Erythromycin
General Information
Macrolide
Restricted formulary antimicrobial: For details see OUH netFormulary
AWaRe antibiotic classification: 'Watch'. Use as per guidelines. All other indications to be discussed with Micro/ID.
For all information regarding interactions, contraception, pregnancy and breastfeeding and additional information, see BNF.
Standard Dose
Treatment doses:
|
|
Oral dose |
Intravenous dose |
|
Standard dose |
250mg – 500mg QDS (total daily dose may also be given in two divided doses) |
6.25mg/kg every 6 hours (maximum 2g in 24 hours) |
|
Severe infections |
500mg – 1000mg QDS |
12.5mg/kg every 6 hours (maximum 4g in 24 hours) |
Renal and hepatic impairment
Renal impairment
|
eGFR (mL/min/1.73m2) |
Oral and intravenous dose |
|
10 or more |
Dose as in normal renal function. |
|
Less than 10 |
Dose as in normal renal function. Oral = Suggest using QDS dose to avoid peaks produced by BD dosing |
|
HD/PD |
Not dialysed. Dose as in normal renal function. |
|
HDF/High Flux |
Unknown dialysability. Dose as in normal renal function. |
Hepatic impairment
No dose adjustment required.
Erythromycin is primarily excreted via the liver; use with caution:
- In patients with impaired hepatic function particularly with acute hepatic insufficiency
- In patients receiving high doses of erythromycin in those who have existing hepatic function.
- In patients receiving concurrent hepatotoxic medicines as it may cause idiosyncratic hepatotoxicity.
MHRA Drug Safety Updates
MHRA Drug Safety Update (December 2020):
Potential risk of hypertrophic pyloric stenosis in infants, especially in the first 2 weeks of breastfeeding. Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis
MHRA Drug Safety Update (December 2020):
Reports of cardiotoxicity (QT interval prolongation) and drug interaction with rivaroxaban Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban - GOV.UK
MHRA Drug Safety Update (February 2022):
Erythromycin has an increased risk of causing cardiovascular events when used with Hydroxychloroquine and chloroquine. Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions - GOV.UK
References
- Panpharma UK Ltd. Erythromycin 1g powder for solution for infusion summary of product characteristics. Electronic medicines compendium. Last revision of the text: 9/4/25 Accessed via: www.emc.medicines.org.uk [Accessed 2026 Feb 02].
- Waymade plc. Erythromycin Tablets BP 250mg summary of product characteristics. Electronic medicines compendium. Last revision of the text: 25/10/23. Accessed via: www.emc.medicines.org.uk [Accessed 2026 Feb 02].
- The Renal Drug Database. Erythromycin- last updated: 2018 Feb 20. Accessed via: https://renaldrugdatabase.com [Accessed 2026 Feb 02].
- Sanford Guide [online]. Erythromycin Base, Esters. Last updated 2022 Jan 25. Accessed via: https://webedition.sanfordguide.com [Accessed 2026 Feb 02].
- British National Formulary. Erythromycin. Accessed via: https://bnf.nice.org.uk [Accessed 2026 Feb 02].
- MHRA. Drug Safety update (December 2020) Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban. Accessed via https://www.gov.uk/drug-safety-update/erythromycin-caution-required-due-to-cardiac-risks-qt-interval-prolongation-drug-interaction-with-rivaroxaban [Accessed 2026 Feb 02].
- MHRA. Drug Safety update (February 2022) Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions. Accessed via: https://www.gov.uk/drug-safety-update/hydroxychloroquine-chloroquine-increased-risk-of-cardiovascular-events-when-used-with-macrolide-antibiotics-reminder-of-psychiatric-reactions [Accessed 2026 Feb 02].
- MHRA. Drug Safety update (December 2020) Erythromycin: update on known risk of infantile hypertrophic pyloric stenosis. Accessed via: https://www.gov.uk/drug-safety-update/erythromycin-update-on-known-risk-of-infantile-hypertrophic-pyloric-stenosis [Accessed 2025 Sept 29].