Erythromycin Lactobionate Injection Shortage

• • Pfizer did not provide a reason for the shortage.

• • Erythrocin powder for solution for injection, Pfizer, 500 mg, ADD-Vantage vial, 10 count, NDC 00409-6476-44
  • Erythrocin powder for solution for injection, Pfizer, 500 mg, vial, 10 count, NDC 00409-6482-01

Estimated Resupply Dates

• • Pfizer has erythromycin lactobionate 500 mg vials and 500 mg ADD-Vantage vials available.[6]

Alternative Agents & Management

• Table 1. Alternatives to Erythromycin Lactobionate Injection in Selected Situations1-5

  Situation	Recommendation	Comments
  Gastroparesis1-2	Metoclopramide 5 mg 3 times daily initial dose. Dosage range 5 mg to 10 mg 2 to 3 times daily before meals (maximum dose 40 mg daily). Erythromycin 250 mg to 500 mg orally 3 times daily before meals.	Metoclopramide - Liquid preferred to increase absorption. Use drug holidays or dose reductions when clinically possible.Side effects such as drowsiness and tardive dyskinesia may limit the utility of metoclopramide. Erythryomycin oral - Limit duration of therapy, tacyphylaxis may occur after 4 weeks.
  Gastroparesis following partial large or small bowel resection surgery with primary anastomosis 3	Alvimopan 12 mg orally 30 minutes to 5 hours before surgery, then 12 mg orally twice daily for up to a maximum of 15 doses	May only be used in hospitals. Hospitals must be enrolled in the Entereg Access Support and Education (EASE) program.
  Premature Rupture of Membranes (PROM)4-5	Ampicillin 2 gram IV every 6 hours and erythromycin 250 mg IV every 6 hours for 48 hours followed by oral amoxicillin 250 mg every 8 hours and erythromycin 333 mg every 8 hours.	Azithromycin may be used as an alternative to erythromycin. A small retrospective study (N=168) found no difference in time of latency between patients who received ampicillin and azithromycin (9.4+10.4 days) and patients who received ampicillin and erythromycin (9.6+13.2 days, p=0.40). Azithromycin dose and route not specified in study. 5

  
  

References

• 1. Camilleri M, Parkman HP, Shafi MA et al. Clinical Guideline: Management of Gastroparesis. Am J Gastroenterol. 2013;108 (1):18-38.
  2. Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc; 2018.
  3. Entereg (alvimopan) capsules [product information]. Whitehouse Station, NJ: Merck; 2015.
  4. ACOG Practice Bulletin No. 188: Premature Rupture of Membranes. Clinical managment guidelines for obstetrician-gynecologists. Obstet Gynecol. Jan 2018; 131:e1-14.
  5. Pierson RC, Gordon SS, Haas DM. A Retrospective Comparison of Antibiotic Regimens for Preterm Premature Rupture of Membranes. Obstetrics and Gynecology. 2014;124 (3):515-519.
  6. Pfizer. Personal communication. December 9, 2019; January 3, February 20, and March 27, 2020.