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Macrolide antibiotic used for pertussis, neonatal chlamydial infections, and atypical pneumonias when newer agents are not suitable.
Weight-based dosing (40 to 50 mg/kg/day divided every 6 hours for many infections) requires caregiver adherence to multiple daily doses.
Classic uses include treatment and post-exposure prophylaxis for pertussis, chlamydial conjunctivitis in neonates, and atypical pneumonias caused by Mycoplasma pneumoniae or Chlamydia pneumoniae.
GI intolerance is common; proactive counseling about dosing with food, hydration, and when to call the clinic reduces discontinuation.
Monitor for rare but serious hepatotoxicity, especially with the estolate formulation, and for potential QT prolongation in high-risk patients.
Significant cytochrome P450 3A4 inhibition necessitates a careful medication reconciliation before starting therapy.
Erythromycin retains key pediatric roles when azithromycin is unavailable or contraindicated.
Macrolide with activity against Bordetella pertussis, atypical respiratory pathogens, and Chlamydia species.
| Condition | Age Range | First Line? | Notes |
|---|---|---|---|
| Bordetella pertussis treatment and post-exposure prophylaxis | Infants, children, and adolescents | Yes | Administer four times daily for 14 days when azithromycin is unavailable or contraindicated; counsel caregivers on adherence and GI upset. |
| Neonatal Chlamydia trachomatis conjunctivitis or pneumonia | Neonates | Yes | Oral erythromycin 50 mg/kg/day divided four times daily for 14 days remains an alternative when azithromycin is not selected; monitor for pyloric stenosis. |
| Community-acquired pneumonia with atypical pathogen coverage | Children and adolescents | No | Use when macrolide therapy is indicated but azithromycin or clarithromycin are not options and susceptibility supports erythromycin. |
| Group A Streptococcal pharyngitis in severe penicillin allergy | Children and adolescents | No | Reserve for confirmed susceptible isolates and ensure a full 10-day course. |
| Campylobacter enteritis with severe disease | Children | No | Shortens illness and shedding when started early; consider azithromycin when tolerated. |
| Prokinetic therapy for gastroparesis or functional dyspepsia | No | Low-dose erythromycin stimulates motilin receptors; use limited-duration courses to reduce tachyphylaxis and monitor for QT prolongation. |
FDA-approved primary uses with Level A evidence
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Quick selection guides and diagnostic pearls
When to consider other medications
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Most children tolerate erythromycin with only mild stomach upset. Because the suspension requires four daily doses, anticipatory guidance about GI effects and drug interactions keeps families engaged and safe.
Nausea, abdominal cramping, and diarrhea are the most common adverse effects, reflecting the macrolide's motilin agonist activity. Rare but serious events include cholestatic hepatitis (particularly with estolate formulations), ventricular arrhythmias due to QT prolongation, and infantile hypertrophic pyloric stenosis in young neonates.
Nausea and abdominal cramping
Common • mild
Diarrhea
Common • mild
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Cholestatic hepatitis
Rare • severe
QT prolongation and torsades de pointes
Rare • severe
Rash or urticaria
Uncommon • variable
Organized by affected organ systems
How to discuss side effects with families
Management protocols and monitoring
Common concerns and practical guidance
Detailed guidance for administering erythromycin ethylsuccinate (EES) to children.
Shake the suspension well until uniformly mixed, then measure the dose with an oral syringe or dosing spoon from the pharmacy. Aim for administration every 6 hours while awake (for example, breakfast, mid-afternoon, dinner, and bedtime). If the child vomits within 15 minutes, call the prescriber to discuss repeating the dose. Always finish the full course even if symptoms improve.
Refrigeration is not required for most EES suspensions but keeping the bottle cool can make the taste more palatable. Offer a cold drink or small snack after each dose to reduce nausea. Document each dose on a dosing log, especially in multi-caregiver households. Space erythromycin at least 2 hours apart from aluminum- or magnesium-containing antacids to avoid reduced absorption.
Emergency contact: Seek urgent care for severe abdominal pain, projectile vomiting, jaundice, or signs of allergic reaction (hives, swelling of the face or throat, difficulty breathing).
Stay closely connected with your care team while your child is on erythromycin. Prompt calls for questions or concerning symptoms help keep therapy safe and effective.
Different formulations and concentrations
Safe preparation and measuring techniques
Tailored approaches for different ages
Solutions for common challenges
Storage guidelines and safety tips
Expert pearls and evidence-based tips
Erythromycin is a macrolide that halts bacterial protein synthesis and also stimulates GI motility via motilin receptors.
Binds the 23S rRNA of the 50S ribosomal subunit, blocking peptide chain translocation. Resistance arises from methylation of the binding site (erm genes) or efflux pumps.
Simple explanations and helpful analogies
Receptors, enzymes, and cellular targets
Absorption, metabolism, and elimination
Age-related differences and special populations
Evidence-backed pearls for using erythromycin safely in pediatrics.
Core insights every provider should know
Recent updates that change how we practice
Organized by dosing, administration, and safety
How to explain treatments to families
Real-world cases with evidence-based approaches
Key numbers, algorithms, and decision tools
Understanding your child's medication is important. We've created comprehensive guides to help you safely administer Erythromycin (EES) and monitor your child's response to treatment.
Children often feel better within a few days of treatment as coughing paroxysms lessen and fevers improve, but the full course (typically 14 days for pertussis) must be completed to eradicate the bacteria and limit transmission.
Yes. Giving doses with a small meal or snack can reduce stomach upset and does not significantly affect absorption of the ethylsuccinate suspension. Avoid large amounts of grapefruit juice, which can increase medicine levels.
In infants younger than 2 weeks, monitor for vomiting, feeding intolerance, or projectile emesis and call your clinician if these occur; very rarely erythromycin has been linked to hypertrophic pyloric stenosis.