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Erythromycin Antibiotic Alternatives

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These are some facts about the common antibiotic alternatives for Erythromycin.

Erythromycin is a drug of choice in a case when a patient is allergic to penicillin. However, using the same antibiotic may result to tolerance. Here are other antibiotic alternatives that are often prescribed by physician in replacement for Erythromycin.

  • Josamycin

Josamycin has been marketed in Japan and in Europe primarily for treatment of respiratory and genitourinary infection. It is a macrolide antibiotic that blocks most staphylococci – gram positive bacteria that affects the skin and soft tissues that line body cavities as the nose, throat etc. But unlike Erythromycin, Josamycin does not induce resistance to these microorganisms. Josamycin has also fewer side effects than Erythromycin. In a Japanese study comparing the two antibiotics, infrequent mild gastrointestinal disturbances like anorexia and epigastric distress were seen with Josamycin.

Brand name: Sine, Josalid, Josacine, Iosalide, Josamina, Wilprafen, Josamy.

  • Azithromycin

Azithromycin is an azalide, a subclass of macrolide antibiotics. Azithromycin is acid-stable unlike Erythromycin and Josamycin. Thus, this macrolide can be taken orally with no need of protection from gastric acids. It is readily absorbed, but its absorption is greater on an empty stomach.

More to this, unlike Erythromycin and Clarithromycin it does not inhibit CYP3A4 - a group of enzymes that is involved in drug metabolism.

Brand name: Zithromax, Zmax, Sumamed, Azitrox.

  • Clarithromycin

Clarithromycin has a more superior pharmacokinetic properties compared to Erythromycin. Like Azithromycin, it is also more stable in gastric acid than Erythromycin. The antibiotic Clarithromycin was invented by scientists at the Japanese drug company Taisho Pharmaceutical in the 1970s as a result of their efforts to overcome the acid instability of Erythromycin.

Brand name: Klaricid, klarmyn, Biaxin, Fromilid, Klacid, Klabax, Lekoklar.

  • Roxithromycin

It is used to treat respiratory tract, urinary and soft tissue infections. Roxithromycin has also been tested to possess antimalarial activity. It is also currently undergoing clinical trials for the treatment of male-pattern hair loss. Roxithromycin has fewer interactions than Erythromycin as it has a lower attraction for CYP3A4. With this, Roxithromycin does not interact with hormonal contraceptives, prednisolone, carbamazepine, ranitidine or antacids.

Brand name: Macrol, Rulid, Roxl-150, Roxo, Surlid, Rulide, Biaxsig, Roxar, Roximycin, Roxomycin, Tirabicin and Coroxin.

 Image by noii


  • The antibiotics discussed are under the Macrolide classification same as Erythromycin. These medications will not cause allergies for penicillin allergic patients.
  • As a Macrolide, these antibiotics prevent bacteria from growing by interfering with their ability to make proteins.
  • The common indications of Macrolides are for skin and soft tissue infection (dental or infection of the middle ear), upper and lower respiratory infections (tonsillitis, laryngitis, bronchitis, pneumonia, and sinusitis), gastrointestinal infections, genitourinary infections (UTI) and for venereal diseases (syphilis and other STD).
  • The most common side effects are diarrhea, nausea, abdominal pain and vomiting. While nervousness, dermatologic reactions can be rare, Pseudomembranous colitis can also be possible.
  • Erythromycin is available in tablet, capsule, suspension, injection and in topical form. However, these alternatives are applicable for the oral forms only.


The facts and information about this article are solely for reference. The author is not provoking self-medication. Seeking help and advice from a registered physician is still the best.


Wilson and Gisvold Textbook of Inorganic Medicinal and Pharmaceutical Chemistry 9th edition

PPDr Philippine Pharmaceutical Directory Review 5th edition

Pharmacognosy 9th Edition


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