr or age 40 whichever is longer, secondary prophylaxis (American Heart Association)
• Adult:
PO
250–500 mg (base, estolate or stearate) every 6 hr or 400–800 mg (ethylsuccinate) every 6 hr
• Adolescent/child/infant:
PO
20–50 mg/kg/day, divided every 6 hr, max adult doses
Chlamydia trachomatis
• Adult/adolescent:
PO
CDC recommends erythromycin base 500 mg qid or erythromycin ethylsuccinate 800 mg qid × 7 days as alternatives to first-line agents doxycycline or azithromycin
• Pregnant females:
PO
As alternatives to first-line agents azithromycin or amoxicillin, CDC recommends base 500 mg qid × 7 days, base 250 mg qid × 14 days, ethylsuccinate 800 mg qid × 7 days, ethylsuccinate 400 mg qid × 14 days
• Child
≤
45 kg:
PO
CDC recommends base or ethylsuccinate 50 mg/kg/day in 4 doses × 14 days
Chlamydia trachomatis
• Adult/adolescent:
PO
(base) 500 mg qid
Chlamydia trachomatis
including trachoma and inclusion conjunctivitis
• Pregnant/lactating woman/child
<
8 yr:
PO
250–500 mg qid × 10–14 days
Chlamydia trachomatis
• Infant/neonate:
PO
(base or ethylsuccinate) CDC recommends 50 mg/kg/day 4 divided doses × 14 days
Chlamydia trachomatis
or
Ureaplasma urealyticum
• Adult/adolescent:
PO
CDC recommends 500 mg (base) qid or 800 mg (ethylsuccinate) qid × 7 days as alternatives to first-line agents doxycycline or azithromycin
• Pregnant female:
PO
CDC recommends base 500 mg qid × 7 days
• Child
<
45 kg:
PO
CDC recommends base 50 mg/kg/day in 4 divided doses × 10–14 days, second course of therapy may be required
Chlamydia trachomatis
• Neonate:
PO
(erythromycin base or ethylsuccinate) CDC recommends 50 mg/kg/day in qid × 14 days, may repeat if condition returns
Chlamydia trachomatis
• Adult:
PO
(base) CDC recommends 500 mg qid × 21 days as an alternative to doxycycline
Corynebacterium diphtheriae
in carriers
• Adult:
PO
500 mg every 6 hr × 10 days
• Adult:
PO
250 mg every 6 hr × 10–14 days
• Adolescent/child:
PO
30–50 mg/kg/day, divided every 6 hr × 10–14 days, max adult dose
Neisseria gonorrhoeae
• Adult:
IV
500 mg (lactobionate) every 6 hr × 3 days, then PO 250 mg (base, estolate, stearate) or
PO
400 mg (ethylsuccinate) every 6 hr × 7 days
Bordetella pertussis
or for postexposure pertussis prophylaxis:
• Adult:
PO
500 mg qid (2 g total) × 14 days
• Adolescent/child/infant:
PO
40–50 mg/kg/day (max 2 g/day) in 4 divided doses × 14 days
Treponema pallidum
) in penicillin-allergic nonpregnant patients
• Adult:
PO
(CDC) 500 mg qid × 14 days as an alternative therapy
• Adult:
It is generally recommended that if surgery is scheduled for 8 am, 1 g of erythromycin PO with neomycin sulfate PO should be given at 1 pm, 2 pm, and 11 pm on the day before surgery
Available forms:
Base:
enteric-coated tabs 250, 333, 500 mg; film-coated tabs 250, 500 mg; enteric-coated caps 250, 333 mg;
stearate:
film-coated tabs 250 mg;
ethylsuccinate:
granules for oral susp 200, 400 mg/5 ml; powder for inj 500 mg, 1 g (lactobionate), 1 g (as gluceptate)
•
Do not break, crush, or chew time rel cap or tab; chew only chewable tabs; 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 before or 2 hr after meals
•
Chew tab: crush or chew
•
After
reconstituting
500 mg or less/10 ml sterile water without preservatives; dilute further in 100-250 ml of 0.9% NaCl, LR, Normosol-R; may be
further diluted
to 1 mg/ml and
given
as cont inf; run 1 g or less/100 ml over 1/2-1 hr; cont inf over 6 hr, may require buffers to neutralize pH if dilution is <250 ml, use inf pump
Y-site compatibilities:
Acyclovir, alfentanil, amikacin, aminocaproic acid, aminophylline, amiodarone, anidulafungin, atenolol, atosiban, atracurium, atropine, azaTHIOprine, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride/gluconate, CARBOplatin, caspofungin, cefotaxime, cefTAZidime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, CISplatin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTINomycin, DAPTOmycin, dexmedetomidine, digoxin, diltiazem, diphenhydrAMINE, DOBUTamine, DOCEtaxel, DOPamine, doxacurium, doxapram, DOXOrubicin, enalaprilat, ePHEDrine, EPINEPHrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, esmolol, etoposide, famotidine, fenoldopam, fentaNYL, fluconazole, fludarabine, fluorouracil, folic acid, foscarnet, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, hydrocortisone, HYDROmorphone, hydrOXYzine, IDArubicin, ifosfamide, imipenem-cilastatin, insulin (regular), irinotecan, isoproterenol, labetalol, levofloxacin, lidocaine, LORazepam, LR, mannitol, mechlorethamine, meperidine, methicillin, methotrexate, methoxamine, methyldopate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, miconazole, midazolam, milrinone, mitoXANtrone, morphine, multiple vitamins injection, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, oxytocin, PACLitaxel, palonosetron, pamidronate, pancuronium, papaverine, pentamidine, pentazocine, perphenazine, phenylephrine, phytonadione, piperacillin, piperacillin-tazobactam, polymyxin B, procainamide, prochlorperazine, promethazine, propranolol, protamine, pyridoxine, quiNIDine, ranitidine, Ringer’s, ritodrine, sodium acetate/bicarbonate, succinylcholine, SUFentanil, tacrolimus, temocillin, teniposide, theophylline, thiamine, thiotepa, tigecycline, tirofiban, TNA, tobramycin, tolazoline, TPN, trimetaphan, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinCRIStine, vinorelbine, vitamin B complex/C, voriconazole, zidovudine, zoledronic acid
CNS:
Seizures
CV:
Dysrhythmias, QT prolongation
EENT:
Hearing loss, tinnitus
GI:
Nausea, vomiting, diarrhea
,
hepatotoxicity,
abdominal pain, stomatitis, heartburn, anorexia,
pseudomembranous colitis
GU:
Vaginitis, moniliasis
INTEG:
Rash, urticaria, pruritus, thrombophlebitis (IV site)
SYST:
Anaphylaxis
Peak 4 hr (base); 1/2-2½ hr (ethylsuccinate); half-life 1-2 hr; metabolized in liver; excreted in bile, feces; protein binding 75%-90%; inhibitor of CYP3A4 and P-glycoprotein
Serious dysrhythmias—diltiazem, itraconazole, ketoconazole, nefazodone, pimozide, protease inhibitors, verapamil
Increase:
action, toxicity of alfentanil, ALPRAZolam, bromocriptine, busPIRone, carBAMazepine, cilostazol, clindamycin, cloZAPine, cycloSPORINE, diazepam, digoxin, disopyramide, ergots, felodipine, HMG-CoA reductase inhibitors, methylPREDNISolone, midazolam,
quiNIDine, rifabutin, sildenafil, tacrolimus, tadalafil, theophylline, triazolam, vardenafil, vinBLAStine, warfarin
Increase:
AST/ALT
Decrease:
folate assay
False increase:
17-OHCS/17-KS