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.
Summary of
Interactions with Vitamins, Herbs, and Foods
In some cases, an herb or supplement may appear in more than one category, which may seem
contradictory. For clarification, read the full article for details about the summarized
interactions.
 May Be Beneficial: Depletion or
interference—The medication may deplete or interfere with the absorption or
function of the nutrient. Taking these nutrients may help replenish them. |
Multiple nutrients* (Magnesium, Vitamin B6, Vitamin B12) Vitamin K* |
| May Be Beneficial: Side effect
reduction/prevention—Taking these supplements may help reduce the likelihood and/or
severity of a potential side effect caused by the medication. |
Bifidobacterium Bifidobacterium longum* Lactobacillus acidophilus* Lactobacillus casei* Saccharomyces boulardii* Saccharomyces cerevisiae* Vitamin K* |
| May Be Beneficial: Supportive
interaction—Taking these supplements may support or otherwise help your medication
work better. |
Bromelain* Saccharomyces boulardii* |
Check: Other—Before taking any of these supplements or eating any of
these foods with your medication, read this article in full for details. |
Calcium Digitalis Folic acid |
| Reduced drug absorption/bioavailability |
None known |
| Adverse interaction |
None known |
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 Dietary 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
Bifidobacterium longum 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 boulardii3 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.
Interactions with Foods and Other Compounds
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
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.