Neonatal Drug Therapy Manual

Erythromycin

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated November 18, 2022 - 3:00pm

Classification: 
Macrolide Antibiotic
Original Date: 
June 1996
Revised Date: 
November 2022
Indications: 
  • Infections due to Ureaplasma urealyticum, Mycoplasma pneumoniae, Legionella pneumophilla and Chlamydia
  • Prokinetic agent for GI motility
Administration: 
  • IV intermittent infusion: over 30 - 60 minutes
  • PO (Note: PO suspension currently not available)
Dosage: 
  • IV
    • Antibiotic: 20 - 40 mg/kg/day divided Q6H
    • GI Motility (use lowest effective dose): 
      • Starting dose: 2.5-3 mg/kg/dose IV Q6H
      • Intermediate dose: 5 mg/kg/dose IV Q6H
      • Recommended maximum: 10 mg-12.5 mg/kg/dose, however risk of adverse effects are greater with higher doses. If using these higher doses, it is recommended to step down after 2 days if possible
         
  • PO (Note: PO suspension not currently available) 
    • Antibiotic:
      • 0 - 7 days:  20 mg/kg/day divided Q12H
      • > 7 days:
        • < 1.2 kg: 20 mg/kg/day divided Q12H
        • 1.2 - 2 kg: 30 mg/kg/day divided Q8H
        • > 2 kg: 40 mg/kg/day divided Q6H
           

NOTE: Assess risk-benefit in patients < 14 days of age, due to association of infantile hypertrophic pyloric stenosis

Side Effects: 
  • CVS: ventricular arrhythmia, prolongation of QT interval, bradycardia, hypotension (with IV administration)
  • GI: infantile hypertrophic stenosis, loose stools
  • Hematologic: eosinophilia
  • Hepatitis: cholestatic hepatitis, jaundice
  • Local: venous irritation, thrombophlebitis (with IV administration)
Parameters to Monitor: 
  • HR and BP during infusion
  • CBC
  • Injection site
  • Liver function tests
  • ECG (baseline and with dose increases recommended)
Reconstitution and Stability: 
  • Erythromycin 500 mg (lactobionate) (Erythrocin)
    • Add 10 mL SWFI
    • Take 2 mL (100 mg) and add to 48 mL 0.9% NaCl
    • Final concentration: 2 mg/mL

* Dilution guidelines applicable to specified brand

Compatibility: 

- Solutions Compatible: 0.9% NaCl

- Y-site Compatible: ampicillin, calcium gluconate, dobutamine, dopamine, epinephrine, fentanyl, heparin, KCl, midazolam, morphine, sodium bicarbonate, TPN

References: 

-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 17th Editions. Hudson: Lexi-Comp Inc.; 2010.

-Trissel LA. Handbook on Injectable Drugs. 16th Edition. Bethesda: American Society of Health-System Pharmacists; 2011

-Lau E. (Editor).  Drug Handbook and Formulary - The Hospital for Sick Children. Toronto; 2011-12.

-Ng E, Shah VS. Erythromycin for the prevention and treatment of feeding intolerance in preterm infants. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD001815.

-Patole S, Rao S, Doherty D. Erythromycin as a prokinetic agent in preterm neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed. 2005 Jul;90(4):F301-6.

- British National Formulary for Children, 2018/19. 

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