ERYTHROMYCIN ETHYLSUCCINATE

ERYTHROMYCIN ETHYLSUCCINATE (er-ith-roe-mye'sin) Apo-Erythro-ES , E.E.S., E.E.S.-200, E.E.S.-400, EryPed, Pediamycin Classifications: macrolide antibiotic; Therapeutic: antibiotic Prototype: Erythromycin Pregnancy Category: B

Availability

200 mg chewable tablet, 400 mg tablets; 100 mg/2.5 mL, 200 mg/5 mL, 400 mg/5 mL suspension

Action

Macrolide antibiotic that binds to the 50S ribosomal subunit of bacteria, thus inhibiting bacterial protein synthesis.

Therapeutic Effect

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

Uses

See ERYTHROMYCIN.

Contraindications

Hypersensitivity to erythromycins or any macrolide antibiotic; history of erythromycin-associated hepatitis; preexisting liver disease; congenital QT prolongation; electrolyte imbalances.

Cautious Use

Myasthenia gravis; history of GI disease; seizure disorders; pregnancy (category B), lactation.

Route & Dosage

Infection Adult: PO 400 mg q6h up to 4 g/d according to severity of infection Child: PO 30–50 mg/kg/d in 4 divided doses (max: 100 mg/kg/d) for severe infections

Administration

• Note: 400 mg erythromycin ethylsuccinate is approximately equal to 250 mg erythromycin base.

Oral

• Chewable tablets should be chewed and not swallowed whole.
• Suspensions are stable for 14 d at room temperature unless otherwise stated by manufacturer. Note expiration date.
• Store tablets in tight containers unless otherwise directed.

Adverse Effects (≥1%)

GI: Diarrhea, nausea, vomiting, stomatitis, abdominal cramps, anorexia, hepatotoxicity. Skin: Skin eruptions. Special Senses: Ototoxicity. Body as a Whole: Potential for superinfections.

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

Absorption: Readily absorbed from GI tract. Peak: 2 h. Distribution: Concentrates in liver; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: Primarily in bile and feces. Half-Life: 2–5 h.

Nursing Implications

Assessment & Drug Effects

• Lab tests: Determine C&S prior to treatment. Periodic liver function tests and blood cell counts if therapy is prolonged 10 d.
• Cholestatic hepatitis syndrome is most likely to occur in adults who have received erythromycin estolate for >10 d or who have had repeated courses of therapy. The condition generally clears within 3–5 d after cessation of therapy.

Patient & Family Education

• Advise patient to report immediately the onset of adverse reactions and to be on the alert for signs and symptoms associated with jaundice (see Appendix F).
• Ototoxicity is most likely to occur in patients receiving high dosage or who have impaired kidney function. Report immediately the onset of tinnitus, vertigo, or hearing impairment.

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