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Erytromycin

Klassificering: A

Preparat: Abboticin, Abboticin Amdipharm, Abboticin®, Abboticin® Novum, Ery 500 mg, Ery-Max®, Erythro-base, Erythrocine, Erythromycin, Erythromycin Ebb, Erythromycin Panpharma

ATC kod: J01FA01

Substanser: erytromycin, erytromycinacistrat, erytromycinestolat, erytromycinetylkarbonat, erytromycinetylsuccinat, erytromycinglukeptat, erytromycinlaktobionat, erytromycinpropionat, erytromycinstearat, erytromycinstinoprat, erytromycintiocyanat

Sammanfattning

Erytromycin är associerat med QT-förlängning på EKG och därmed risk för allvarlig rytmrubbning av typen Torsades de pointes kammartakykardi. Könsskillnad har inte påvisats för just erytromycin men en känd riskfaktor för att utveckla rytmrubbningen av typ Torsades de pointes är kvinnligt kön.

Additional information

Pharmacokinetics and dosing

Erythromycin pharmacokinetics was examined after a single dose intravenous administration to healthy volunteers (12 men, 12 women; age 17-23 years). A small sex difference was found in total body clearance adjusted per kilogram bodyweight. The serum concentration-time profiles of erythromycin in men and women were not sufficiently different over the 7h to warrant dosage adjustment [1]. No sex differentiation in dosing has been recommended by the pharmaceutical company [2].

During pregnancy, erythromycin blood concentration is decreased, due to increased volume of distribution and enhanced metabolism [3, 4].

Effects

A study showed that a four-day treatment with erythromycin 500 mg twice daily against chlamydia trachomatis infection was not better than seven-day treatment and the results were similar in men and women [5].A study found no association between occurrence of erythromycin resistance and the patient’s sex [6].

Adverse effects

Erythromycin has been associated with prolonged QT-interval and a risk of Torsades de pointes ventricular tachycardia [2, 7-9]. Among the known risk factors of drug-induced ventricular arrhythmias are female sex, hypokalemia, bradycardia, and base line QT-prolongation [10].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Försäljning på recept

Fler kvinnor än män hämtade ut läkemedel innehållande erytromycin (ATC-kod J01FA01) på recept i Sverige år 2020, totalt 9 279 kvinnor och 5 963 män. Det motsvarar 1,8 respektive 1,2 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 0-4 år hos båda könen. I åldersgruppen 0-9 år var läkemedel innehållande erytromycin i genomsnitt 1,1 gånger vanligare hos pojkar och i åldersgruppen 10 år och äldre i genomsnitt 1,9 gånger vanligare hos flickor/kvinnor [11].

Uppdaterat: 2021-04-19

Litteratursökningsdatum: 2021-01-11

Referenser

  1. Austin KL, Mather LE, Philpot CR, McDonald PJ. Intersubject and dose-related variability after intravenous administration of erythromycin. Br J Clin Pharmacol. 1980;10:273-9. PubMed
  2. Ery-Max (erytromycin). Summary of Product Characteristics. Swedish Medical Products Agency [updated 2020-03-24, cited 2021-01-11]
  3. Chow AW, Jewesson PJ. Pharmacokinetics and safety of antimicrobial agents during pregnancy. Rev Infect Dis. 1985;7:287-313. PubMed
  4. Philipson A, Sabath LD, Charles D. Erythromycin and clindamycin absorption and elimination in pregnant women. Clin Pharmacol Ther. 1976;19:68-77. PubMed
  5. Worm AM, Avnstorp C, Petersen CS. Erythromycin against Chlamydia trachomatis infections A double blind study comparing 4- and 7-day treatment in men and women. Dan Med Bull. 1985;32:269-71. PubMed
  6. Seppälä H, Klaukka T, Lehtonen R, Nenonen E, Huovinen P. Erythromycin resistance of group A streptococci from throat samples is related to age. Pediatr Infect Dis J. 1997;16:651-6. PubMed
  7. Shaffer D, Singer S, Korvick J, Honig P. Concomitant risk factors in reports of torsades de pointes associated with macrolide use: review of the United States Food and Drug Administration Adverse Event Reporting System. Clin Infect Dis. 2002;35:197-200. PubMed
  8. Hancox JC, Hasnain M, Vieweg WV, Gysel M, Methot M, Baranchuk A. Erythromycin, QTc interval prolongation, and torsade de pointes: Case reports, major risk factors and illness severity. Ther Adv Infect Dis. 2014;2:47-59. PubMed
  9. Drici MD, Knollmann BC, Wang WX, Woosley RL. Cardiac actions of erythromycin: influence of female sex. JAMA. 1998;280:1774-6. PubMed
  10. Roden DM. Drug-induced prolongation of the QT interval. N Engl J Med. 2004;350:1013-22. PubMed
  11. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2020 [cited 2021-03-10.] länk

Författare: Linnéa Karlsson Lind

Faktagranskat av: Diana Rydberg

Godkänt av: Karin Schenck-Gustafsson

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