Erythromycin

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Also indexed as:

A/T/S, Akne-Mycin, E-Mycin, EES, Emgel, Ery-Tab, Eryc, Erycette, EryDerm, Erygel, Erymax, Eryped, Erythrocin, Ilosone, Ilotycin, PCE, Staticin, T-Stat, Theramycin

Erythromycin is a macrolide antibiotic used to treat a wide variety of bacterial infections. Several chemical forms of erythromycin are available for oral use to treat infections in the body. Erythromycin-containing products are also available to treat eye and skin infections.

Herbs

Summary of Interactions for Erythromycin

Depletion or interference	Multiple nutrients* (Magnesium, Vitamin B6, Vitamin B12) Vitamin K*
Adverse interaction	None known
Side effect reduction/prevention	Bifidobacterium Bifidobacterium longum* Lactobacillus acidophilus* Lactobacillus casei* Saccharomyces boulardii* Saccharomyces cerevisiae* Vitamin K*
Supportive interaction	Bromelain* Saccharomyces boulardii*
Reduced drug absorption/bioavailability	None known
Other (see text)	Calcium Digitalis Folic acid

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Supplements

Probiotics

A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Yogurt containing Bifidobacteriumlongum culture has decreased erythromycin-induced diarrhea in a single-blind study of ten healthy people.¹ Yogurt containing live cultures has also protected against other antibiotic-induced diarrhea.

Controlled studies have shown that taking probiotic microorganisms-such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii -helps prevent antibiotic-induced diarrhea.²

The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast-such as Saccharomyces boulardii ³ or Saccharomyces cerevisiae (baker's or brewer's yeast)⁴ -helps prevent recurrence of this infection. In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection.⁵ Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.

Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as "dysbiosis"). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.⁶

Bromelain

One report found bromelain improved the action of antibiotic drugs, including penicillin and erythromycin, in treating a variety of infections. In that trial, 22 out of 23 people who had previously not responded to the antibiotics did so after adding bromelain four times per day.⁷ Doctors will sometimes prescribe enough bromelain to equal 2,400 gelatin dissolving units (listed as GDU on labels) per day. This amount would equal approximately 3,600 MCU (milk clotting units), another common measure of bromelain activity.

Vitamin K

Several cases of excessive bleeding have been reported in people who take antibiotics.^{8, 9, 10, 11} This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal.¹² Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.

Other vitamins and minerals

Erythromycin may interfere with the absorption and/or activity of calcium, folic acid, magnesium, vitamin B6 and vitamin B12,¹³ which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral.

Interactions with Herbs

Digitalis (Digitalis lanata, Digitalis purpurea)

Digitalis refers to a family of plants commonly called foxglove that contain digitalis glycosides, chemicals with actions and toxicities similar to the prescription drug digoxin.

Erythromycin can increase the serum level of digitalis glycosides, increasing the therapeutic effects and risk of side effects.¹⁴ Erythromycin and digitalis-containing products should be used only under the direct supervision of a doctor trained in their use.

Other Interactions

Food

Some forms of erythromycin are best absorbed when taken on an empty stomach, one hour before or two hours after food.¹⁵ Individuals who experience stomach upset taking these forms of erythromycin on an empty stomach should use one of the other forms that can be taken with food.

Other forms of erythromycin may be taken with or without food.¹⁶ People taking erythromycin should ask their pharmacist about the form of erythromycin they are taking and compatibility with or without food. Erythromycin is best taken with water, rather than other beverages, to prevent degradation of the drug before it reaches the intestines.¹⁷ Erythromycin tablets should be swallowed whole, without cutting, chewing, or crushing.¹⁸

References

1. Colombel JF, Cortot A, Neut, Romond C. Yoghurt with Bifidobacterium longum reduces erythromycin-induced gastrointestinal effects. Lancet 1987;ii:43 [letter].
2. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
3. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
4. Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.
5. Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.
6. Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
7. Neubauer RA. A plant protease for potentiation of and possible replacement of antibiotics. Exp Med Surg 1961;19:143-60.
8. Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292-4.
9. Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706-7.
10. Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610-2.
11. Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524-5.
12. Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531-9.
13. Holt GA. Food and Drug Interactions. Chicago: Precept Press, 1998, 107-8.
14. Bizjak ED, Mauro VF. Digoxin-macrolide drug interaction. Ann Pharmacother 1997;31:1077-9.
15. Threlkeld DS, ed. Systemic Anti-Infectives, Macrolides. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Oct 1998, 343c-344.
16. Threlkeld DS, ed. Systemic Anti-Infectives, Macrolides. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Oct 1998, 343c-344.
17. Holt GA. Food and Drug Interactions. Chicago: Precept Press, 1998, 106-7.
18. Threlkeld DS, ed. Systemic Anti-Infectives, Macrolides. In Facts and Comparisons Drug Information. St. Louis, MO: Facts and Comparisons, Oct 1998, 343c-344.

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Last Review: 01-21-2009

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires February 2010.

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