Side Effects of Erythromycin

For Healthcare Professionals

associated with prolonged QT interval (heart

rhythm disorder that can cause serious
irregular heart rhythms/arrhytmias) have been

Applies to erythromycin: compounding powder,

reported following intravenous administration

injectable powder for injection, oral capsule, oral

of erythromycin lactobionate. (less than 0.4%).

delayed release capsule, oral delayed release

tablet, oral granule for reconstitution, oral

One case of erythromycin-related

suspension, oral tablet, oral tablet chewable, oral

polymorphous ventricular tachycardia reported

tablet coated particles

in a patient treated for pneumonia was

General
The most common side effects associated with
oral erythromycin were gastrointestinal and
were dose-related.

1. Gastrointestinal
Onset of pseudomembranous colitis symptoms
has been reported during or after antibacterial

characterized by a normal QT interval.

Frequency not reported: QT prolongation,
ventricular arrhythmias, ventricular
tachycardia, hypotension.

3. Hepatic
Rare (less than 0.1%): Hepatotoxicity,
fulminant hepatic necrosis, false isolated
elevations of serum glutamic oxaloacetic
transaminase (SGOT) enzymes.

therapy.
Frequency not reported: Hepatic dysfunction
((Pseudomembranous colitis terjadi ketika bakteri
berbahaya di usus biasanya C. difficile melepaskan

(including increased liver enzymes) and

hepatocellular and/or cholestatic hepatitis (with
or without jaundice) have been reported with

racun kuat yang mengiritasi usus besar. Bakteri

oral erythromycin. Transient elevations of liver

berbahaya biasanya tidak akan tumbuh berlebih akibat

function tests, hepatitis, abnormal liver function

keberadaan bakteri sehat dalam sistem pencernaan. Akan

test results, intrahepatic cholestasis

tetapi, keseimbangan ini bisa terganggu saat populasi

bakteri sehat menurun akibat penggunaan antibiotik dan
obat-obatan lain.))

Rare (less than 0.1%): Pancreatitis,

pancreatitis without biliary obstruction
Frequency not reported: Nausea, abdominal
pain, Clostridium difficile associated diarrhea,

4. Hypersensitivity
Frequency not reported: Allergic reactions
(ranging from urticaria to anaphylaxis),
hypersensitivity reactions (presented as rash,
eosinophilia, fever), hypersensitivity with
noninfectious hepatitis

5. Dermatologic

vomiting (P. Colitis syndrome) also Anorexia,

Rare (less than 0.1%): Skin rash,

infantile hypertrophic pyloric stenosis.

maculopapular rashes (generalized, pruritic)

2. Cardiovascular
Life-threatening episodes of ventricular
tachycardia (an abnormally rapid heart rate)

Frequency not reported: Skin reactions

(ranging from mild eruptions to erythema

multiforme, Stevens-Johnson syndrome, toxic

epidermal necrolysis)

4. Bowler WA, Hostettler C, Samuelson D, et al "Gastrointestinal side effects of intravenous erythromycin: incidence
and reduction with prolonged infusion time and glycopyrrolate pretreatment." Am J Med 92 (1992): 249-53

5. McComb JM, Campbell NP, Cleland J "Recurrent ventricular tachycardia associated with QT prolongation after
mitral valve replacement with intravenous administration of erythromycin." Am J Cardiol 54 (1984): 922-3

6. Nervous system
Rare (less than 0.1%): Convulsions
(involuntary contraction of muscles), reversible
hearing loss, reversible ototoxicity

6. Oberg KC, Bauman JL "QT interval prolongation and torsades de pointes due to erythromycin lactobionate."
Pharmacotherapy 15 (1995): 687-92

7. Freedman RA, Anderson KP, Green LS, Mason JW "Effect of erythromycin on ventricular arrhythmias and
ventricular repolarization in ideopathic long T syndrome." Am J Cardiol 59 (1987): 168-9

8. Chennareddy SB, Siddique M, Karim MY, Kudesia V "Erythromycin-induced polymorphous ventricular tachycardia
with normal QT interval." Am Heart J 132 (1996): 691-4

Frequency not reported: Exacerbation of

myasthenia gravis symptoms, new onset of
myasthenic syndrome.

9. Orban Z, Macdonald LL, Peters MA, Guslits B "Erythromycin-induced cardiac toxicity." Am J Cardiol 75 (1995):
859-61

10. Brown GR "Erythromycin-induced hypotension." Ann Pharmacother 29 (1995): 934-5

11. Nattel S, Ranger S, Talajic M, et al "Erythromycin-induced long QT syndrome: concordance with quinidine and

Reversible hearing loss was reported primarily

in patients with renal dysfunction and in
patients receiving high doses of erythromycin.

underlying cellular electrophysiologic mechanism." Am J Med 89 (1990): 235-8

12. Tschida SJ, Guay DRP, Straka RJ, Hoey LL, Johanning R, Vancebryan K "QT(c)-interval prolongation associated
with slow intravenous erythromycin lactobionate infusions in critically ill patients: a prospective evaluation and review
of the literature." Pharmacotherapy 16 (1996): 663-74

13. Brandriss MW, Richardson WS, Barold SS "Erythromycin-induced QT prolongation and polymorphic ventricular

Several published reviews have indicated that

ototoxicity (toxicity in ear) was associated with
erythromycin dosages greater than 4 grams
per day, preexisting liver or kidney disease,
and advanced age. Recovery generally
occurred within two weeks.

tachycardia (torsades de pointes): case report and review." Clin Infect Dis 18 (1994): 995-8

14. Granberry MC, Gardner SF "Erythromycin monotherapy associated with torsade de pointes." Ann Pharmacother
30 (1996): 77-8

15. Guelon D, Bedock B, Chartier C, Haberer JP "QT prolongation and recurrent "torsades de pointes" during
erythromycin lactobionate infusion." Am J Cardiol 58 (1986): 666

16. Diehl AM, Latham P, Boitnott JK, et al "Cholestatic hepatitis from erythromycin ethylsuccinate." Am J Med 76
(1984): 931-4

17. Gomezlechon MJ, Carrasquer J, Berenguer J, Castell JV "Evidence of antibodies to erythromycin in serum of a

7. Hematologic

patient following an episode of acute drug-induced hepatitis." Clin Exp Allergy 26 (1996): 590-6

18. Howe E, Howe E, Benn RA "Hepatotoxicity due to erythromycin ethylsuccinate." Med J Aust 158 (1993): 142-4

A case of hemolytic anemia has been reported

in a patient with severe underlying diseases
and erythromycin-associated hepatitis.

19. Gumaste VV "Erythromycin-induced pancreatitis." Am J Med 86 (1989): 725

20. Inman WH, Rawson NS "Erythromycin estolate and jaundice." Br Med J 286 (1983): 1954-5

21. Sullivan D, Csuka ME, Blanchard B "Erythromycin ethylsuccinate hepatotoxicity." JAMA 243 (1980): 1074

8. Renal
Frequency not reported: Interstitial nephritis

22. Fang CC, Wang HP, Lin JT "Erythromycin-induced acute pancreatitis." J Toxicol Clin Toxicol 34 (1996): 93-5

23. Keeffe EB, Reis TC, Berland JE "Hepatotoxicity to both erythromycin estolate and erythromycin ethylsuccinate."
Dig Dis Sci 27 (1982): 701-4

9. Local
Rare (less than 0.1%): Slow infusion of diluted
erythromycin (continuously or intermittently
over no less than 20 to 60 minutes) almost
invariably alleviated venous irritation.

24. Bachman BA, Boyd WP Jr, Brady PG "Erythromycin ethylsuccinate-induced cholestasis." Am J Gastroenterol 77
(1982): 397-400

25. Gholson CF, Warren GH "Fulminant hepatic failure associated with intravenous erythromycin lactobionate." Arch
Intern Med 150 (1990): 215-6

26. Hawksworth CR "Acute pancreatitis associated with infusion of erythromycin lactobionate." Br Med J 298 (1989):
190

27. Lestico MR, Smith AD "Stevens-johnson syndrome following erythromycin administration." Am J Health Syst

References

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3. Saloranta P, Roos L, Elonen E, Allonen H "Erythromycin ethylsuccinate, base and acistrate in the treatment of
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31. Agusti C, Ferran F, Gea J, Picado C "Ototoxic reaction to erythromycin." Arch Intern Med 151 (1991): 380

32. May EF, Calvert PC "Aggravation of myasthenia gravis by erythromycin." Ann Neurol 28 (1990): 577-9

33. Krobeth PD, McNeil MA, Kreeger A, et al "Hearing loss and erythromycin pharmacokinetics in a patient receiving
hemodialysis." Arch Intern Med 143 (1983): 1263-5

34. Schweitzer VG, Olson NR "Ototoxic effect of erythromycin therapy." Arch Otolaryngol 110 (1984): 258-60

35. Mery JP, Kanfer A "Alterations in pharmacokinetics and ototoxicity of erythromycin in renal failure." Am J Kidney
Dis 4 (1984): 95

disease (VD); and ear, intestine, lung,

urinary tract, and skin infections. It is also
used before some surgery or dental work to
prevent infection.
(US National Library of Medicine
https://www.nlm.nih.gov/medlineplus/druginfo/meds

36. Swanson DJ, Sung RJ, Fine MJ, et al "Erythromycin ototoxicity: prospective assessment with serum
concentrations and audiograms in a study of patients with pneumonia." Am J Med 92 (1992): 61-8

37. Umstead GS, Neumann KH "Erythromycin ototoxicity and acute psychotic reaction in cancer patients with hepatic
dysfunction." Arch Intern Med 146 (1986): 897-9

38. Sacristan JA, Soto JA, de Cos MA "Erythromycin-induced hypoacusis: 11 new cases and literature review." Ann
Pharmacother 27 (1993): 950-5

39. Black RJ, Dawson TAJ "Erythromycin and nightmares." Br Med J 296 (1988): 1070

40. Haydon RC, Thelin JW, Davis WE "Erythromycin ototoxicity: analysis and conclusions based on 22 case reports."
Otolaryngol Head Neck Surg 92 (1984): 678-84

41. Williams NR "Erythromycin: a case of nightmares." Br Med J 296 (1988): 214

42. Kemp E, Keidar S, Brook JG "Sensorineural hearing loss with low dose erythromycin." Br Med J 302 (1991): 1341

43. Schwartz JI, Maggini GA "Erythromycin-induced ototoxicity substantiated by rechallenge." Clin Pharm 1 (1982):
374-6

44. Vasquez EM, Maddux MS, Sanchez J, Pollak R "Clinically significant hearing loss in renal allograft recipients
treated with intravenous erythromycin." Arch Intern Med 153 (1993): 879-82

45. Taylor R, Schofield IS, Ramos JM, et al "Ototoxicity of erythromycin in peritoneal dialysis patients." Lancet
10/24/81 (1981): 935-6

46. Pastor E, LInares M, Grau E "Erythromycin-induced agranulocytosis." DICP 25 (1991): 1136

47. Rosenfeld J, Gura V, Boner G, et al "Interstitial nephritis with acute renal failure after erythromycin." Br Med J 286
(1983): 938-9

48. Vandersande FM, Hoorntje SJ "Acute interstitial nephritis with septicemia and erythromycin." Nephron 67 (1994):

/a682381.html)

Erythromycin can be used for the treatment

of pneumonias. It is the drug of choice for
a Legionella pneumonia and a good alternative
to tetracyclines for chlamydial infections and
mycoplasmas. Pneumococcal pneumonias
normally also respond well to
erythromycin; Haemophilus influenzae, on the
other hand, is often resistant.
Erythromycin can be considered as an
alternative to penicillin for streptococcal
pharyngitis; however, even streptococci are
partially resistant nowadays. Erythromycin
serves in the prophylaxis and treatment of
diphtheria carriers.
Erythromycin is also suitable for the treatment
of skin infections (eryspela, impetigo); it is the
drug of choice for erythrasma. Erythromycin
has a similar effect as tetracyclines
against acne; it can be used systemically
and topically.

244

49. "Product Information. ERYC (erythromycin)." Parke-Davis, Morris Plains, NJ.

Indication of Erythromycin
Erythromycin is an antibiotic used to treat
certain infections caused by bacteria, such
as bronchitis; diphtheria; Legionnaires'
disease; pertussis (whooping cough);
pneumonia; rheumatic fever; venereal

Erythromycin has good efficacy

against chlamydial infections in the genitourinary tract as well as in the eyes
(conjunctivitis).
However, erythromycin is not suitable for the
treatment of syphilis and gonorrhoea nor for
the prophylaxis of endocarditis.
(http://www.infomed.ch/100drugs/erytin
d.html)