Parenteral Manual

Erythromycin lactobionate

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

Alternate Name(s): 
ERYTHROCIN® IV
Classification: 
Macrolide antibiotic
Original Date: 
August 2005
Revised Date: 
December 2019
Indications: 
  • For the treatment of systemic infections caused by susceptible bacteria
  • Treatment of penicillin-sensitive organisms in patients hypersensitive to penicillin

 

Reconstitution and Stability: 

VIAL SIZE

STERILE WATER for INJECTION REQUIRED

FINAL CONCENTRATION

500 mg

10 mL

50 mg/mL

1,000 mg

20 mL

50 mg/mL

  • Powder is stable at room temperature
  • Reconstituted solution is stable for 24 hours at room temperature or 14 days refrigerated
  • Infusion stable at room temperature for 24 hours  in NS
  • Solutions are most stable at pH 6-8 and inactivated rapidly at pH 4 and below
Compatibility: 

- Solutions Compatible: D5W, NS, dextrose-saline combinations, ringer's lactate

- Additives/Above Cassette Compatible: KCl (up to 40 mmol/L), penicillin, ranitidine

- Y-site Compatible: esmolol, foscarnet, magnesium sulfate, midazolam, morphine,  TPN (amino acids/dextrose)

Incompatible: ampicillin, ceftazidime, furosemide, heparin

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

NO

IV Intermittent Infusion

YES

Syringe pump dilution: 2 mg/mL

Large Volume Pump dilution: 1 to 2.5 mg/mL.  Don't use a minibag smaller than 50 mL

Infusion time: 30-60 minutes

IV Continuous Infusion

YES

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:     

  • 20 - 50 mg/kg/day IV ÷ Q6H
  • Maximum: 4 g/day

Adult:  

  • 15-20 mg/kg/day IV ÷ Q 6 hours (250-1000 mg IV Q6H) or given as a continuous infusion
  • Maximum: 4 g/day

DOSING ADJUSTMENT IN RENAL IMPAIRMENT:

  • GFR < 10 mL/minute should get 50-75% of normal dose with same interval and maximum dose not to exceed 2 g/day.
Potential hazards of parenteral administration: 
  • Hypersensitivity (skin rashes, urticaria)
  • Venous irritation or thrombosis with extravasation. If extravasation occurs, click HERE for treatment guidelines.   
  • Pain or burning on injection
  • Hypotension, ventricular arrhythmias, Q-T interval prolongation
  • Ototoxicity
Notes: 
  • Monitor liver function tests, BP, HR
  • May accumulate in patients with severe liver disease; reduction in dose may be necessary.
  • May decrease clearance of terfenadine and astemizole leading to cardiotoxicity
  • Decreases clearance of cyclosporin, carbamazepine
  • May increase prothrombin time with oral anticoagulants

 

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