Ilosone: Potent Macrolide Antibiotic for Bacterial Infection Resolution
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| Product dosage: 500 mg | |||
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Synonyms | |||
Ilosone (erythromycin estolate) is a well-established macrolide antibiotic indicated for the treatment of a wide range of susceptible bacterial infections. With a proven history of clinical efficacy spanning decades, it remains a trusted option for healthcare providers managing respiratory, skin, and soft tissue infections caused by Gram-positive organisms. Its unique estolate formulation enhances oral absorption, ensuring reliable systemic delivery. This profile details the pharmacological characteristics, appropriate usage, and safety considerations essential for informed prescribing decisions.
Features
- Active ingredient: Erythromycin estolate
- Drug class: Macrolide antibiotic
- Available forms: Oral tablets, oral suspension
- Mechanism: Inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit
- Spectrum: Primarily effective against Gram-positive bacteria including Streptococcus pyogenes, Streptococcus pneumoniae, and Staphylococcus aureus (methicillin-susceptible)
- Bioavailability: Enhanced absorption compared to erythromycin base due to estolate salt formation
Benefits
- Effective against common respiratory pathogens, making it suitable for pharyngitis, tonsillitis, and acute bronchitis
- Provides reliable coverage for skin and soft tissue infections including impetigo and erysipelas
- Useful alternative for penicillin-allergic patients requiring antibacterial therapy
- Well-established safety profile with extensive clinical use history
- Convenient oral dosing formulations support outpatient treatment and adherence
Common use
Ilosone is indicated for the treatment of mild to moderate infections caused by susceptible strains of microorganisms. Common clinical applications include streptococcal pharyngitis and skin structure infections. It may be employed for respiratory tract infections including acute bronchitis when caused by susceptible organisms. Off-label uses may include treatment for pertussis (whooping cough) and chlamydial infections in specific patient populations, though alternative agents are often preferred for these indications based on current guidelines.
Dosage and direction
Dosage should be individualized based on the severity of infection and the patient’s clinical status. For adults, the usual dosage ranges from 250 mg to 500 mg every 6 hours, or 500 mg to 1,000 mg every 12 hours for more severe infections. The maximum recommended daily dose is 4 grams. For children, dosage is based on body weight at 30-50 mg/kg/day divided into 3-4 doses. The oral suspension should be shaken well before administration. Tablets should be swallowed whole and may be taken with food to minimize gastrointestinal upset. Treatment should continue for at least 10 days for streptococcal infections to prevent rheumatic fever.
Precautions
Hepatic function should be monitored during prolonged therapy, as erythromycin estolate has been associated with cholestatic hepatitis. Use with caution in patients with pre-existing liver disease. May prolong the QT interval; avoid use in patients with known QT prolongation, hypokalemia, or those taking other QT-prolonging drugs. Caution is advised in patients with myasthenia gravis due to potential exacerbation of symptoms. Superinfections with nonsusceptible organisms including fungi may occur. Prescribers should consider the potential development of bacterial resistance when selecting antibacterial therapy.
Contraindications
Ilosone is contraindicated in patients with known hypersensitivity to erythromycin or any macrolide antibiotic. Should not be used in patients with pre-existing liver disease or hepatic dysfunction. Contraindicated concomitantly with ergot derivatives, cisapride, pimozide, or terfenadine due to potential for serious drug interactions. Not recommended for patients with known history of QT prolongation or ventricular arrhythmias including torsades de pointes.
Possible side effect
Gastrointestinal disturbances are most common, including nausea, vomiting, abdominal pain, and diarrhea. Mild to moderate reactions may include skin rash, urticaria, and pruritus. Transient hearing loss has been reported, usually with high doses or renal impairment. Hepatic effects may range from elevated liver enzymes to cholestatic hepatitis. Cardiac effects including QT prolongation and ventricular arrhythmias are rare but serious. Other potential effects include pseudomembranous colitis, pancreatitis, and reversible ototoxicity.
Drug interaction
Significant interactions occur with drugs metabolized by CYP3A4. May increase concentrations of carbamazepine, cyclosporine, digoxin, theophylline, and warfarin (monitor prothrombin time). Concomitant use with simvastatin, lovastatin, or other statins metabolized by CYP3A4 may increase risk of rhabdomyolysis. Potentially serious interactions with ergot alkaloids may cause ergotism. Concurrent administration with colchicine may increase colchicine toxicity. May reduce clearance of benzodiazepines and disopyramide. Antacids containing aluminum or magnesium may decrease absorption.
Missed dose
If a dose is missed, it should be taken as soon as remembered. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed administration. Maintenance of consistent serum levels is important for antibacterial efficacy, so adherence to the prescribed dosing schedule should be emphasized.
Overdose
Symptoms of overdose may include severe nausea, vomiting, diarrhea, and abdominal pain. Hearing loss, which may be permanent, has been reported with excessive doses. QT prolongation and ventricular arrhythmias may occur. Management is primarily supportive with attention to electrolyte balance and cardiac monitoring. Gastric lavage may be considered if ingestion was recent. Not removed significantly by hemodialysis or peritoneal dialysis. Specific antidote is not available.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from light and moisture. Keep container tightly closed. The oral suspension remains stable for 14 days after reconstitution when stored at room temperature; do not freeze. Keep out of reach of children. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is intended for healthcare professionals and should not replace professional medical advice, diagnosis, or treatment. The prescribing physician should be consulted for specific recommendations tailored to individual patients. Full prescribing information including boxed warnings should be reviewed before administration. The efficacy and safety of this product may vary based on individual patient factors and local resistance patterns.
Reviews
Clinical studies have demonstrated efficacy rates of 85-95% for streptococcal pharyngitis when treated with appropriate dosing. Dermatological applications show similar success rates for susceptible skin infections. The estolate formulation is generally well-tolerated, though gastrointestinal side effects remain the most frequently reported concern in post-marketing surveillance. Many clinicians appreciate its utility in penicillin-allergic patients, though cross-reactivity concerns should be considered in patients with severe penicillin allergy. Emerging resistance patterns have somewhat limited its use in certain geographic regions, though it remains effective against many community-acquired pathogens.