ERYTHROMYCIN GLUCEPTATE

ERYTHROMYCIN GLUCEPTATE
(er-ith-roe-mye'sin)
Ilotycin Gluceptate
ERYTHROMYCIN LACTOBIONATE
Erythrocin Lactobionate-I.V.
Classifications: macrolide antibiotic;
Therapeutic: antibiotic

Prototype: Erythromycin
Pregnancy Category: B

Availability

500 mg, 1 g injection

Action

Soluble salt of erythromycin. It binds to the 50S ribosome subunits of susceptible bacteria, resulting in the suppression of protein synthesis of bacteria.

Therapeutic Effect

More active against gram-positive than gram-negative bacteria.

Uses

When oral administration is not possible or the severity of infection requires immediate high serum levels. See erythromycin.

Contraindications

Hypersensitivity to erythromycin or macrolide antibiotics; congenital QT prolongation; electrolyte imbalances.

Cautious Use

Impaired liver function; seizure disorders; pregnancy (category B), lactation.

Route & Dosage

Infections
Adult/Child: IV 15–20 mg/kg/d in 4 divided doses

Legionnaires' Disease
Adult: IV 0.5–1 g q6h x 21 d

Pelvic Inflammatory Disease
Adult: IV 500 mg q6h x 3d, then convert to PO

Administration

Intravenous

PREPARE: Intermittent/Continuous (preferred): Initial solution is prepared by adding 10 mL sterile water for injection without preservatives to each 500 mg or fraction thereof. Shake vial until drug is completely dissolved.  Intermittent: Further dilute each 1 g dose in 100–250 mL of RL or NS.  Continuous: Further dilute each 1 g in 1000 mL RL or NS. Give within 4 h.  

ADMINISTER: Intermittent: Give 1 g or fraction thereof over 20–60 min. Slow rate if pain develops along course of vein.  Continuous: Continuous infusion is administered slowly, usually over 6 h.  

INCOMPATIBILITIES Solution/additive: Dextrose-containing solutions, ascorbic acid, carbenicillin, colistimethate, clindamycin, furosemide, heparin, linezolid, metaraminol, metoclopramide, tetracycline, vitamin B complex with C. Y-site: Cefepime, ceftazidime, fluconazole.

  • Store: Gluceptate, reconstituted solution is stable up to 7 d if refrigerated at 2°–8° C (36°–46° F); use solution diluted for infusion within 4 h. Lactobionate, reconstituted solution is stable up to 14 d if refrigerated at 2°–8° C (36°–46° F); use solution diluted for infusion within 8 h.

Adverse Effects (≥1%)

Body as a Whole: Pain and venous irritation after IV injection; allergic reactions, anaphylaxis (rare); superinfections. GI: Nausea, vomiting, diarrhea, abdominal cramps, variations in liver function tests following prolonged or repeated therapy. (See also ERYTHROMYCIN.)

Interactions

Drug: Serum levels and toxicities of alfentanil, bexarotene, carbamazepine, cevimeline, cilostazol, clozapine, cyclosporine, disopyramide, estazolam, fentanyl, midazolam, methadone, modafinil, quinidine, sirolimus, digoxin, theophylline, triazolam, warfarin are increased. Ergotamine may increase peripheral vasospasm. May increase risk of arrhythmias.

Pharmacokinetics

Peak: 1 h. Distribution: Concentrates in liver; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: Primarily in bile and feces; 12–15% in urine. Half-Life: 3–5 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Determine C&S prior to initiation of therapy. Periodic liver function tests with daily high doses or prolonged or repeated therapy.
  • Monitor hearing impairment may occur with large doses of this drug. It may occur as early as the second day and as late as the third week of therapy.
  • Monitor for S&S of thrombophlebitis (see Appendix F). IV infusion of large doses is reported to increase risk.

Patient & Family Education

  • Notify physician immediately of tinnitus, dizziness, or hearing impairment.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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