What is erythromycin?

Erythromycin, the generic name erythromycin stearate, is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria. It can even kill sensitive bacteria by reducing the production of proteins which are vital to the survival of the bacteria.

It can be taken by people who are allergic to penicillin and it is used to treat a wide variety of bacterial infections. Antibiotics are not used to treat viral infections such as herpes, measles, mumps, German measles, the common cold and flu as they will not work. In addition, using antibiotics unnecessarily will increase the risk of you contracting an infection at a later date that is antibiotic-resistant.

Uses of erythromycin

Erythromycin is used to treat many different conditions which include:

  • Upper respiratory tract infections including laryngitis, pharyngitis, sinusitis, tonsillitis and secondary infections associated with colds and flu
  • Lower respiratory tract infections including acute and chronic bronchitis, tracheitis, lobar pneumonia, bronchopneumonia, primary atypical pneumonia, bronchiectasis and legionnaires disease
  • Eye infections such as blepharitis
  • Ear infections including otitis media, otitis externa and mastoiditis
  • Oral infections such as gingivitis and Vincent’s angina
  • Skin and soft tissue infections including boils and carbuncles, abscesses, pustular acne, paronychia, impetigo, cellulitis and erysipelas
  • Gastrointestinal infections such as staphylococcal enterocolitis and cholecystitis 
  • Other infections for which erythromycin is used include gonorrhoea, syphilis, urethritis, osteomyelitis, lymphogranuloma venereum, diphtheria, prostatitis and scarlet fever
  • Erythromycin has also been found to be valuable in the treatment of endocarditis and septicaemia; in these circumstances, the initial treatment with erythromycin should be given intravenously

Erythromycin can also be used in some circumstances as a prophylactic against infection. The conditions it is used in this manner for include pre and postoperatively, burns, general trauma and rheumatic fever.

Who can take erythromycin?

Generally speaking, erythromycin is suitable to use in the treatment of men, women and children as well as pregnant or breastfeeding women. There are however some groups of people who may not use this form of antibiotic and they include:

  • People who have had in the past an allergic reaction to erythromycin or other antibiotics
  • If they have a rare inherited blood disorder called porphyria
  • If they have liver or kidney problems
  • If, when they have taken antibiotics previously it has caused them to have diarrhoea
  • If they have very rapid or irregular heartbeats
  • If you have a sexually transmitted infection called syphilis but you are also pregnant. Taking erythromycin alone may not prevent your baby from getting the infection
  • If a person is suffering from myasthenia gravis which is a muscle-wasting condition; taking erythromycin may make the symptoms worse

How should erythromycin be taken?

Erythromycin is available on prescription in a number of forms including tablets, capsules, or as a liquid to drink. It is also available as a skin solution that can be used to treat conditions such as acne.

The usual dose of erythromycin is between 250mg and 1000mg to be taken four times a day although sometimes it may be taken twice daily. The dose given to children will be lower.

Doses should be spread evenly over the day and it tends to be better to take erythromycin with food to prevent it from upsetting your stomach.

Even if you are feeling better and think that the problem is cured, it is important to continue taking the medication until the course is completed. If you fail to do this there is the risk that the infection could return.

What if I miss a dose or take too much?

Should you forget to take a dose then take it as soon as you remember. That is unless it is almost time to take the next dose in which case miss that dose completely and move on to take the next dose. Do not take two doses at the same time to make up for a missed dose.

Whilst taking too much erythromycin by accident is not likely to be harmful, the chance of experiencing side effects may be increased.

If you have any concerns there is the advice of your GP.

Side effects of Erythromycin

Erythromycin, as is the case with most types of medication, has some side effects although not everyone will necessarily get any.

Common side effects:

  • Nausea
  • Vomiting and diarrhea
  • Stomach cramps
  • Loss of appetite
  • Bloating and indigestion
  • If this antibiotic has to be used over prolonged or repeated periods then this can result in your developing a candida infection, either in the mouth or vagina. If this happens, speak to your GP who will be able to prescribe treatment

Serious side effects

Serious side effects are rare and occur in less than one in every thousand people. For this reason, if you experience any of the following you must seek medical advice as soon as possible.

  • Chest pains
  • Abnormal heartbeat
  • Skin rash
  • Severe stomach pain
  • Yellowing of the skin or whites of the eyes
  • Passing pale coloured faeces or dark coloured urine
  • Seizures
  • Hallucinations
  • Ringing in the ears, temporary hearing loss
  • Dizziness or feeling unsteady on the feet
  • A high temperature of 38 degrees Celsius or higher
  • The most serious reaction which may happen is anaphylactic shock which is an extreme allergic reaction. If this happens it is imperative that you seek medical treatment immediately. Symptoms of anaphylactic shock include:
    • Wheezing
    • Skin rash with itching, redness, swelling, blistering or peeling 
    • You are finding it difficult to breathe or speak
    • Your mouth, throat, face lips or tongue begin to swell

Contraindications of using erythromycin

There are a number of different medications that may interact with erythromycin. They include:

  • Antihistamine medication such as astemizole, terfenadine or mizolastine
  • An antiemetic or anti-sickness drug also known as domperidone
  • Some mental health medications including pimozide and amisulpride
  • Some migraine medications including ergotamine and dihydroergotamine
  • A medication designed to lower cholesterol levels called simvastatin
  • A medication to treat bladder weakness called tolterodine

Mixing erythromycin with herbal remedies does not cause any known problems. However, it is always advisable to ask for advice from your healthcare professional in advance or beginning treatment.

It is advisable to avoid eating grapefruit or drinking grapefruit juice whilst taking erythromycin as it can cause an increase in the levels of the medication in the body which in turn can leave you at a greater risk of experiencing side effects.

Conclusion

Our investigations into erythromycin have shown the antibiotic to be very versatile and it has a broad spectrum of applications; it is in fact what is known as a broad-spectrum antibiotic in that it is effective when used to fight many different types of bacteria. Erythromycin is still effective today in the treatment of infections despite the growing problem of antibiotic-resistant strains of bacteria.

I think that it is essential to reiterate that taking antibiotics routinely should be avoided at all costs. The reason for this is that it accelerates the evolution of new antibiotic-resistant varieties of bacteria which in turn means that the chance of their infections being successfully treated.

The World Health Organisation says:

“Bacteria, not humans or animals, become antibiotic-resistant. These bacteria may infect humans and animals, and the infections they cause are harder to treat than those caused by non-resistant bacteria. Antibiotic resistance leads to higher medical costs, prolonged hospital stays, and increased mortality.”

For these reasons, we must aim to protect the efficacy of broad-spectrum antibiotics such as erythromycin and others like it. Otherwise, we will eventually have a situation where we cannot develop new types of antibiotics quickly enough to keep up with the developing resistance and this leaves the human race wide open to the effects of stronger, untreatable variants of bacteria.