Complete a thorough medication review before prescribing erythromycin to identify CYP3A substrates and QT-prolonging agents.
Absolute: hypersensitivity to macrolides; concomitant cisapride, pimozide, ergot alkaloids, or astemizole due to life-threatening QT prolongation. Relative: hepatic impairment, electrolyte disturbances, neonates at risk for pyloric stenosis, and myasthenia gravis.
History of hypersensitivity to erythromycin or other macrolide antibiotics
Concomitant use with drugs highly dependent on CYP3A that have a narrow therapeutic index (e.g., astemizole, cisapride, pimozide)
Clinically significant hepatic impairment or prior cholestatic hepatitis associated with macrolide use
Congenital or acquired QT prolongation, ventricular arrhythmias, or electrolyte disturbances
Concomitant QT-prolonging medicines (review risk-benefit)
Use in neonates younger than 2 weeks—risk of infantile hypertrophic pyloric stenosis; weigh benefits carefully
Myasthenia gravis—monitor for worsening muscle weakness