Erygyl Suspension

Description: Erygyl powder 125 mg/5ml.

Composition: Erythromycin estolate equivalent to 125 mg of erythromycin in 5 ml when reconstituted.

Actions and Pharmacology:
Erythromycin. a bacteriostatic antibiotic, may be bactericidal in high concentrations or when used against highly susceptible organisms. It is thought to penetrate the bacterial cell membrane and to reversibly bind to the bacterial ribosomes so that translocation of peptides is prevented and subsequent protein synthesis is inhibited.

Pharmacokinetics:
Erythromycin estolate is absorbed into the blood as the estolate salt and hydrolyzed to erythromycin base in the gastrointestinal tract and in the blood. Peak plasma concentration generally occur between 1 and 4 hours after administration.
It is widely distributed throughout body tissues and fluids, although it does not cross the blood- brain barrier and concentrations in CSF are low. Relatively high concentrations are found in the liver and spleen. Around 70 to 75% of the base is protein bound. Erythromycin crosses the placenta and is distributed into breast milk. It is excreted in high concentrations in the bile and 2 to 5% of an oral dose is excreted in the urine. It has half-life of about 1.5 to 2.5 hours.

Indications Indicated in the treatment or prophylaxis of the following:
• Upper and lower respiratory tract infections.
• Skin and soft-tissue infections including erythrasma.
Genitourinary tract infections including gonorrhoea and syphilis.
• Intestinal amoebiasis.
• Others include bacterial endocarditis, streptococcal pharyngitis, diphtheria, Legionnaires’ disease and pertussis.

Contra Indications: Avoid in patients known to be hypersensitive to erythromycins.

Precautions:
• Caution in patients with impaired hepatic function.
• Safety for use in pregnancy and lactation has not been established.
• Following prolonged or repeated erythromycin therapy, overgrowth of non-susceptible bacteria or fungi may occur.
Should not be used by hypersensitive patients.

Warning:
Rare cases of serious cardiovascular adverse event including deaths, cardiac arrests, torsades de pointes and other ventricular arrhythmia have been observed, when used in patients taking concomitant terfenadine or astemizole.

Main Side/Adverse Effects:
• Abdominal discomfort, diarrhoea, nausea, vomiting and ototoxicity (after high doses).
• Mild allergic reactions such as urticaria and other skin rashes.
• Serious allergic reactions including anaphylaxis.
• Hearing loss and/or tinnitus (patients with renal and hepatic insufficiency and on high dose).

Drug Interactions:
• Concurrent use with aminophylline, oxtriphylline or theophylline may result in increased serum theophylline levels; dosage adjustments may be necessary.
• Co-administration of lincomycins or penicillins is not recommended since erythromycins may interfere with their effects.

Overdosage:
Symptoms of overdose: Nausea, vomiting, diarrhoea, Treat overdosage by emesis or gastric lavage, if appropriate; with the necessary symptomatic and supportive measures, if required.

Dosage and Administration:
Adults: Antibacterial-oral, the equivalent of erythromycin 400 mg every 6 hours or 800 mg every 12 hours.
Antibacterial-continuous prophylaxis of streptococcal infections in patients(streptococcal prophylaxis) with a history of rheumatic heart disease and / or chorea oral, the equivalent of erythromycin 400 mg every 12 hours.
Antiprotozoal -oral, the equivalent of erythromycin 400 mg every 6 hours for ten to fourteen days.
Gonorrhoea (disseminated) – oral, the equivalent of erythromycin 800 mg every 6 hours for seven days.
Legionaires’ Disease -oral, the equivalent of erythromycin 400 mg to 1 gram every 6 hours.
Syphilis -oral, the equivalent of erythromycin 800 mg every 6 hours for 15 days (early syphilis) or for 30 days (late syphilis).

Usual adult prescribing limits- Antibacterial – the equivalent of erythromycin up to 4 grams daily.

Note: Doses up to the equivalent of 8 grams of erythromycin daily are apparently well tolerated.

Children:
Antibacterial – oral, the equivalent of erythromycin 7.5 to 25 mg per kg of body weight every 6 hours.
Antiprotozoal – oral, the equivalent of erythromycin 7.5 to 12.5 mg per kg of body weight every 6 hours for 10 to 14 days.

CONSTITUTION: To reconstitute, add cooled boiled water until well dispersed, then add water to the appropriate mark.

Tell your Doctor or Pharmacist if you notice any undesirable symptoms, even those not mentioned in this writeup.