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Pediatric Reference

Erythromycin (EES) Side EffectsComprehensive Pediatric Safety Guide

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.

4 Categories
7 Clinical Sources
Evidence-Based
Back to Erythromycin (EES) Overview

Essential Information

1

Give doses with a small snack or milk to limit stomach upset while maintaining absorption.

2

Report vomiting, jaundice, dark urine, or pale stools promptly because these may signal hepatic injury.

3

Review the child's medicine list for QT-prolonging agents or CYP3A substrates like certain antihistamines or anticonvulsants.

Clinical Overview

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.

Side Effect Categories

4 Systems

Gastrointestinal

3 documented effects

Total Sources: 4

Nausea and abdominal cramping

Incidence: Common
Onset: Often within the first few doses
mild
2 sources
Duration

Improves as the child adapts or after completion

Management

Give with food, smaller frequent meals, encourage hydration

Monitoring Guidelines

Call if vomiting persists beyond two doses or hydration suffers

2 clinical sources• PubMed • Clinical Guidelines • FDA

Diarrhea

Incidence: Common
Onset: Anytime during therapy
mild
1 sources
Duration

Not specified

Management

Maintain hydration; consider probiotics if clinician agrees

Monitoring Guidelines

Seek care for bloody stools, fever, or signs of dehydration

1 clinical sources• PubMed • Clinical Guidelines • FDA

Infantile hypertrophic pyloric stenosis (IHPS)

Incidence: Rare
Onset: Typically after 1 to 2 weeks of exposure in neonates
severe
1 sources
Duration

Not specified

Management

Stop drug and arrange urgent evaluation if projectile vomiting appears

Monitoring Guidelines

Educate caregivers of neonates to call for vomiting, poor feeding, or weight loss

1 clinical sources• PubMed • Clinical Guidelines • FDA

Hepatic

1 documented effect

Total Sources: 1

Cholestatic hepatitis

Incidence: Rare
Onset: Usually after 1 to 3 weeks of therapy
severe
1 sources
Duration

Not specified

Management

Stop erythromycin; obtain liver function tests; refer for evaluation

Monitoring Guidelines

Watch for jaundice, dark urine, pruritus, pale stools

1 clinical sources• PubMed • Clinical Guidelines • FDA

Cardiac

1 documented effect

Total Sources: 1

QT prolongation and torsades de pointes

Incidence: Rare
Onset: Typically in children with underlying risk factors or concomitant QT-prolonging drugs
severe
1 sources
Duration

Not specified

Management

Stop erythromycin, correct electrolytes, obtain ECG, manage per ACLS if arrhythmia occurs

Monitoring Guidelines

Screen medication lists; consider ECG if high risk

1 clinical sources• PubMed • Clinical Guidelines • FDA

Dermatologic/Allergic

1 documented effect

Total Sources: 1

Rash or urticaria

Incidence: Uncommon
Onset: Not specified
variable
1 sources
Duration

Not specified

Management

Mild rash may be observed with clinician guidance; stop and seek urgent care for hives, angioedema, or mucosal involvement

Monitoring Guidelines

Differentiate benign rash from evolving hypersensitivity

1 clinical sources• PubMed • Clinical Guidelines • FDA

Parent Communication Guide

Age-Appropriate Explanations

Infants (0-12 months)

Call us if feeding goes poorly or there is forceful vomiting.

Toddlers (1-3 years)

Tummy aches can happen; we can slow down doses with snacks.

Children (4-12 years)

Let an adult know if you feel dizzy, your heart races, or you cannot keep medicine down.

Adolescents (13+ years)

Avoid taking extra doses or mixing with unprescribed medicines; watch for palpitations or jaundice.

Common Parent Concerns

Q: Frequent diarrhea

A: Common and usually mild; keep fluids up and use barrier cream as needed.

When to validate: Call if severe, bloody, or accompanied by fever.

Q: Multiple daily doses are hard to remember

A: Use alarms or dosing charts and partner with school nurses for daytime doses.

When to validate: Discuss adherence aids if a dose is missed.

Clinical Decision Support

Severity Assessment Framework

Framework for triaging erythromycin adverse effects by severity and impact.

Mild
Indicators: Transient nausea, Soft stools without dehydration
Action: Continue therapy with supportive counseling
Moderate
Indicators: Persistent vomiting, Increasing abdominal pain
Action: Reassess dosing with food, consider antiemetic, monitor hydration
Severe
Indicators: Projectile vomiting, Jaundice, Syncope or palpitations
Action: Stop medicine, arrange urgent evaluation, consider alternative antibiotic

Treatment Decision Guidelines

Immediate Discontinuation

  • • Evidence of hepatotoxicity
  • • Serious allergic reaction
  • • Documented QT prolongation

Consider Alternatives

  • • Refractory GI intolerance
  • • Adherence failure due to dosing frequency

Dose Modification

  • • Mild GI symptoms relieved by food adjustment

Clinical References

Erythromycin Ethylsuccinate Oral Suspension — DailyMed•U.S. National Library of Medicine (2024)Label
Erythromycin for bacterial infections•Medicines for Children (2024)Patient education
FDA Drug Safety Communication: Rare risk of infantile hypertrophic pyloric stenosis with oral erythromycin•U.S. Food and Drug Administration (2011)Safety communication
Macrolides•StatPearls Publishing (2025)Review

Frequently Asked Questions

Parent and clinician concerns about Erythromycin (EES)