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8/26/2019

Erythromycin Lactobionate Injection

Reason for the Shortage

    • Pfizer had Erythrocin on shortage due to manufacturing delays.

Available Products

    • Erythrocin powder for solution for injection, Pfizer, 500 mg, vial, 10 count, NDC 00409-6482-01
    • Erythrocin powder for solution for injection, Pfizer, 500 mg, ADD-Vantage vial, 10 count, NDC 00409-6476-44

Estimated Resupply Dates

    • Pfizer has Erythrocin 500 mg ADD-Vantage vials and 500 mg regular vials available.

Alternative Agents & Management

  • Table 1. Alternatives to Erythromycin Lactobionate Injection in Selected Situations1-5
    SituationRecommendationComments
    Gastroparesis1-2 Metoclopramide 5 mg 3 times daily initial dose. Dosage range 5 mg to 10 mg 2 to 3 times daily before meals (maximum dose 40 mg daily).

    Erythromycin 250 mg to 500 mg orally 3 times daily before meals.
    Metoclopramide - Liquid preferred to increase absorption. Use drug holidays or dose reductions when clinically possible.Side effects such as drowsiness and tardive dyskinesia may limit the utility of metoclopramide.

    Erythryomycin oral - Limit duration of therapy, tacyphylaxis may occur after 4 weeks.
    Gastroparesis following partial large or small bowel resection surgery with primary anastomosis 3 Alvimopan 12 mg orally 30 minutes to 5 hours before surgery, then 12 mg orally twice daily for up to a maximum of 15 dosesMay only be used in hospitals. Hospitals must be enrolled in the Entereg Access Support and Education (EASE) program.
    Premature Rupture of Membranes (PROM)4-5 Ampicillin 2 gram IV every 6 hours and erythromycin 250 mg IV every 6 hours for 48 hours followed by oral amoxicillin 250 mg every 8 hours and erythromycin 333 mg every 8 hours.


    Azithromycin may be used as an alternative to erythromycin.

    A small retrospective study (N=168) found no difference in time of latency between patients who received ampicillin and azithromycin (9.4+10.4 days) and patients who received ampicillin and erythromycin (9.6+13.2 days, p=0.40). Azithromycin dose and route not specified in study. 5

References

    1. Camilleri M, Parkman HP, Shafi MA et al. Clinical Guideline: Management of Gastroparesis. Am J Gastroenterol. 2013;108 (1):18-38.
    2. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc; 2018.
    3. Entereg (alvimopan) capsules [product information]. Whitehouse Station, NJ: Merck; 2015.
    4. ACOG Practice Bulletin No. 188: Premature Rupture of Membranes. Clinical managment guidelines for obstetrician-gynecologists. Obstet Gynecol. Jan 2018; 131:e1-14.
    5. Pierson RC, Gordon SS, Haas DM. A Retrospective Comparison of Antibiotic Regimens for Preterm Premature Rupture of Membranes. Obstetrics and Gynecology. 2014;124 (3):515-519.

Updated

Updated August 26, 2019 by Michelle Wheeler, PharmD, Drug Information Specialist. Created July 11, 2016 by Michelle Wheeler, PharmD, Drug Information Specialist. © 2019, Drug Information Service, University of Utah, Salt Lake City, UT.

Disclaimer

This information is provided through the support of Vizient 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. Vizient, 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 Vizient, 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 Vizient, ASHP nor University of Utah endorses or recommends the use of any drug.

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