Treatment of AOM in children caused by susceptible Haemophilus influenzae. The fixed-combination preparation containing erythromycin ethylsuccinate and sulfisoxazole acetyl must be used; erythromycin is not effective when used alone for treatment of H. influenzae infections.
The fixed-combination preparation containing erythromycin ethylsuccinate and sulfisoxazole acetyl is an alternative (not a preferred agent) for treatment of AOM. The drug is recommended as an alternative in patients with type I penicillinhypersensitivity. May not be effective for treatment of AOM that fails to respond to amoxicillin since a high incidence of S. pneumoniae resistant to the fixed-combination drug has been reported.
Pharyngitis and Tonsillitis
Treatment of pharyngitis and tonsillitis caused by S. pyogenes (group A β-hemolytic streptococci). Generally effective in eradicating S. pyogenes from the nasopharynx, but efficacy in prevention of subsequent rheumatic fever has not been established to date.
CDC, AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice; oral cephalosporins and oral macrolides considered alternatives. Amoxicillin sometimes used instead of penicillin V, especially for young children.
Erythromycin usually the preferred alternative for treatment of streptococcal pharyngitis in patients hypersensitive to penicillin. Although S. pyogenes resistant to erythromycin and other macrolides have been reported and may be prevalent in some areas of the world (e.g., Japan, Finland), the incidence of these resistant S. pyogenes in the US has been relatively low to date.
Respiratory Tract Infections
Treatment of respiratory tract infections caused by susceptible S. pneumoniae.
Treatment of respiratory tract infections caused by Mycoplasma pneumoniae or C. pneumoniae.
Erythromycin usually not effective when used alone for treatment of respiratory tract infections caused by H. influenzae.
Skin and Skin StructureInfections
Treatment of mild to moderate skin and skin structure infections caused by S. pyogenes or Staphylococcus aureus. Consider that erythromycin-resistant Staphylococci may develop during treatment.
Treatment of erythrasma caused by Corynbacterium minutissimum.
Acne
Treatment of acne†.
Amebiasis
Has been used for treatment of intestinal amebiasis caused by Entamoeba histolytica. Erythromycin generally not recommended for treatment of amebiasis; regimen of choice for intestinal amebiasis is metronidazole or tinidazole followed by a luminal amebicide such as iodoquinol or paromomycin.
Anthrax
Alternative for treatment of anthrax†.
Multiple-drug parenteral regimens recommended for treatment of inhalational anthrax that occurs as the result of exposure to B. anthracis spores in the context of biologic warfare or bioterrorism. Initiate treatment with IV ciprofloxacin or doxycycline and 1 or 2 other anti-infective agents predicted to be effective (e.g., chloramphenicol, clindamycin, rifampin, vancomycin, clarithromycin, imipenem, penicillin, ampicillin); if meningitis is established or suspected, use IV ciprofloxacin (rather than doxycycline) and chloramphenicol, rifampin, or penicillin.
Bartonella Infections
Has been used in conjunction with IM or IV ceftriaxone for treatment of bacteremia caused by Bartonella quintana† (formerly Rochalimaea quintana).
Optimum regimens for treatment of infections caused by B. quintana or for treatment of cat scratch disease or other B. henselae infections have not been identified.
USPHS/IDSA suggests that long-term suppression with erythromycin or doxycycline be considered to prevent recurrence of Bartonella infection in HIV-infected patients†.
Campylobacter Infections
Treatment of symptomatic enteric infections caused by Campylobacterjejuni†. Recommended by CDC, IDSA, and AAP as a treatment of choice.
Chancroid
Treatment of chancroid† (genital ulcers caused by H. ducreyi).
CDC and others recommend azithromycin, ceftriaxone, ciprofloxacin or erythromycin as drugs of choice for treatment of chancroid. HIV-infected patients and uncircumcised patients may not respond to treatment as well as those who are HIV-negative or circumcised. Some experts prefer the 7-day erythromycin regimen instead of single-dose azithromycin or ceftriaxone regimens in HIV-infected individuals.
Chlamydial Infections
Alternative for treatment of uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis when tetracyclines and azithromycin are contraindicated or not tolerated. Erythromycin is less effective than either azithromycin or doxycycline and GI effects associated with the drug may discourage patient compliance with the regimen; CDC recommends that the first dose be taken under supervision.
A drug of choice for treatment of urogenital chlamydial infections in pregnant women and in young children.
Alternative for presumptive treatment of coexisting chlamydial infections in patients receiving treatment for gonorrhea. Preferred drugs are azithromycin or doxycycline; erythromycin may be preferred in young children.
Treatment of urethritis caused by Ureaplasma urealyticum.
Treatment of initial episodes and recurrences of chlamydial conjunctivitis in neonates.
Alternative to doxycycline for treatment of lymphogranuloma venereum† caused by invasive serotypes of C. trachomatis (serovars L1, L2, L3). Erythromycin may be the preferred regimen for pregnant and lactating women.
Alternative for treatment of psittacosis when tetracyclines are contraindicated (e.g., in pregnant women, children younger than 9 years of age).
Diphtheria
Adjunct to diphtheria antitoxin for treatment of diphtheria caused by Corynebacterium diphtheria. Diphtheria antitoxin is the most important aspect of treatment of respiratory diphtheria. Anti-infectives may eliminate C. diphtheriae from infected sites, prevent spread of the organism and further toxin production, and prevent or terminate the diphtheria carrier state, but appear to be of no value in neutralizing diphtheria toxin and should not be considered a substitute for antitoxin therapy.
Because diphtheria infection often does not confer immunity, active immunization with a diphtheria toxoid preparation should be initiated or completed during convalescence.
Prevention of diphtheria in close contacts of patients with diphtheria. Prophylaxis is indicated in all household or other close contacts of individuals with suspected or proven diphtheria, regardless of vaccination status; prophylaxis should be initiated promptly and should not be delayed pending culture results. An age-appropriate diphtheria toxoid preparation also may be necessary depending on immunization status.
Elimination of diphtheria carrier state in individuals known to carry toxigenic strains of C. diphtheriae.
Granuloma Inguinale (Donovanosis)
Alternative for treatment of granuloma inguinale† (donovanosis) caused by Calymmatobacterium granulomatis.
CDC recommends doxycycline or co-trimoxazole as drugs of choice; ciprofloxacin, erythromycin, and azithromycin are alternatives. Erythromycin may be preferred in pregnant and lactating women.
Legionnaires’ Disease
Treatment of Legionnaires’ disease caused by Legionella pneumophila; used with or without rifampin.
Lyme Disease
Alternative for treatment of early Lyme disease†. IDSA, AAP, and others recommend doxycycline, amoxicillin, or cefuroxime as first-line agents; macrolides may be less effective.
Nongonococcal Urethritis
Treatment of nongonococcal urethritis (NGU).
CDC and others recommend azithromycin or doxycycline as drugs of choice for treatment of NGU; erythromycin (erythromycin base or ethylsuccinate) or fluoroquinolones (levofloxacin, ofloxacin) are alternatives. A regimen of erythromycin and metronidazole is recommended by CDC for treatment of recurrent and persistent urethritis in patients who were compliant with their initial regimen and have not been re-exposed.
Pelvic Inflammatory Disease (PID)
IV erythromycin lactobionate followed by oral erythromycin has been used for treatment of PID) caused by N. gonorrhoeae, but erythromycins are not included in current CDC recommendations for treatment of PID.
Prevention of pertussis in contacts of patients with the disease; drug of choice.
CDC, AAP, and other clinicians recommend anti-infective prophylaxis for all household and other close contacts (e.g., those in childcare) of individuals with pertussis, regardless of age or vaccination status. Close contacts <7 years of age who are not fully immunized against pertussis also should receive the remaining required doses of a preparation containing pertussis vaccine (using minimal intervals between doses) and those who are fully immunized but have not received a vaccine dose within the last 3 years should receive a booster dose of a pertussis vaccine preparation.
Syphilis
Has been used as an alternative for treatment of primary syphilis in penicillin-allergic individuals.
Penicillin G is drug of choice for treatment of all stages of syphilis. Erythromycin is less effective than other possible penicillin alternatives and is not included in CDC recommendations for treatment of any form of syphilis in adults or adolescents (including primary, secondary, latent, or tertiary syphilis or neurosyphilis).
Preoperative Intestinal Antisepsis
Adjunct to mechanical cleansing of the large intestine for intestinal antisepsis prior to elective colorectal surgery; used in conjunction with neomycin.
Prevention of Bacterial Endocarditis
Has been used as an alternative to penicillins for prevention of bacterial endocarditis in penicillin-allergic patients undergoing certain dental, oral, respiratory tract, or esophageal procedures who have cardiac conditions that put them at high or moderate risk. AHA no longer recommends erythromycin for this use, but states that practitioners who have successfully used an erythromycin (i.e., erythromycin ethylsuccinate, erythromycin stearate) for prophylaxis in individual patients may choose to continue using these agents.
Erythromycins are not appropriate for prevention of bacterial endocarditis in patients undergoing GI, biliary, or genitourinary tract procedures because causative organisms are likely to be erythromycin-resistant.
Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis.
Prevention of Rheumatic Fever Recurrence
Alternative to IM penicillin G benzathine, oral penicillin V potassium, and oral sulfadiazine for prevention of recurrence of rheumatic fever (secondary prophylaxis) in patients hypersensitive to penicillins and sulfonamides.
Continuous prophylaxis recommended following treatment of documented rheumatic fever (even if manifested solely by Sydenham chorea) and in those with evidence of rheumatic heart disease.
Prevention of Perinatal Group B Streptococcal Disease
Alternative to penicillin G or ampicillin for prevention of perinatal group B streptococcal (GBS) disease† in penicillin-allergic pregnant women at risk for anaphylaxis with a β-lactam anti-infective.
Intrapartum anti-infective prophylaxis to prevent early-onset neonatal GBS disease is administered to women identified as GBS carriers during routine prenatal GBS screening performed at 35–37 weeks during the current pregnancy and to women who have GBS bacteriuria during the current pregnancy, a previous infant with invasive GBS disease, unknown GBS status with delivery at <37 weeks gestation, amniotic membrane rupture for ≥18 hours, or intrapartum temperature of ≥38°C.
Penicillin G is the regimen of choice and ampicillin is the preferred alternative. Cefazolin can be used in penicillin-allergic women who do not have immediate-type penicillin hypersensitivity, but clindamycin or erythromycin should be used in penicillin-allergic women at high risk for anaphylaxis.
Consider that S. agalactiae (group B streptococci) with in vitro resistance to clindamycin and erythromycin has been reported with increasing frequency; perform in vitro susceptibility tests of clinical isolates obtained during GBS prenatal screening. GBS resistant to erythromycin often are resistant to clindamycin, although this may not be evident in results of in vitro testing. If in vitro susceptibility testing is not possible, results are unknown, or isolates are found to be resistant to erythromycin or clindamycin, vancomycin is recommended for intrapartum prophylaxis in penicillin-allergic women at high risk for anaphylaxis with β-lactams.
Media Gallery
Drug Info Tools
