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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 erythromycin but a known risk factor for Torsade de pointes is female sex.

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 pharmaceutical company [2].

During pregnancy, erythromycin blood concentration is decreased, due to increased volume of distribution and enhanced metabolism [3, 4].

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].A study found no association between occurrence of erythromycin resistance and the patient’s sex [6].

Adverse effects

Erythromycin has been associated with prolonged QT-interval and a risk of Torsades de pointes ventricular tachycardia [2, 7-9]. Among the known risk factors of drug-induced ventricular arrhythmias are female sex, hypokalemia, bradycardia, and base line QT-prolongation [10].

Reproductive health issues

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

Updated: 2021-04-19

Date of litterature search: 2021-01-11

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. Ery-Max (erytromycin). Summary of Product Characteristics. Swedish Medical Products Agency [updated 2020-03-24, cited 2021-01-11]
  3. Chow AW, Jewesson PJ. Pharmacokinetics and safety of antimicrobial agents during pregnancy. Rev Infect Dis. 1985;7:287-313. PubMed
  4. Philipson A, Sabath LD, Charles D. Erythromycin and clindamycin absorption and elimination in pregnant women. Clin Pharmacol Ther. 1976;19:68-77. PubMed
  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. 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
  7. 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
  8. 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
  9. Drici MD, Knollmann BC, Wang WX, Woosley RL. Cardiac actions of erythromycin: influence of female sex. JAMA. 1998;280:1774-6. PubMed
  10. Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-22. PubMed
  11. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2020 [cited 2021-03-10.] länk

Authors: Linnéa Karlsson Lind

Reviewed by: Diana Rydberg

Approved by: Karin Schenck-Gustafsson