Version May 2024
Acne vulgaris (alternative agent):
Note: Reserve for patients who cannot use first-line agents. Use in combination with benzoyl peroxide to reduce the risk for the development of antibiotic resistance (Ref). Therapeutic response may take up to 6 to 8 weeks; discontinue use if no improvement after 6 to 8 weeks or if condition worsens.
Topical:
Gel: Apply sparingly as a thin film over the affected area once or twice daily.
Ointment, solution: Apply to affected area twice daily (morning and evening); drying and peeling may be controlled by reducing the frequency of application.
Pads: Rub pad over affected areas twice daily (morning and evening); additional pads may be used, if needed.
Erysol [Canadian product]: Apply thin film to affected area twice daily (morning and evening after the skin has been thoroughly washed and patted dry); may decrease to once daily if irritation develops at application site. Maximum therapy duration: 3 months.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Erythromycin (topical): Pediatric drug information")
Note: Akne-Mycin ointment has been discontinued in the US for more than 1 year.
Acne vulgaris: Limited data available (Ref): Note: Due to emerging resistance patterns, should not typically be used as monotherapy for the management of acne vulgaris (Ref). Children ≥7 years and Adolescents:
Gel: Apply as a thin film over the affected area once or twice daily. Therapeutic response may take several weeks (up to 6 to 8 weeks); discontinue use if no improvement after 6 to 8 weeks or if condition worsens
Ointment, solution: Apply over the affected area twice daily (morning and evening); drying and peeling may be controlled by reducing frequency of application
Pads (pledgets): Rub pad over affected area twice daily (morning and evening); additional pads may be used if needed
There are no dosage adjustments provided in manufacturer’s labeling.
There are no dosage adjustments provided in manufacturer’s labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Dermatologic: Desquamation, erythema, exfoliation of skin, oily skin, pruritus, rough skin (leather appearance), skin fissure (around mouth), skin tenderness, urticaria, xeroderma
Local: Application site irritation (includes local dryness, localized burning, localized erythema, localized tenderness, stinging of the skin)
Ophthalmic: Eye irritation
<1%, postmarketing and/or case reports: Abdominal distress, abdominal pain, diarrhea, facial edema, hypersensitivity reaction, skin rash
Hypersensitivity to erythromycin or any component of the formulation
Concerns related to adverse effects:
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment. Discontinue if significant diarrhea, abdominal cramps, or passage of blood and mucus occurs.
Concurrent drug therapy issues:
• Concurrent topical acne therapy: Use with caution especially with peeling, desquamating or abrasive agents; irritation may be cumulative. Discontinue use if irritation or dermatitis occurs.
Dosage form specific issues:
• Topical gel: May be flammable. Keep away from heat and flame.
Other warnings/precautions:
• Appropriate use: For topical use only; not for ophthalmic use. Avoid contact with eyes, nose, mouth, mucous membranes, or broken skin. Lack of improvement or worsening of acne may indicate microbial resistance. Alternative therapy may be required for severe acne (eg, nodular). Consider alternate therapy in patients with poor tolerance to macrolides or clindamycin. In the treatment of acne, American Academy of Dermatology acne guidelines recommend erythromycin (topical) be used in conjunction with other therapies (not as monotherapy) due to the risk of bacterial resistance. If given for mild acne, erythromycin (topical) should be used in combination with benzoyl peroxide. If given for moderate to severe acne, it should be used in combination with a topical retinoid or systemic antibiotic agent (AAD [Zaenglein 2016]).
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Gel, External:
Erygel: 2% (30 g, 60 g)
Generic: 2% (30 g, 60 g)
Pad, External:
Ery: 2% (60 ea) [contains propylene glycol]
Solution, External:
Generic: 2% (60 mL)
Yes
Gel (Erygel External)
2% (per gram): $6.99
Gel (Erythromycin External)
2% (per gram): $2.02 - $5.48
Solution (Erythromycin External)
2% (per mL): $0.83
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Topical: Prior to treatment, thoroughly wash affected area with mild soap and warm water, rinse, and pat dry. Discard pad after single use. Wash hands after use. Avoid contact with the eyes, nose, mouth and other mucous membranes, and broken skin.
Topical: Prior to treatment, thoroughly wash affected area with mild soap and warm water, rinse, and pat dry. Wash hands after use. Avoid contact with the eyes, nose, mouth and other mucous membranes, and broken skin.
Pads: Discard pad after single use; keep container tightly closed between uses.
Solution: Use applicator tip to apply solution.
Acne vulgaris: Treatment of acne vulgaris.
Erythromycin may be confused with azithromycin, clarithromycin
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Clindamycin (Topical): Erythromycin (Topical) may diminish the therapeutic effect of Clindamycin (Topical). Management: Consider avoiding use of topical erythromycin and topical clindamycin at the same application site when treating acne vulgaris. This recommendation does not appear to apply to intravaginal use of clindamycin for the treatment of bacterial vaginosis. Risk D: Consider therapy modification
ISOtretinoin (Topical): May enhance the adverse/toxic effect of Erythromycin (Topical). Risk C: Monitor therapy
The amount of erythromycin available systemically following topical application is considered to be very low (Akhavan 2003). Systemic absorption would be required in order for erythromycin to cross the placenta and reach the fetus.
Topical erythromycin may be used for the treatment of acne in pregnancy (AAD [Zaenglein 2016]; Eichenfield 2013).
It is not known if erythromycin is present in breast milk following topical application. However, the amount of erythromycin available systemically following topical application is considered to be very low (Akhavan 2003). Systemic absorption would be required in order for erythromycin to enter breast milk and reach the breastfeeding infant.
Although the manufacturer recommends that caution be exercised when administering to breastfeeding women, topical erythromycin is considered to be compatible with breastfeeding (Murase 2014).
Antibacterial activity is due to inhibition of RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation. Alcohol component induces skin drying and peeling.
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