Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Pediatrics:** 40 mg/kg/day PO in divided doses Q6H OR 15-20 mg/kg/day IV in divided doses Q6H.Indications1. Mycoplasma pneumonia, Chlamydia pneumoniae, Campylobacter jejuni, Bordetella pertussis or Haemophilus ducreyi(chancroid) infections.2. Community-acquired pneumonia. (Given with additional medications in patients over the age of 60 with comorbidity orsevere pneumonia).3. Alternative for susceptible Gram-positive bacterial infections, such as streptococcal pharyngitis, in patients allergic topenicillin or cephalosporins.4. Legionnaire’s disease.5. Acne vulgaris - topical.6. Surgical prophylaxis orally, as the base, with neomycin, in therapeutic doses prior to colorectal surgery (see AppendixB).7. Prevention of further toxin production and eradication of the carrier state in Corynebacterium diphtheriae infections.8. Bordetella pertussis prophylaxis and treatment (40-50 mg/kg/day PO in 4 divided doses or 500 mg Q6H PO x 10 days).9. Chlamydial conjunctivitis or pneumonia in infants.10. Gonococcal ophthalmia neonatorum prophylaxis – topical.CommentsIV dose adjustment required for renal impairment. See renal dosing guideline on uconnect.Orally, use the minimally effective dose because as many as 30% of patients experience severe gastrointestinalintolerance which can limit erythromycin's use. Patients with severe infections should receive the drug intravenously. TheIV dose for Legionnaire's pneumonia is 2 to 4 g daily in divided doses, dependent upon the severity of the infection. Casereports have documented that ototoxicity can occur with high dose (1 g Q6H) therapy. For IV administration, lidocaine 10mg may be added to the erythromycin to decrease pain in adults.Drug InteractionsErythromycin inhibits the hepatic metabolism of many drugs, resulting in increased serum levels and reduced clearance.Some of the drugs affected in this way are:• Azole antifungals • Felodipine• Benzodiazepines • Fentanyl• Bosentan • HMG-CoA reductase inhibitors• Budesonide • Sirolimus• Buspirone • Tacrolimus• Carbamazepine • Tadalafil• Cilostazol • Theophylline• Cinacalcet • Tolterodine• Colchicine • Tramadol• Cyclosporine • Triptans• Docetaxel • Valproic acid• Ergot derivatives (contraindicated) • Warfarin• EplerenoneErythromycin prolongs the QT interval and has additive effects with other drugs that prolong the QT interval, such as:• Anti-arrhythmics • Fluconazole• Anti-emetics • Fluoroquinolones• Anti-psychotic drugs • Isradipine• Arsenic trioxide • Pentamidine• Astemizole (contraindicated) • Terfenadine (contraindicated)• Chloral hydrate • TMP/Sulfa• Chloroquine • Vasopressin• Clindamycin • Verapamil