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Erythromycin Lactobionate Injection

[19 November 2014]

Products Affected - Description

Erythrocin Lactobionate Injection

Reason for the Shortage

  • Hospira had Erythrocin 500 mg vials on shortage due to manufacturing delays.1
  • Hospira is the sole supplier of erythromycin lactobionate.
     

Available Products

Erythrocin Lactobionate, Hospira
500 mg vials, 10 count (NDC 00409-6482-01)
500 mg Add-Vantage vials, 10 count (NDC 00409-6476-44)

Estimated Resupply Dates

All presentations are currently available.

Implications for Patient Care

  • Erythromycin lactobionate injection is labeled for the treatment of respiratory tract infections caused by susceptible strains of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae (in combination with sulfonamides), Mycoplasma pneumoniae; skin and skin structure infections caused by Streptococcus pyogenes and Staphylococcus aureus; Diphtheria; erythrasma due to infections caused by Corynebacterium minutissimum; and pelvic inflammatory disease caused by Neisseria gonorrhoeae for patients with penicillin allergy.2
  • Erythromycin lactobionate injection is also used as a promotility agent in patients with gastroparesis.3,4

Alternative Agents & Management

  • Oral erythromycin therapy may be an option for some patients.
  • The Table provides alternatives for selected situations. 

Table 1. Alternatives to Erythromycin Lactobionate Injection in Selected Situations

Situation

Recommendation

Comments

Gastroparesis3,4,5,6

Metoclopramide 10 mg orally or IV QID administered 30 minutes before meals.

Erythromycin 250 mg orally TID

Side effects such as drowsiness and tardive dyskinesia may limit the utility of metoclopramide.5

Gastroparesis following partial large or small bowel resection surgery with primary anastomosis7

Alvimopan 12 mg orally 30 minutes to 5 hours before surgery, then 12 mg orally twice daily for up to a maximum of 15 doses

May only be used in hospitals. Hospitals must be enrolled in the Entereg Access Support and Education (EASE) program.

Premature Rupture of Membranes (PROM)

Ampicillin 2 gram IV Q6H and erythromycin 250 mg IV Q6H for 48 hours then give oral doses of amoxicillin and erythromycin for 5 days.8-10

Limited information available for azithromycin.10,11

Related Shortages

References

  1. Hospira (personal communications and website) March 10, April 25, June 24, July 29, August 15 and 29, October 2 and 30, and November 19, 2014.
  2. Erythrocin Lactobionate - IV [product information]. Lake Forest, IL: Hospira, Inc.; 2010.
  3. Prakash C. Gastrointestinal Diseases. In: Cooper DH, Krainik AJ, Lubner SJ, Reno HEL, eds. The Washington Manual of Medical Therapeutics. 32th ed. Philadelphia, PA: Lippincott-Williams & Wilkins; 2007;439-472.
  4. McQuaid KR. Drugs Used in the Treatment of Gastrointestinal Diseases. In: Katzung BG, Masters SB, Trevor AJ: Basic and Clinical Pharmacology, 12th Edition, 2009. Available online at www.accessmedicine.com (accessed on September 7, 2012).
  5. Food and Drug Administration. MedWatch Alert – Metoclopramide-Containing Drugs. February 26, 2009. (accessed on September 7, 2012).
  6. Metoclopramide. In: Lacy CF, Armstrong LL, Goldman P, Lance LL, eds. The Drug Information Handbook. 2008 – 2009. Hudson, OH: Lexicomp; 2009:1024-1025.
  7. Entereg (alvimopan) capsules [product information]. Research Triangle Park, NC: GlaxoSmithKline;2008.
  8. ACOG Practice Bulletin No. 80: premature rupture of membranes. Clinical management guidelines for obstetrician-gynecologists. Obstet Gynecol. Apr 2007;109(4):1007-1019.
  9. Mercer BM. Preterm premature rupture of the membranes: diagnosis and management. Clin Perinatol. Dec 2004;31(4):765-782, vi.
  10. Mercer BM, Miodovnik M, Thurnau GR, et al. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Jama. Sep 24 1997;278(12):989-995.
  11. Giorlandino C, Cignini P, Cini M, et al. Antibiotic prophylaxis before second-trimester genetic amniocentesis (APGA): a single-centre open randomised controlled trial. Prenat Diagn. Jun 2009;29(6):606-612.

Updated

Updated November 19, 2014 by Jane Chandramouli, PharmD, Drug Information Specialist. Created September 3, 2003 by M. Christina Beckwith, PharmD, and Erin R. Fox, PharmD, Drug Information Specialists. Copyright 2014, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Novation to ASHP solely as a service to its members, which shall not use this information for their further commercial use. The content was prepared by the Drug Information Center of University of Utah. Novation, ASHP, and the University of Utah make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, which respect to such information, and specifically disclaim all such warranties. Users of this information are advised that decisions regarding the use of drugs and drug therapies are complex medical decisions and that in using this information, each user must exercise his or her own independent professional judgment. Neither Novation, ASHP nor the University of Utah assumes any liability for persons administering or receiving drugs or other medical care in reliance upon this information, or otherwise in connection with this bulletin. Neither Novation, ASHP nor University of Utah endorses or recommends the use of any drug.

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