Erythromycin Therapy Guidelines

Primary Indications and Dosage

The Centers for Disease Control and Prevention recommends dosing of 40-50 mg/kg/day in 4 divided doses for 14 days for children and 2 g/day in 4 divided doses for 14 days for adults for the treatment of pertussis 1
The American Academy of Pediatrics suggests that erythromycin should only be used when azithromycin is unavailable, and infants must be monitored for infantile hypertrophic pyloric stenosis (IHPS) 1

The Infectious Diseases Society of America indicates that erythromycin is an alternative choice for primary syphilis in penicillin-allergic patients, with mandatory spinal fluid examination before treatment and as part of follow-up 5

The Centers for Disease Control and Prevention warns that erythromycin carries an increased risk of IHPS in neonates, particularly those <3 weeks old, with 7 cases out of 157 erythromycin-exposed infants versus 0 cases out of 125 unexposed infants 1
The Centers for Disease Control and Prevention advises that parents must be counseled about IHPS signs if erythromycin is prescribed to newborns 1
The National Institutes of Health notes that erythromycin is a potent inhibitor of the cytochrome P450 enzyme system (CYP3A subclass) and is contraindicated with astemizole, cisapride, pimazole, or terfenadine due to the risk of QT prolongation, cardiac arrest, and torsades de pointes 1

The Infectious Diseases Society of America recommends that erythromycin is the drug of choice for Legionella pneumonia, with treatment initiated as rapidly as feasible 4
The American Thoracic Society suggests that for hospitalized patients, azithromycin or fluoroquinolones are now preferred, but erythromycin remains acceptable for outpatients 4