Erythromycin 500mg Vidipha Treatment of infection (10 blisters x 10 tablets)

erythromycin and other macrolids are associated with the 50S unit subunit of ribosom sensitive bacteria and protein synthesis inhibitors. The effect of erythromycin is bactericidal but can be pliers at high concentrations for very sensitive strains. The effect of the drug increases in mild alkaline pH (about 8.5), especially with Gram -negative bacteria.

erythromycin has a broad spectrum with pathogenic bacteria including Gram -positive bacteria, streptococcus such as streptococcus pneumoniae, sreptococcus pyogenes. Many Staphylococcus aureus strains are still sensitive, although the resistance increases rapidly. The data in the ASTS report shows that in recent years, Staphylococcus, Pneumococcus, Streptococcus blood solubility group A resistant to Erythromycin increased much, the rate to increase resistance to 40% (Streptococcus pneumoniae), 55% (Enterococcus FAECALIS), 51% (Streptoccus vidans), and 50%) (Staphylococcus aureus). Erythromycin resistance increases each year in Vietnam due to the abuse of macrolids. Macrolids in general and Erythromycin in particular have to limit their use, only used when needed, so that the chance of reducing drug resistance.

Many other gram -positive bacteria are also sensitive to erythromycin including: Bacillus anthracis, corynebacterium diphteria, erysipelothris thisioparthiae, listeria monocyogenes. The drug has an average effect on anaerobic bacteria such as Clostridium spp.

erythromycin works with Gram -negative bacteria such as Neisseria Meningitidis, N. Gonorrheae and Moraxella (Branhamella) Catatrhalis.

Other Gram -negative bacteria have a change in sensitivity, but the drug still works effectively: Bordetella spp And Pasteurella, Haemophilus Ducreyi is still sensitive, but H. Influenzae is less sensitive. Entobacteriaceae are generally not sensitive, but some sensitive strains with alkaline drugs.

Of the Gram -negative anaerobic bacteria, Helicobacter PyloRidis and many Campylobacter Jejuni are sensitive (about 10% of the following strains are resistant). Most bacterioides fragilis and many fusobacterium strains are resistant to erythromycin.

Bacteria sensitive to drugs include Actinomyces, Chlamydia, Rickettsia spp. Mycoplasma in cells is usually resistant, including M. Fortuitum.

Mushrooms, yeast and viruses are all resistant to erythromycin. The minimum inhibitory concentration of erythromycin can be lower than 0.001 micrograms/ml for Mycoplasma Pneumoniae and minimum inhibitory concentration from 0.01 - 0.25 micrograms/ml for Listeria, Neisseria Gonorrheae and Corynebacterium Diphteria, Moraxella CatVrhalis and Bordetella pertussissis. The bacteria with a minimum inhibitory concentration of 0.5 micrograms/ml are considered to be sensitive to antibiotics and bacteria with a minimum inhibitor from 0.5 - 2 micrograms/ml of average sensitivity.

Dynamic pharmacokinetics

erythromycin base unstable in stomach acid environment, so the absorption changes and unstable. Base form often prepares films or tablets in the intestine, stable salt in acidic environment. Foods can reduce the absorption of base or stearate form, but the level depends on the formula.

Peak concentration in plasma is reached from 1 to 4 hours after taking a dose, depending on the form of the drug. Peak of about 0.3 -1.0 micrograms/ml at a dose of 250mg erythromycin base and from 0.3 to 1.9 micrograms/ml at a dose of 500mg. For the same stearate form. The peak concentration may be higher when used 4 times/day.

The bioavailability of erythromycin varies from 30 to 65% depending on the type of salt. The drug is widely distributed throughout the fluid and tissue, including the middle -eared leaking, prostate and semen. High concentration is seen in the spleen and great protection. The drug is poorly absorbed through the bloody barrier and has low concentrations in the cerebrospinal fluid; But when the meningitis, the medicine in the cerebrospinal fluid increases.

from 70 to 75% of base forms are attached to plasma proteins. Erythromycin through the placenta, the plasma concentration of the fetus changes by about 5-20% of the mother. The drug is distributed to milk, the concentration is about 50% of plasma concentrations.

Selling time is about 1.5 - 2.5 hours, which can last longer in patients with renal failure, which has reported about 4-7 hours in people with severe renal failure. Erythromycin is partially metabolized in the liver to form an inactive form, this metabolite has not been determined.

erythromycin eliminates mainly in the form of non -changing bile and reabsorption in the intestine. Elimination through urine from 2 - 15% in non -change form.

erythromycin is almost not eliminated by hemolysis or abdominal viagers.

Adjusting the dose for people with renal failure: The maximum dose of erythromycin is 1.5 g/day recommended for people with severe renal failure.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose?

Symptoms:

loss of hearing, severe nausea, vomiting and diarrhea.

Management:

For epinephrin, corticosteroids and antihistamine drugs to handle allergic reactions, douche stomach to eliminate unprocessed drugs from the body; And when you need to use supportive measures.

If the overdose occurs, it is recommended to go to the nearest medical facility for medical staff to have treatment methods.

What to do when you forget the dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Do not drink twice as prescribed.

Be cautious when taking drugs

erythromycin is excreted mainly in the liver, so it is necessary to be careful when using antibiotics for patients with liver function impairment or when used simultaneously with drugs that can toxic liver. Liver dysfunction includes liver enzymes and/or cholestatic hepatitis, whether or not without jaundice, have been regularly reported to erythromycin.

Palm of fake colitis has been reported with almost all antibiotics, including macrolid groups, and the level of inflammation may fluctuate from mild to serious, life -threatening. Clostridium difficile (CDAD) has been reported when used almost with all antibiotics including erythromycin, and the level of mild to serious to mild diarrhea, to death colitis. The treatment with antibiotics changes the normal microbiological system of the intestine, which can lead to overworking C. Difficile. CDAD must be considered in all patients with diarrhea after antibiotics.

Be careful with a history of the disease because there is a report on the CDAD occurring for more than two months after taking antibacterial drugs.

should carefully monitor patients with erythromycin simultaneously with drugs that may cause QT range. Contraindications to Erythromycin simultaneously with some of these drugs (see contraindications and drug interactions).

There have been reports that erythromycin concentration to the fetus is not enough to prevent congenital syphilis. Babies born from women during pregnancy are taken Erythromycin to treat early syphilis should be treated with appropriate penicillin treatment regimen.

There has been an erythromycin report that can worsen muscle weakness in patients with myasthenia gravis.

erythromycin affects the fluorescent test to identify catecholamine in the urine.

Penal patterns with or without renal failure have been reported in patients with severe illness oral erythromycin simultaneously with statin medications.

There have been reports on enlarged pyloric stenosis in children (IHPS) occurring in newborns after treatment with erythromycin. Since erythromycin can be used in the treatment of diseases with significant mortality or epidemics (such as pertussis or chlamydia) in young children, the benefits of erythromycin treatment need to be considered with the potential risks of iHPS development. Parents must notify the doctor if vomiting or discomfort.

Need to monitor patients when using the drug because the drug contains excipients Erythrosine Lake can cause allergic reactions, excipients with castor can have abdominal pain and diarrhea.

The ability to drive and operate machinery

Precautions when taking the drug because the drug can cause seizures, muscle weakness.

During pregnancy and lactation

pregnancy

erythromycin passes through each other. Although there is no evidence of pregnancy and teratogenic poisoning in animal studies, there is no satisfactory studies and are closely checked for the use of erythromycin for pregnant women or at birth, so do not use erythromycin for pregnant women, unless there are no replacement therapy and must be monitored carefully.

Breastfeeding period

erythromycin is excreted in breast milk, medicine needs to be used with caution for breastfeeding women.

Drug interaction

When used simultaneously, erythromycin may increase the serum concentration of drugs metabolized by the following cytochrom P450 system: Acenocoumarol, Alfentanil, Astemizol, Bromocriptin Carbamazepin, Cilostazol, Cyclosporin, Digoxin, Digotight Disopyramid, Ergotamin, Hexobarbiton, Methylprednisolon, Midazolam, Omeprazol, Phenytoin, Quinidin, Rifabutin, Sildenafil, Tacrolimus, Terfenadin, Domperidon, Theophylllin, Triazolam, Valproat, Vinblat, VinblaLastin Fluconazole, ketoconazole and otraconazole. Proper monitoring should be performed and should adjust the dose when necessary. Special care should be taken when using erythromycin along with known drugs is causing extension of qtc on the electrocyte.

CYP3A4 induction drugs (such as rifampicin, phenytoin, carbamazepin, phenobarbital, wart st John) may affect the metabolism of erythromycin. This may cause erythromycin concentrations below the therapy threshold and reduce the effect. This touch decreases for two weeks after stopping treatment with CYP3A4 induction drugs. Erythromycin should not be used for and two weeks after treatment with CYP3A4 induction drugs.

HMG-CoA Reductase inhibitors: Erythromycin has been reported to increase the concentration of HMG-CAA Reductase inhibitors (eg lovastatin and simvastatin). There have been a rare report on muscle panodus in patients who use these drugs at the same time with erythromycin.

contraceptive pills: There has been a rare report on bacterial hydrolysis of some antibiotics that interfere with steroids in the intestine, reducing the effects of birth control pills and leading to an uneasy steroid reabsorption. The result can reduce the concentration of operating steroids.

Antagonism with antihistamines H1: Patients should be monitored when they share erythromycin with antacids such as Terfenadin, Astemizol and Mizolastin by erythromycin to change the metabolism of these drugs.

erythromycin significantly changes the metabolism of terfenadin, astemizol and pimozid when used simultaneously. Rarely there are cases of serious cardiovascular complications, likely to cause death such as heart -stopping heart, torsion and other ventricular arrhythmia have been observed (see contraindications and unwanted effects).

Antibacterial drugs: In vitro research shows that erythromycin is opposed to beta-lactam antibiotics (eg penicillin, cephalosporin). Erythromycin against the effect of clindamycin, lincomycin and chloramphenicol. Similarly, antagonists acting with streptomycin, tetracycline and colistin.

Protease inhibitors: Observed the decomposition of erythromycin has been inhibited when used simultaneously with erythromycin and protease inhibitors.

Oral anticoagulant: There has been a report on an increase in anticoagulant effects when using Erythromycin simultaneously and oral anticoagulant (e.g. warfarin).

triazolobenzodiazepins (such as triazolam and alprazolam) and benzodiazepin drugs: Erythromycin reports have reduced the clearance of triazolam, midazolam, and benzodiazepine groups, and therefore can increase the pharmacological effects of this benzodiazepin.

Simultaneous use of erythromycin with ergotamine or dihydroergotamine causing Ergot toxicity is characterized by the vasoconstriction and ischemia of the central nervous system, limbs and other tissues (see the contraindication section).

This can lead to extension of QTC and arrhythmia include ventricular tachycardia, ventricular vibration and torsion. The same effect has been observed when used simultaneously pimozid with clarithromycin, other macrolid antibiotics.

Using erythromycin in patients who are taking high doses theophyllin may be associated with the increase of theophyllin and potential toxicity of theophyllin. In the case of theophyllin poisoning and/or theophylllin concentration in high serum, theophylllin should be reduced when the patient is being treated simultaneously with erythromycin. The published report showed that the concentration of erythromycin decreased significantly in the serum when giving erythromycin oral at the sameophyllin. This decline can lead to the occurrence of concentrations below the treatment threshold of erythromycin.

There have been reports on colchicin toxicity when using simultaneously erythromycin and colchicin.

Hypotension, arrhythmia and lactic acidic contamination have been observed in patients using erythromycin simultaneously with Verapamil, calcium channel blockers.

Cimetidine can inhibit Erythromycin metabolism, which can lead to increased plasma erythromycin concentrations.

erythromycin has been reported to reduce Zopiclon clearance and thus can increase the pharmacological effect of this drug.