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Erythromycin has traditionally been used for various respiratory infections (i.e., community-acquired pneumonia, Legionnaires disease), prophylaxis of neonatal conjunctivitis, and chlamydia. It is also FDA-approved for treating skin infections, intestinal amebiasis, rheumatic fever, prophylaxis, syphilis, and pelvic inflammatory disease (PID). In addition, if mixed with tretinoin cream or benzoyl peroxide, it is effective for treating acne. This activity will highlight the mechanism of action, adverse event profile, pharmacology, monitoring, and relevant interactions of erythromycin, other key factors (e.g., dosing, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the interprofessional team in the treatment of patients with infections and other conditions where this agent is indicated. Objectives: Describe the mechanism of antibacterial action for erythromycin. Outline the infectious and non-infectious indications for erythromycin. Review the potential adverse events associated with erythromycin. Explain the importance of improving care coordination among the interprofessional team to enhance the delivery of care for patients when using erythromycin. Access free multiple choice questions on this topic.

Macrolide antibiotics have varying levels of cardiotoxicity. Erythromycin carries the most prominent risk of cardiotoxicity among the more commonly used macrolide antibiotics. It induces QT prolongation and increases the risk of the potentially deadly heart rhythm known as torsades de pointes. Careful monitoring of the QTc interval on the EKG is recommended to minimize risk. Clinicians should monitor potassium, magnesium, and calcium levels in high-risk patients. There is no known reversal agent for erythromycin.[19]

Erythromycin causes common adverse drug reactions such as nausea, vomiting, diarrhea, and serious adverse drug reactions such as QT prolongation and pseudomembranous colitis. The clinician who is prescribing erythromycin should monitor the patient for QT prolongation. Torsades de pointes require the immediate cessation of therapy, referral to a cardiologist, and prompt treatment. Pseudomembranous colitis requires referral to a gastroenterologist. Pharmacists should check for potential drug-drug interactions as erythromycin is a known enzyme inhibitor. Pharmacists should also ensure proper medication reconciliation. The nurses can play a vital role in medication administration and patient education. The Core Elements of Antibiotic Stewardship compromise a framework for improving antibiotic prescribing, including macrolides, for individual clinicians and healthcare organizations. Prescribing erythromycin for labeled indications can significantly improve antibiotic resistance and optimally uses an interprofessional team approach.[25] Any interprofessional team member who encounters any issues with therapy, including adverse events or signs of therapeutic failure, must immediately note their findings in the patient health record and report this information to other team members to take corrective action. The interprofessional team approach that includes clinicians, specialists, nurses, and pharmacists, would maximize therapeutic efficacy, minimize the risk of adverse drug reactions and antibiotic resistance, and ultimately achieve the best possible patient outcome. [Level 5]