THE USUAL ORAL ADULT DOSE IS THE EQUIVALENT OF ERYTHROMYCIN 1 TO 2 G DAILY IN 2 TO 4 DIVIDED DOSES; FOR SEVERE INFECTIONS THIS MAY BE INCREASED TO UP TO 4 G DAILY IN DIVIDED DOSES. DAILY DOSES HIGHER THAN 1 G SHOULD BE GIVEN IN MORE THAN 2 DIVIDED DOSES. DOSES MAY NEED TO BE LIMITED IN PATIENTS WITH RENAL IMPAIRMENT . FOR CHILDREN THE DOSE IS USUALLY ABOUT 30 TO 50 MG/KG DAILY IN DIVIDED DOSES ALTHOUGH IT MAY BE DOUBLED IN SEVERE INFECTIONS; BASED ON AGE, CHILDREN OF 2 TO 8 YEARS MAY BE GIVEN 1 G DAILY IN DIVIDED DOSES AND INFANTS AND CHILDREN UP TO 2 YEARS OF AGE MAY BE GIVEN 500 MG DAILY IN DIVIDED DOSES.
FOR THE PREVENTION OF STREPTOCOCCAL INFECTIONS IN PATIENTS WITH EVIDENCE OF RHEUMATIC FEVER OR HEART DISEASE, WHO ARE UNABLE TO TAKE PENICILLIN OR SULFONAMIDES, A DOSE OF 250 MG TWICE DAILY MAY BE GIVEN.
FOR THE MANAGEMENT OF ACNE, MAINTENANCE DOSES AS LOW AS 250 MG DAILY HAVE BEEN USED IN ADULTS BUT RESISTANT STRAINS OF PROPIONIBACTERIA ARE WIDESPREAD; THE BNF RECOMMENDS A DOSE OF 500 MG TWICE DAILY.
IN PATIENTS WHO ARE UNABLE TO TAKE ERYTHROMYCIN BY MOUTH AND IN THOSE WHO ARE SEVERELY ILL, IN WHOM IT IS NECESSARY TO ATTAIN AN IMMEDIATE HIGH BLOOD CONCENTRATION, ERYTHROMYCIN MAY BE GIVEN INTRAVENOUSLY IN THE FORM OF ONE OF ITS MORE SOLUBLE SALTS SUCH AS THE GLUCEPTATE OR THE LACTOBIONATE, IN DOSES EQUIVALENT TO THOSE BY MOUTH.
TO REDUCE THE RISK OF VENOUS IRRITATION IT SHOULD BE GIVEN ONLY BY CONTINUOUS OR INTERMITTENT INTRAVENOUS INFUSION OF A SOLUTION CONTAINING NOT MORE THAN 0.5% OF ERYTHROMYCIN. INTERMITTENT INFUSIONS SHOULD BE GIVEN EVERY 6 HOURS OVER 20 TO 60 MINUTES.
EARLY SYPHILIS, 500 MG 4 TIMES DAILY FOR 14 DAYS
UNCOMPLICATED GENITAL CHLAMYDIA, NON-GONOCOCCAL URETHRITIS, 500 MG TWICE DAILY FOR 14 DAYS
BY INTRAVENOUS INFUSION, ADULT AND CHILD SEVERE INFECTIONS, 50 MG/KG DAILY BY CONTINUOUS INFUSION OR IN DIVIDED DOSES EVERY 6 HOURS; MILD INFECTIONS (ORAL TREATMENT NOT POSSIBLE), 25 MG/KG DAILY; NEONATE 30 - 45 MG/KG DAILY IN 3 DIVIDED DOSES
FOR THE PREPARATION OF SOLUTIONS OF ERYTHROMYCIN GLUCEPTATE OR LACTOBIONATE FOR INFUSION, A PRIMARY SOLUTION CONTAINING NOT MORE THAN 5% OF ERYTHROMYCIN SHOULD BE PREPARED FIRST; ONLY WATER FOR INJECTION SHOULD BE USED IN PREPARING THE PRIMARY SOLUTION. IT SHOULD BE FURTHER DILUTED WITH SODIUM CHLORIDE 0.9% OR OTHER SUITABLE INTRAVENOUS FLUID BEFORE USE. ACIDIC SOLUTIONS, SUCH AS GLUCOSE, SHOULD ONLY BE USED IF NEUTRALISED WITH SODIUM BICARBONATE.
OTHER ROUTES. ERYTHROMYCIN WAS FORMERLY GIVEN BY INTRAMUSCULAR INJECTION, BUT SUCH INJECTIONS ARE PAINFUL AND ARE NO LONGER GENERALLY RECOMMENDED. ERYTHROMYCIN HAS BEEN USED AS A 0.5% OPHTHALMIC OINTMENT FOR THE TREATMENT AND PROPHYLAXIS OF INFECTIONS OF THE EYE, PARTICULARLY OF NEONATAL CONJUNCTIVITIS. IT MAY ALSO BE APPLIED TOPICALLY AS A 2 TO 4% GEL OR SOLUTION FOR THE TREATMENT OF ACNE VULGARIS.