Drug: E.E.S.

Erythromycin is produced by a strain of Saccharopolyspora erythraea (formerly Streptomyces erythraeus) and belongs to the macrolide group of antibiotics. It is basic and readily forms salts with acids. The base, the stearate salt, and the esters are poorly soluble in water. Erythromycin ethylsuccinate is an ester of erythromycin suitable for oral administration. Erythromycin ethylsuccinate is known chemically as erythromycin 2'-(ethylsuccinate). The molecular formula is C43H75NO16 and the molecular weight is 862.06. The structural formula is: E.E.S. (erythromycin ethylsuccinate) Granules are intended for reconstitution with water. Each 5-mL teaspoonful of reconstituted cherry-flavored suspension contains erythromycin ethylsuccinate equivalent to 200 mg of erythromycin. The pleasant tasting, fruit-flavored liquids are supplied ready for oral administration. E.E.S. 200 Liquid (erythromycin ethylsuccinate) : Each 5-mL teaspoonful of fruit-flavored suspension contains erythromycin ethylsuccinate equivalent to 200 mg of erythromycin. E.E.S. (erythromycin ethylsuccinate) 400 Liquid: Each 5-mL teaspoonful of orange-flavored suspension contains erythromycin ethylsuccinate equivalent to 400 mg of erythromycin. Granules and ready-made suspensions are intended primarily for pediatric use but can also be used in adults. E.E.S. (erythromycin ethylsuccinate) 400® Filmtab® Tablets: Each tablet contains erythromycin ethylsuccinate equivalent to 400 mg of erythromycin. The Filmtab® tablets are intended primarily for adults or older children. Inactive Ingredients E.E.S. 200 Liquid (erythromycin ethylsuccinate) : FD&C Red No. 40, methylparaben, polysorbate 60, propylparaben, sodium citrate, sucrose, water, xanthan gum and natural and artificial flavors. E.E.S. (erythromycin ethylsuccinate) 400 Liquid: D&C Yellow No. 10, FD&C Yellow No. 6, methylparaben, polysorbate 60, propylparaben, sodium citrate, sucrose, water, xanthan gum and natural and artificial flavors. E.E.S. (erythromycin ethylsuccinate) Granules: Citric acid, FD&C Red No. 3, magnesium aluminum silicate, sodium carboxymethylcellulose, sodium citrate, sucrose and artificial flavor. E.E.S. (erythromycin ethylsuccinate) 400 Filmtab Tablets: Cellulosic polymers, confectioner's sugar (contains corn starch), corn starch, D&C Red No. 30, D&C Yellow No. 10, FD&C Red No. 40, magnesium stearate, polacrilin potassium, polyethylene glycol, propylene glycol, sodium citrate, sorbic acid, and titanium dioxide.

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The most frequent side effects of oral erythromycin preparations are gastrointestinal and are dose-related. They include nausea, vomiting, abdominal pain, diarrhea and anorexia. Symptoms of hepatitis, hepatic dysfunction and/or abnormal liver function test results may occur. (See WARNINGS.) Onset of pseudomembranous colitis symptoms may occur during or after antibiotic treatment. (See WARNINGS.) Erythromycin has been associated with QT prolongation and ventricular arrhythmias, including ventricular tachycardia and torsades de pointes. Allergic reactions ranging from urticaria to anaphylaxis have occurred. Skin reactions ranging from mild eruptions to erythema multiforme, Stevens- (erythromycin ethylsuccinate) Johnson syndrome, and toxic epidermal necrolysis have been reported rarely. There have been rare reports of pancreatitis and convulsions. There have been isolated reports of reversi (erythromycin ethylsuccinate) ble hearing loss occurring chiefly in patients with renal insufficiency and in patients receiving high doses of erythromycin. Read the E.E.S. (erythromycin ethylsuccinate) Side Effects Center for a complete guide to possible side effectsLearn More »

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Erythromycin ethylsuccinate suspensions and Filmtab tablets may be administered without regard to meals. Children Age, weight, and severity of the infection are important factors in determining the proper dosage. In mild to moderate infections the usual dosage of erythromycin ethylsuccinate for children is 30 to 50 mg/kg/day in equally divided doses every 6 hours. For more severe infections this dosage may be doubled. If twice-a-day dosage is desired, one-half of the total daily dose may be given every 12 hours. Doses may also be given three times daily by administering one-third of the total daily dose every 8 hours. The following dosage schedule is suggested for mild to moderate infections: Body Weight Total Daily Dose Under 10 lbs 30-50 mg/kg/day
15-25 mg/kg/q 12 h 10 to 15 lbs 200 mg 16 to 25 lbs 400 mg 26 to 50 lbs 800 mg 51 to 100 lbs 1200 mg over 100 lbs 1600 mg Adults 400 mg erythromycin ethylsuccinate every 6 hours is the usual dose. Dosage may be increased up to 4 g per day according to the severity of the infection. If twice-a-day dosage is desired, one-half of the total daily dose may be given every 12 hours. Doses may also be given three times daily by administering one-third of the total daily dose every 8 hours. For adult dosage calculation, use a ratio of 400 mg of erythromycin activity as the ethylsuccinate to 250 mg of erythromycin activity as the stearate, base or estolate. In the treatment of streptococcal infections, a therapeutic dosage of erythromycin ethylsuccinate should be administered for at least 10 days. In continuous prophylaxis against recurrences of streptococcal infections in persons with a history of rheumatic heart disease, the usual dosage is 400 mg twice a day. For Treatment of Urethritis Due to C. trachomatis or U. urealyticum 800 mg three times a day for 7 days. For Treatment of Primary Syphilis Adults: 48 to 64 g given in divided doses over a period of 10 to 15 days. For Intestinal Amebiasis Adults 400 mg four times daily for 10 to 14 days. Children 30 to 50 mg/kg/day in divided doses for 10 to 14 days. For Use in Pertussis Although optimal dosage and duration have not been established, doses of erythromycin utilized in reported clinical studies were 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days. For Treatment of Legionnaires' Disease Although optimal doses have not been established, doses utilized in reported clinical data were those recommended above (1.6 to 4 g daily in divided doses.)

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Erythromycin use in patients who are receiving high doses of theophylline may be associated with an increase in serum theophylline levels (erythromycin ethylsuccinate) and potential theophylline toxicity. In case of theophylline toxicity and/or elevated serum theophylline levels, (erythromycin ethylsuccinate) the dose of theophylline should be reduced while the patient is receiving concomitant erythromycin therapy. Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients receiving concurrent verapamil, belonging to the calcium channel blockers drug class. Concomitant administration of erythromycin and digoxin has been reported to result in elevated digoxin serum levels. (erythromycin ethylsuccinate) There have been reports of increased anticoagulant effects when erythromycin and oral anticoagulants were used concomitantly. Increased anticoagulation effects due to interactions of erythromycin with various oral anticoagulants may be more pronounced in the elderly. Erythromycin is a substrate and inhibitor of the 3A isoform subfamily of the cytochrome p450 enzyme system (CYP3A). Coadministration of erythromycin and a drug primarily metabolized tions. Interactions with other drugs metabolized by the CYP3A isoform are also possible. The following CYP3A based drug interactions have been observed with erythromycin products in post-marketing experience: Ergotamine/dihydroergotamine Concurrent use of erythromycin and ergotamine or dihydroergotamine has been associated in some patients with acute ergot toxicity characterized by severe peripheral vasospasm and dysesthesia. Triazolobenzodiazepines (such as triazolam and alprazolam) and related benzodiazepines Erythromycin has been reported to decrease the clearance of triazolam and midazolam, and thus, may increase the pharmacologic effect of these benzodiazepines. HMG-CoA Reductase Inhibitors Erythromycin has been reported to increase concentrations of HMG-CoA reductase inhibitors (e.g., lovastatin and simvastatin). Rare reports of rhabdomyolysis have been reported in patients taking these drugs concomitantly. Sildenafil (Viagra) Erythromycin has been reported to increase the systemic exposure (AUC) of sildenafil. Reduction of sildenafil dosage should be considered. (See Viagra package insert.) There have been spontaneous or published reports of CYP3A based interactions of erythromycin with cyclosporine, carbamazepine, tacrolimus, alfentanil, disopyramide, rifabutin, quinidine, methylprednisolone, cilostazol, vinblastine, and bromocriptine. Concomitant administration of erythromycin with cisapride, pimozide, astemizole, or terfenadine is contraindicated. (See CONTRAINDICATIONS.) In addition, there have been reports of interactions of erythromycin with drugs not thought to be metabolized by CYP3A, including hexobarbital, phenytoin, and valproate. Erythromycin has been reported to significantly alter the metabolism of the nonsedating antihistamines terfenadine and astemizole when taken concomitantly. Rare cases of serious cardiovascular adverse events, including electrocardiographic QT/QTc interval prolongation, cardiac arrest, torsades de pointes, and other ventricular arrhythmias have been observed. (See CONTRAINDICATIONS.) In addition, deaths have been reported rarely with concomitant administration of terfenadine and erythromycin. There have been post-marketing reports of drug interactions when erythromycin is co-administered with cisapride, resulting in QT prolongation, cardiac arrhythmias, ventricular tachycardia, ventricular fibrillation, and torsades de pointes, most likely due to inhibition of hepatic metabolism of cisapride by erythromycin. Fatalities have been reported. (See CONTRAINDICATIONS.) Drug/Laboratory Test Interactions Erythromycin interferes with the fluorometric determination of urinary catecholamines. Last reviewed on RxList: 2/11/2009
This monograph has been modified to include the generic and brand name in many instances.

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To reduce the development of drug-resistant bacteria and maintain the effectiveness (erythromycin ethylsuccinate) of E.E.S. (erythromycin ethylsuccinate) and other antibacterial drugs, E.E.S. (erythromycin ethylsuccinate) should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy. E.E.S. (erythromycin ethylsuccinate) is indicated in the treatment of infections caused by susceptible strains of the designated organisms in the diseases listed below Upper respiratory tract infections of mild to moderate degree caused by Streptococcus pyogenes, Streptococcus pneumoniae, or Haemophilus influenzae (when used concomitantly with adequate doses of sulfonamides, since many strains of H. influenzae are not susceptible to the erythromycin concentrations ordinarily achieved). (See appropriate sulfonamide labeling for prescribing information.) Lower-respiratory tract infections of mild to moderate severity caused by Streptococcus pneumoniae or Streptococcus pyogenes. Listeriosis caused by Listeria monocytogenes. Pertussis (whooping cough) caused by Bordetella pertussis. Erythromycin is effective in eliminating the organism from the nasopharynx of infected individuals rendering them noninfectious. Some clinical studies suggest that erythromycin may be helpful in the prophylaxis of pertussis in exposed susceptible individuals. Respiratory tract infections due to Mycoplasma pneumoniae. Skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus (resistant staphylococci may emerge during treatment). Diphtheria: Infections due to Corynebacterium diphtheriae , as an adjunct to antitoxin, to prevent establishment of carriers and to eradicate the organism in carriers. Erythrasma: In the treatment of infections due to Corynebacterium minutissimum. Intestinal amebiasis caused by Entamoeba histolytica (oral erythromycins only). Extraenteric amebiasis requires treatment with other agents. Acute pelvic inflammatory disease caused by Neisseria gonorrhoeae: As an alternative drug in treatment of acute pelvic inflammatory disease caused by N. gonorrhoeae in female patients with a history of sensitivity to penicillin. Patients should have a serologic test for syphilis before receiving erythromycin as treatment of gonorrhea and a follow-up serologic test for syphilis after 3 months. Syphilis caused by Treponema pallidum: Erythromycin is an alternate choice of treatment for primary syphilis in patients allergic to the penicillins. In treatment of primary syphilis, spinal fluid examinations should be done before treatment and as part of follow-up after therapy. Erythromycins are indicated for the treatment of the following infections caused by Chlamydia trachomatis: conjunctivitis of the newborn, pneumonia of infancy, and urogenital infections during pregnancy. When tetracyclines are contraindicated or not tolerated, erythromycin is indicated for the treatment of uncomplicated urethral, endocervical, or rectal infections in adults due to Chlamydia trachomatis. When tetracyclines are contraindicated or not tolerated, erythromycin is indicated for the treatment of nongonococcal urethritis caused by Ureaplasma urealyticum. Legionnaires' Disease caused by Legionella pneumophila. Although no controlled clinical efficacy studies have been conducted, in vitro and limited preliminary clinical data suggest that erythromycin may be effective in treating Legionnaires' Disease. Prophylaxis Prevention of Initial Attacks of Rheumatic Fever Penicillin is considered by the American Heart Association to be the drug of choice in the prevention of initial attacks of rheumatic fever (treatment of Streptococcus pyogenes infections of the upper respiratory tract, e.g., tonsillitis or pharyngitis). Erythromycin is indicated for the treatment of penicillin-allergic patients.3 The therapeutic dose should be administered for 10 days. Prevention of Recurrent Attacks of Rheumatic Fever Penicillin or sulfonamides are considered by the American Heart Association to be the drugs of choice in the prevention of recurrent attacks of rheumatic fever. In patients who are allergic to penicillin and sulfonamides, oral erythromycin is recommended by the American Heart Association in the long-term prophylaxis of streptococcal pharyngitis (for the prevention of recurrent attacks of rheumatic fever).3

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Erythromycin is contraindicated in patients with known hypersensitivity to this antibiotic. Erythromycin is contraindicated in patients taking terfenadine, astemizole, pimozide, or cisapride. (See PRECAUTIONS - DRUG INTERACTIONS.) Last reviewed on RxList: 2/11/2009
This monograph has been modified to include the generic and brand name in many instances.

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In case of overdosage, erythromycin should be discontinued. Overdosage should be handled with the prompt elimination of unabsorbed drug and all other appropriate measures should be instituted. Erythromycin is not removed by peritoneal dialysis or hemodialysis.

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E.E.S. 200 LIQUID (erythromycin ethylsuccinate oral suspension, USP) is supplied in 1 pint bottles (NDC 0074-6306-16) and in 100-mL bottles (NDC 0074-6306-13). E.E.S. 400® LIQUID (erythromycin ethylsuccinate oral suspension, USP) is supplied in 1 pint bottles (NDC 0074-6373-16) and in 100-mL bottles (NDC 0074-6373-13). Both liquid products require refrigeration to preserve taste until dispensed. Refrigeration by patient is not required if used within 14 days. E.E.S. GRANULES (erythromycin ethylsuccinate for oral suspension, USP) is supplied in 100-mL (NDC 0074-6369-02) and 200-mL ( NDC 0074-6369-10) size bottles. E.E.S. 400 Filmtab tablets (erythromycin ethylsuccinate tablets, USP) 400 mg, are supplied as pink tablets imprinted with the Abbott “A” logo, and two letter Abbo-Code designation, EE, in bottles of 100 (NDC 0074-5729-13), 500 (NDC 0074-5729-53) and 1000 (NDC 0074-5729-19) and in ABBO­PAC unit dose strip packages of 100 (NDC 0074-5729-11). Recommended storage Store tablets below 86°F (30°C). Store granules, prior to mixing, below 86°F. After mixing, refrigerate and use within 10 days. REFERENCES 3. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, the American Heart Association: Prevention of Rheumatic Fever. Circulation. 78(4):1082-1086, October 1988. Abbott Laboratories, North Chicago, IL 60064, U.S.A. FDA rev date: 12/10/2008Last reviewed on RxList: 2/11/2009
This monograph has been modified to include the generic and brand name in many instances.

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General Prescribing E.E.S. (erythromycin ethylsuccinate) in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Since erythromycin is principally excreted by the liver, caution should be exercised when erythromycin is administered to patients with impaired hepatic function. (See CLINICAL PHARMACOLOGY and WARNINGS sections.) Exacerbation of symptoms of myasthenia gravis and new onset of symptoms of myasthenic syndrome has been reported in patients receiving erythromycin therapy. There have been reports of infantile hypertrophic pyloric stenosis (IHPS) occurring in infants following erythromycin therapy. In one cohort of 157 newborns who were given erythromycin for pertussis prophylaxis, seven neonates (5%) developed symptoms of non-bilious vomiting or irritability with feeding and were su (erythromycin ethylsuccinate) bsequently diagnosed as having IHPS requiring surgical pyloromyotomy. A possible dose-response effect was described with an absolute risk of IHPS of 5.1% for infants who took erythromycin for 8-14 days and 10% for infants who took erythromycin for 15-21 days. 4 Since erythromycin may be used in the treatment of conditions in infants which are associated with significant mortality or morbidity (such as pertussis or neonatal Chlamydia trachomatis infections), the benefit of erythromycin therapy needs to be weighed against the potential risk of developing IHPS. Parents should be informed to contact their physician if vomiting or irritability with feeding occurs. Prolonged or repeated use of erythromycin may result in an overgrowth of nonsusceptible bacteria or fungi. If superinfection occurs, erythromycin should be discontinued and appropriate therapy instituted. by CYP3A may be associated with elevations in drug concentrations that could increase or prolong both the therapeutic and adverse effects of the concomitant drug. Dosage adjustments may be considered, and when possible, serum concentrations of drugs primarily metabolized by CYP3A should be monitored closely in patients concurrently receiving erythromycin. The following are examples of some clinically significant CYP3A based drug interac When indicated, incision and drainage or other surgical procedures should be performed in conjunction with antibiotic therapy. Carcinogenesis, Mutagenesis, Impairment of Fertility Long-term (2-year) oral studies in rats with erythromycin ethylsuccinate and erythromycin base did not provide evidence of tumorigenicity. Mutagenicity studies have not been conducted. There was no apparent effect on male or female fertility in rats fed erythromycin (base) at levels (erythromycin ethylsuccinate) up to 0.25% of diet. Pregnancy Teratogenic Effects Pregnancy Category B There is no evidence of teratogenicity or any other adverse effect on reproduction in female rats fed erythromycin base (up to 0.25% of diet) prior to and during mating, during gestation, and through weaning of two successive litters. There are, however, no adequate and well controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Labor and Delivery The effect of erythromycin on labor and delivery is unknown. Nursing Mothers Erythromycin is excreted in human milk. Caution should be exercised when erythromycin is administered to a nursing woman. Pediatric Use See INDICATIONS AND USAGE and DOSAGE AND ADMINISTRATION sections. Geriatric Use Elderly patients, particularly those with reduced renal or hepatic function, may be at increased risk for developing erythromycin-induced hearing loss. (See ADVERSE REACTIONS and DOSAGE AND ADMINISTRATION). Elderly patients may be more susceptible to the development of torsades de pointes arrhythmias than younger patients. (See ADVERSE REACTIONS). Elderly patients may experience increased effects of oral anticoagulant therapy while undergoing treatment with erythromycin. (See PRECAUTIONS - DRUG INTERACTIONS). E.E.S. (erythromycin ethylsuccinate) ® Granules contains 25.9 mg (1.1 mEq) of sodium per individual dose. REFERENCES 4. Honein, M.A., et. al.: Infantile hypertrophic pyloric stenosis after pertussis prophylaxis with erythromycin: a case review and cohort study. The Lancet 1999;354 (9196):2101-5.Last reviewed on RxList: 2/11/2009
This monograph has been modified to include the generic and brand name in many instances.

Source: http://www.rxlist.com

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