Yes

Antibiotic, Macrolide Combination; Antibiotic, Macrolide; Antibiotic, Sulfonamide Derivative

Treatment of susceptible bacterial infections of the upper and lower respiratory tract, otitis media in children caused by susceptible strains of Haemophilus influenzae, and many other infections in patients allergic to penicillin

C

Hepatic dysfunction, known hypersensitivity to erythromycin or sulfonamides; infants <2 months of age (sulfas compete with bilirubin for binding sites); patients with porphyria; concurrent use with pimozide, terfenadine, astemizole, or cisapride

Use with caution in patients with impaired renal or hepatic function, G-6-PD deficiency (hemolysis may occur)

>10%: Gastrointestinal: Abdominal pain, cramping, nausea, vomiting

1% to 10%:

Gastrointestinal: Oral candidiasis

Local: Phlebitis at the injection site

Miscellaneous: Hypersensitivity reactions

<1%: Ventricular arrhythmias, fever, headache, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, hypertrophic pyloric stenosis, diarrhea, pseudomembranous colitis, crystalluria, eosinophilia, agranulocytosis, aplastic anemia, hepatic necrosis, cholestatic jaundice, thrombophlebitis, toxic nephrosis

Symptoms of overdose include nausea, vomiting, diarrhea, prostration, reversible pancreatitis, hearing loss with or without tinnitus or vertigo

General and supportive care only; keep patient well hydrated

Increased effect/toxicity/levels with erythromycin/sulfisoxazole on alfentanil, astemizole, terfenadine (resulting in potentially life-threatening prolonged Q-T interval), bromocriptine, carbamazepine, cyclosporine, digoxin, disopyramide, theophylline, triazolam, lovastatin/simvastatin, ergots, methylprednisolone, cisapride, pimozide, felodipine, phenytoin, barbiturate anesthetics, methotrexate, sulfonylureas, uricosuric agents, and warfarin; may inhibit metabolism of protease inhibitors

Increased toxicity of sulfonamides occurs with concurrent diuretics, indomethacin, methenamine, probenecid, and salicylates

Reconstituted suspension is stable for 14 days when refrigerated

Erythromycin inhibits bacterial protein synthesis; sulfisoxazole competitively inhibits bacterial synthesis of folic acid from para-aminobenzoic acid

Erythromycin ethylsuccinate:

Absorption: Well absorbed from GI tract

Distribution: Crosses the placenta; appears in breast milk

Protein binding: 75% to 90%

Metabolism: In the liver

Half-life: 1-1.5 hours

Elimination: Unchanged drug is excreted and concentrated in bile

Sulfisoxazole acetyl: Hydrolyzed in the GI tract to sulfisoxazole which has the following characteristics:

Absorption: Readily absorbed

Distribution: Crosses the placenta; appears in breast milk

Protein binding: 85%

Half-life: 6 hours, prolonged in renal impairment

Elimination: 50% excreted in urine as unchanged drug

Oral (dosage recommendation is based on the product's erythromycin content):

Adults >45 kg: 400 mg erythromycin and 1200 mg sulfisoxazole every 6 hours

Dosing adjustment in renal impairment (sulfisoxazole must be adjusted in renal impairment):

Cl_cr 10-50 mL/minute: Administer every 8-12 hours

Cl_cr <10 mL/minute: Administer every 12-24 hours

CBC and periodic liver function test

False-positive urinary protein

No information available to require special precautions

No effects or complications reported

See individual agents. Pregnancy precautions: Inform prescriber if you are or intend to get pregnant.

Suspension, oral: Erythromycin ethylsuccinate 200 mg and sulfisoxazole acetyl 600 mg per 5 mL (100 mL, 150 mL, 200 mL, 250 mL)

Rodriguez WJ, Schwartz RH, Sait T, et al, "Erythromycin-Sulfisoxazole vs Amoxicillin in the Treatment of Acute Otitis Media in Children," Am J Dis Child, 1985, 139(8):766-70.

Tartaglione TA, "Therapeutic Options for the Management and Prevention of Mycobacterium avium Complex Infection in Patients With the Acquired Immunodeficiency Syndrome," Pharmacotherapy, 1996, 16(2):171-82.