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- Discussion:
    - for group A strep (pyogenes), alpha hemolytic strep and n. gonorrhea, s. pneumoniae, mycoplasma, legionnaire's, soft tissue infection with s.aureus;
    - adult: 250-500mg PO qid or 500mg-1gm IV qid;
    - IV administration of erythromycin is painful and may cause thrombophlebitis;
           - this is minimized by giving: 500mg/250-500 ml IV fluid slowly over 6hrs;
    - prophylaxis of bacterial endocarditis: 1gm PO 2hr before procedure; and 0.5gm PO 6hrs later;
    - peds: 20-40 mg/kg/24hr upto max dose of 2 gm/24hr IV or PO in 4 DD;

- Supplied:
    - powder for injection as lactobionate and gluceptate salts 250mg, 500mg, 1gm;
    - base as tablets 250mg, 333mg, 500mg and caps: 125mg, 250mg;
    - estolate as chewable tablets 125mg, 250mg and caps: 125mg, 250mg,
          - estolate salt is associatted with cholestatic jaundice;
          - supplied drops 100 mg/1 ml, susp 125, 250 mg/5 ml, chewable tap 125, 250 mg;
    - suspension 125mg/5ml, 250mg/5ml; stearate as tablets 250mg, 500mg;
    - ethylsuccinate as chewable tablets 200 mg and tabs: 400 mg and suspension 200mg/ml, 400 mg/ml;

- Cautions:
    - beware GI complaints, jaundice;
    - erythromycin base not well absorbed from the GI tract and often used as part of the " condon bowel prep"
         - a 2-3 day prep that includes oral laxatives and cleansing enemas; for an 8 am operation, 1 gm of erythromycin base and 1 gm of neomycin are given at about 1 pm, 3pm, an 11 pm the day prior to surgery;
    - diffusion from blood into CSF minimal even w/ inflammation;
         - ratio of CSF to blood level (%): normal meninges: 1-12, inflammed meninges: 7-25;
    - 15 % of dose will be excreted in urine (w/ nl R F(x))
    - dosing regimens for patients with renal in-sufficiency:
         - dose for 70kg adult (gm/dosing interval in hours):
              - CrCl: > 80, 0.5-1/6
              - CrCl: 50-79, 0.5-1/6
              - CrCl: 30-49, 0.5-1/6
              - CrCl: 10-29, 0.5-1/6
    - otoxicity; requires - dose reductionin hepatic dysfunction;
    - will increase action of benzodiazepines, will increase levels of carbamazepine (nystagmus, N/V ataxia);
    - will increase effectiveness of cortisol, increase serum levels digoxin, will increase serum levels of theophyllin;
    - may cause N/V, seizures, apnea;
    - with oral anticoagulants may increase PT;
    - use lactobionate salt with caution in neonates as it contains benzyl alcohol

Impetigo contagiosa III. Comparative efficacy of oral erythromycin and topical mupirocin.