1. Name Of The Medicinal Product
Erythrocin IV Lactobionate or Erythromycin Lactobionate
2. Qualitative And Quantitative Composition
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3. Pharmaceutical Form
Lyophilisate
4. Clinical Particulars
4.1 Therapeutic Indications
Erythromycin lactobionate is indicated in severe and immunocompromised cases of infections caused by sensitive organisms where high blood levels are required at the earliest opportunity or when the oral route is compromised.
1. Upper Respiratory Tract infections: tonsillitis, peritonsillar abscess, pharyngitis, laryngitis, sinusitis, secondary infections in influenza and common colds
2. Lower Respiratory Tract infections: tracheitis, acute and chronic bronchitis, pneumonia (lobar pneumonia, bronchopneumonia, primary atypical pneumonia), bronchiectasis, Legionnaire's disease
3. Ear infection: otitis media and otitis externa, mastoiditis
4. Oral infections: gingivitis, Vincent's angina
5. Eye infections: blepharitis
6. Skin and soft tissue infections: boils and carbuncles, paronychia, abscesses, pustular acne, impetigo, cellulitis, erysipelas
7. Gastrointestinal infections: cholecystitis, staphylococcal enterocolitis
8. Prophylaxis: peri-operative secondary infection prophylaxis, severe trauma and burns secondary infection prophylaxis, endocarditis prophylaxis (dental procedures)
9. Septicaemia
10. Endocarditis
11. Other infections: osteomyelitis, urethritis, gonorrhoea, syphilis, lymphogranuloma venereum, diphtheria, prostatitis, scarlet fever
4.2 Posology And Method Of Administration
Adults: severe and immunocompromised infections, 50mg/kg/day, preferably by continuous infusion (equivalent to 4g per day for adults).
Mild to moderate infections (oral route compromised) 25mg/kg/day.
Newborn infant (birth to 1 month): 10-15mg/kg 3 times daily.
Children: 12.5mg/kg 4 times daily. Doses can be doubled in severe infections.
Elderly: No special dosage recommendations.
Recommended Administration
Continuous intravenous infusion with an erythromycin concentration of 1mg/ml (0.1% solution) is recommended. The infusion should be completed within 8 hours of preparation to ensure potency.
If required, solution strengths up to 5mg/ml (0.5% solution) may be used, but should not be exceeded. Higher concentrations may result in pain along the vein.
Bolus injection is not recommended.
However, if it is decided to administer the daily dose as 4 doses once every 6 hours, then the erythromycin concentration should not exceed 5mg/ml and the time of each infusion should be between 20 and 60 minutes.
4.3 Contraindications
Known hypersensitivity to erythromycin. Erythromycin is contraindicated in patients taking astemizole, terfenadine, cisapride or pimozide.
Erythromycin is contraindicated with ergotamine and dihydroergotamine.
4.4 Special Warnings And Precautions For Use
Erythromycin is excreted principally by the liver, so caution should be exercised in administering the antibiotic to patients with impaired hepatic function or concomitantly receiving potentially hepatotoxic agents. Hepatic dysfunction including increased liver enzymes and/or cholestatic hepatitis, with or without jaundice, has been infrequently reported with erythromycin.
There have been reports suggesting erythromycin does not reach the foetus in adequate concentrations to prevent congenital syphilis. Infants born to women treated during pregnancy with oral erythromycin for early syphilis should be treated with an appropriate penicillin regimen.
There have been reports that erythromycin may aggravate the weakness of patients with myasthenia gravis.
Erythromycin interferes with the fluorometric determination of urinary catecholamines.
As with other broad spectrum antibiotics, pseudomembranous colitis has been reported rarely with erythromycin.
Rhabdomyolysis with or without renal impairment has been reported in seriously ill patients receiving erythromycin concomitantly with lovastatin.
Prolonged QTc interval and ventricular arrhythmias have rarely been reported in patients receiving erythromycin IV.
4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction
Concomitant use of erythromycin with terfenadine or astemizole is likely to result in an enhanced risk of cardiotoxicity with these drugs. The concomitant use of erythromycin with either astemizole or terfenadine is therefore contraindicated.
The metabolism of terfenadine and astemizole is significantly altered when either are taken concomitantly with erythromycin. Rare cases of serious cardiovascular events have been observed, including torsades de pointes, other ventricular arrhythmias and cardiac arrest. Death has been reported with the terfenadine / erythromycin combination.
Elevated cisapride levels have been reported in patients receiving erythromycin and cisapride concomitantly. This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and Torsades de pointes. Similar effects have been observed with concomitant administration of pimozide and clarithromycin, another macrolide antibiotic.
Mizolastine has a weak potential to prolong QT interval and has not been associated with arrhythmias, however, the metabolism of mizolastine is inhibited by erythromycin, therefore concomitant use should be avoided.
Concurrent use of erythromycin and ergotamine or dihydroergotamine has been associated in some patients with acute ergot toxicity characterised by the rapid development of severe peripheral vasospasm and dysaesthesia.
Increases in serum concentrations of the following drugs metabolised by the cytochrome P450 system may occur when administered concurrently with erythromycin: alfentanil, astemizole, bromocriptine, carbamazepine, cyclosporin, digoxin, dihydroergotamine, disopyramide, ergotamine, hexobarbitone, midazolam, phenytoin, quinidine, tacrolimus, terfenadine, theophylline, triazolam, valproate, acenocoumarol, rifabutin, and warfarin. Appropriate monitoring should be undertaken and dosage should be adjusted as necessary.
Erythromycin has been reported to decrease the clearance of zopiclone and thus may increase the pharmacodynamic effects of this drug.
When oral erythromycin is given concurrently with theophylline, there is also a significant decrease in erythromycin serum concentrations. The decrease could result in subtherapeutic concentrations of erythromycin.
4.6 Pregnancy And Lactation
There is no evidence of hazard from erythromycin in human pregnancy. It has been in widespread use for a number of years without apparent ill consequence. Animal studies have shown no hazard.
Erythromycin has been reported to cross the placental barrier in humans, but foetal plasma levels are generally low.
Erythromycin is excreted in breast milk, therefore, caution should be exercised when erythromycin is administered to a nursing mother.
4.7 Effects On Ability To Drive And Use Machines
None reported.
4.8 Undesirable Effects
Occasional side effects such as nausea, abdominal discomfort, vomiting and diarrhoea may be experienced. Reversible hearing loss associated with doses of erythromycin usually greater than 4g per day has been reported. Allergic reactions are rare and mild, although anaphylaxis has occurred. Skin reactions ranging from mild eruptions to erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis have rarely been reported. There are no reports implicating erythromycin products with abnormal tooth development, and only rare reports of damage to the blood, kidneys or central nervous system.
Cardiac arrhythmias have been very rarely reported in patients receiving erythromycin therapy. There have been isolated reports of chest pain, dizziness and palpitations, however, a cause and effect relationship has not been established.
Symptoms of hepatitis, hepatic dysfunction and/or abnormal liver function test results may occur.
4.9 Overdose
Symptoms: hearing loss, severe nausea, vomiting and diarrhoea.
Treatment: gastric lavage, general supportive measures.
5. Pharmacological Properties
5.1 Pharmacodynamic Properties
Erythromycin exerts its antimicrobial action by binding to the 50S ribosomal sub-unit of susceptible microorganisms and suppresses protein synthesis. Erythromycin is usually active against most strains of the following organisms both in vitro and in clinical infections:
Gram positive bacteria - Listeria monocytogenes, Corynebacterium diphtheriae (as an adjunct to antitoxin), Staphylococci spp, Streptococci spp (including Enterococci).
Gram negative bacteria - Haemophilus influenzae, Neisseria meningitidis, Neisseria gonorrhoeae, Legionella pneumophila, Moraxella (Branhamella) catarrhalis, Bordetella pertussis, Campylobacter spp.
Mycoplasma - Mycoplasma pneumoniae, Ureaplasma urealyticum.
Other organisms -Treponema pallidum, Chlamydia spp, Clostridia spp, L-forms, the agents causing trachoma and lymphogranuloma venereum.
Note: The majority of strains of Haemophilus influenzae are susceptible to the concentrations reached after ordinary doses.
5.2 Pharmacokinetic Properties
Following intravenous infusion, erythromycin is widely distributed throughout body tissues, including lung tissues.
5.3 Preclinical Safety Data
There are no pre-clinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC.
6. Pharmaceutical Particulars
6.1 List Of Excipients
None.
6.2 Incompatibilities
None Stated.
6.3 Shelf Life
36 months unopened, use within 1 day of opening.
6.4 Special Precautions For Storage
Once reconstituted, store in a refrigerator between 2°C and 8°C and use within 24 hours.
6.5 Nature And Contents Of Container
Glass vial with rubber closure.
6.6 Special Precautions For Disposal And Other Handling
Continuous intravenous infusion with an erythromycin concentration of 1mg/ml (0.1% solution) is recommended. The infusion should be completed within 8 hours of preparation to ensure potency.
If required, solution strengths up to 5mg/ml (0.5% solution) may be used, but should not be exceeded. Higher concentrations may result in pain along the vein.
Bolus injection is not recommended.
7. Marketing Authorisation Holder
Amdipharm plc
Regency House
Miles Gray Road
Basildon
Essex
SS14 3AF
8. Marketing Authorisation Number(S)
PL 20072/0038
9. Date Of First Authorisation/Renewal Of The Authorisation
26/6/79 / 30/01/95
10. Date Of Revision Of The Text
March 2007
11. LEGAL CATEGORY
POM
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