What is erythromycin?

Erythromycin is an antibiotic in the macrolide family. This page relates specifically to its use for perioral dermatitis, where it is the standard alternative when a tetracycline cannot be used.

Why two tablets a dose?

The dose used in skin conditions is 500mg twice a day. In the UK the reliably available strength is the 250mg tablet, so each dose is two tablets. That is four tablets a day, and a four-week course is 112 tablets.

How does it treat perioral dermatitis?

It has both an antibacterial and an anti-inflammatory action on the skin, which is what settles the small red bumps and pustules.

Who this is suitable for

Adults with perioral dermatitis diagnosed by a healthcare professional who cannot take a tetracycline. That most often means pregnancy or breastfeeding, where doxycycline, lymecycline and oxytetracycline are all unsuitable, but it also covers tetracycline allergy. Our prescribers will also consider your symptoms, allergies, medical conditions and current medicines.

It interacts with a lot of other medicines

Erythromycin changes the way the liver handles many other drugs. It must not be taken with simvastatin, terfenadine, astemizole, cisapride, pimozide, ergotamine, dihydroergotamine or lomitapide, and it should be avoided if you have a heart rhythm problem or a long QT interval. Tell your prescriber about every medicine you take, including anything bought over the counter or from a health food shop.

Stopping steroid creams

Perioral dermatitis is very often caused by a steroid cream used on the face. Stopping the steroid is the single most important part of treatment, and the rash will usually flare for two to four weeks after you stop before it begins to settle. The antibiotic is used alongside that to shorten the flare.

Antibiotic stewardship

A course is usually four to six weeks. Treatment is reviewed at twelve weeks and not continued beyond that without an in-person review, to limit the risk of resistance.

How to take erythromycin for perioral dermatitis

If prescribed, take two 250mg tablets twice a day. Always follow your pharmacy label.

With Food: Take each dose with or just before food. This reduces stomach upset, which is the most common side effect.
Swallow Whole: Swallow the tablets whole with water. Do not crush or chew them – some brands have a protective coating.
Space The Doses: Take them roughly twelve hours apart, morning and evening.
Complete The Course: Keep taking them for the full course even once your skin improves.
Do Not Share: Do not share your medicine with anyone else.

If you miss a dose

Take it when you remember, unless it is nearly time for the next one. If it is nearly time, skip the missed dose and continue as normal. Do not take a double dose to make up for one you missed.

If you vomit

If you are sick soon after taking a dose, contact a pharmacist or prescriber for advice, because you may not have absorbed the medicine.

Who should not take erythromycin

Anyone allergic to erythromycin or to other macrolides such as clarithromycin or azithromycin
Anyone taking simvastatin, terfenadine, astemizole, cisapride, pimozide, ergotamine, dihydroergotamine or lomitapide
Anyone with a prolonged QT interval or a ventricular heart rhythm disorder

Tell your prescriber if you take

Warfarin, digoxin, theophylline, a statin, an antidepressant, medicines for epilepsy, or any medicine that affects heart rhythm.

Off-label use

No medicine holds a UK licence specifically for perioral dermatitis. This treatment is prescribed off-label, which means your prescriber is using it outside the terms of its marketing authorisation because the clinical evidence supports it. You will be asked to consent to this during your consultation.

Active ingredient

Each tablet contains 250mg of erythromycin. Depending on the brand supplied this may be erythromycin stearate or gastro-resistant erythromycin.

Other ingredients

Inactive ingredients differ between manufacturers. Read the patient information leaflet supplied with your pack for the complete ingredient list, particularly if you have an allergy or intolerance. If you have a known allergy, tell us during your consultation so our clinicians can check the pack before we dispense.

Like all medicines, erythromycin can cause side effects, although not everyone gets them.

Common or recognised effects

Feeling sick or being sick
Diarrhoea or stomach discomfort
Loss of appetite
Thrush or another fungal overgrowth

Stomach effects are the most frequent and are dose-related. Taking each tablet with or just before food usually helps.

Stop taking erythromycin and call 999 or go to A&E if you develop

Swelling of the face, lips, tongue or throat, difficulty breathing, or a widespread itchy rash
A severe rash with blistering or peeling skin
Palpitations, fainting, or a racing or irregular heartbeat

Contact your GP or call NHS 111 promptly if you develop

Yellowing of the skin or eyes, dark urine, or persistent abdominal pain
Severe or bloody diarrhoea during or after the course
Reduced hearing or ringing in the ears
Thrush that does not settle with pharmacy treatment