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Erythromycin

Classification: A

Drug products: Abboticin Amdipharm, Abboticin®, Abboticin® Novum, Ery 500 mg, Ery-Max®, Erythromycin Ebb, Erythromycin Panpharma

ATC code: J01FA01

Substances: erythromycin, erythromycin acistrate, erythromycin estolate, erythromycin ethyl carbonate, erythromycin ethylsuccinate, erythromycin gluceptate, erythromycin lactobionate, erythromycin propionate, erythromycin stearate, erythromycin stinoprate, erythromycin thiocyanate

Summary

Erythromycin is associated with QT-prolongation on ECG and thus a risk of potentially fatal arrhythmias of the type Torsade de pointes ventricular tachycardia. No difference in risk between men and women has been shown for clarithromycin but a known risk factor for Torsade de Pointes is female sex.
 
In our opinion, the described differences do not motivate differentiated dosing or treatment in men and women.

Additional information

Pharmacokinetics and dosing

Erythromycin pharmacokinetics was examined after a single dose intravenous administration to healthy volunteers (12 men, 12 women; age 17-23 years). A small sex difference was found in total body clearance adjusted per kilogram bodyweight. The serum concentration-time profiles of erythromycin in men and women were not sufficiently different over the 7h to warrant dosage adjustment [1]. No sex differentiation in dosing has been recommended by the manufacturer [4].

During pregnancy, erythromycin blood concentration is decreased, due to increased volume of distribution and enhanced metabolism [2, 3]. 

Effects

A study showed that a four-day treatment with erythromycin 500 mg twice daily against chlamydia trachomatis infection was not better than seven-day treatment and the results were similar in men and women [5].

Adverse effects

Erythromycin has been associated with prolonged QT-interval and a risk of Torsades de pointes ventricular tachycardia [4, 6-8]. Among the known risk factors of drug-induced ventricular arrhythmias are female sex, hypokalemia, bradycardia, and base line QT-prolongation [9].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

A study found no association between occurrence of erythromycin resistance and the patient’s sex [10].

Updated: 2019-02-26

Date of litterature search: 2015-12-10

References

  1. Austin KL, Mather LE, Philpot CR, McDonald PJ. Intersubject and dose-related variability after intravenous administration of erythromycin. Br J Clin Pharmacol. 1980;10:273-9. PubMed
  2. Chow AW, Jewesson PJ. Pharmacokinetics and safety of antimicrobial agents during pregnancy. Rev Infect Dis. 1985;7:287-313. PubMed
  3. Philipson A, Sabath LD, Charles D. Erythromycin and clindamycin absorption and elimination in pregnant women. Clin Pharmacol Ther. 1976;19:68-77. PubMed
  4. Ery-Max (erytromycin) Summary of Product Characteristics. Medical Products Agency Sweden; 2016.
  5. Worm AM, Avnstorp C, Petersen CS. Erythromycin against Chlamydia trachomatis infections A double blind study comparing 4- and 7-day treatment in men and women. Dan Med Bull. 1985;32:269-71. PubMed
  6. Shaffer D, Singer S, Korvick J, Honig P. Concomitant risk factors in reports of torsades de pointes associated with macrolide use: review of the United States Food and Drug Administration Adverse Event Reporting System. Clin Infect Dis. 2002;35:197-200. PubMed
  7. Hancox JC, Hasnain M, Vieweg WV, Gysel M, Methot M, Baranchuk A. Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity. Ther Adv Infect Dis. 2014;2:47-59. PubMed
  8. Drici MD, Knollmann BC, Wang WX, Woosley RL. Cardiac actions of erythromycin: influence of female sex. JAMA. 1998;280:1774-6. PubMed
  9. Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-22. PubMed
  10. Seppälä H, Klaukka T, Lehtonen R, Nenonen E, Huovinen P. Erythromycin resistance of group A streptococci from throat samples is related to age. Pediatr Infect Dis J. 1997;16:651-6. PubMed
  11. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-04-05.] länk

Authors: Linnéa Karlsson Lind, Desirée Loikas

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson