Acnetoin Uses

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What is Acnetoin?

Acnetoin injection is used to treat bacterial infections in many different parts of the body. It is also used to treat diphtheria, acute pelvic inflammatory disease, and Legionnaire's disease. Acnetoin is also used to prevent bacterial endocarditis and rheumatic fever to occur again in patients who have had an allergic reaction to penicillin or sulfa drugs.

Acnetoin belongs to the class of medicines known as macrolide antibiotics. It works by killing bacteria or preventing their growth. However, Acnetoin will not work for colds, flu, or other virus infections.

Acnetoin is to be given only by or under the direct supervision of a doctor.

Acnetoin indications

An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of Acnetoin Base Filmtab tablets and other antibacterial drugs, Acnetoin Base Filmtab (Acnetoin tablets) tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Acnetoin Base Filmtab (Acnetoin tablets) tablets are indicated in the treatment of infections caused by susceptible strains of the designated microorganisms in the diseases listed below:

Upper respiratory tract infections of mild to moderate degree caused by Streptococcus pyogenes; Streptococcus pneumoniae; Haemophilus influenzae (when used concomitantly with adequate doses of sulfonamides, since many strains of H. influenzae are not susceptible to the Acnetoin concentrations ordinarily achieved).

Lower respiratory tract infections of mild to moderate severity caused by Streptococcus pyogenes or Streptococcus pneumoniae.

Listeriosis caused by Listeria monocytogenes.

Respiratory tract infections due to Mycoplasma pneumoniae.

Skin and skin structure infections of mild to moderate severity caused by Streptococcus pyogenes or Staphylococcus aureus (resistant staphylococci may emerge during treatment).

Pertussis (whooping cough) caused by Bordetella pertussis. Acnetoin is effective in eliminating the organism from the nasopharynx of infected individuals, rendering them noninfectious. Some clinical studies suggest that Acnetoin may be helpful in the prophylaxis of pertussis in exposed susceptible individuals.

Diphtheria: Infections due to Corynebacterium diphtheriae, as an adjunct to antitoxin, to prevent establishment of carriers and to eradicate the organism in carriers.

Erythrasma-In the treatment of infections due to Corynebacterium minutissimum.

Intestinal amebiasis caused by Entamoeba histolytica (oral erythromycins only). Extraenteric amebiasis requires treatment with other agents.

Acute pelvic inflammatory disease caused by Neisseria gonorrhoeae: Acnetoin® Lactobionate-I.V. (Acnetoin lactobionate for injection, USP) followed by Acnetoin base orally, as an alternative drug in treatment of acute pelvic inflammatory disease caused by N. gonorrhoeae in female patients with a history of sensitivity to penicillin. Patients should have a serologic test for syphilis before receiving Acnetoin as treatment of gonorrhea and a follow-up serologic test for syphilis after 3 months.

Erythromycins are indicated for treatment of the following infections caused by Chlamydia trachomatis: conjunctivitis of the newborn, pneumonia of infancy, and urogenital infections during pregnancy. When tetracyclines are contraindicated or not tolerated, Acnetoin is indicated for the treatment of uncomplicated urethral, endocervical, or rectal infections in adults due to Chlamydia trachomatis.

How should I use Acnetoin?

Use Acnetoin ointment as directed by your doctor. Check the label on the medicine for exact dosing instructions. Check the label on the medicine for exact dosing instructions.

Ask your health care provider any questions you may have about how to use Acnetoin ointment.

Uses of Acnetoin in details

There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.

Use: Labeled Indications

Bacterial infections: Treatment of susceptible bacterial infections, including S. pyogenes, some S. pneumoniae, some S. aureus, M. pneumoniae, Legionella pneumophila, diphtheria, pertussis, Chlamydia, erythrasma, N. gonorrhoeae, E. histolytica, syphilis and nongonococcal urethritis, and Campylobacter gastroenteritis; used in conjunction with neomycin for decontaminating the bowel

Surgical (preoperative) prophylaxis (colorectal): Colorectal decontamination, in conjunction with other agents, prior to surgical intervention

Off Label Uses

Acne vulgaris

Based on the American Academy of Dermatology guidelines of care for the management of acne vulgaris, oral Acnetoin, in combination with topical therapy, may be considered as a treatment option for moderate and severe acne and forms of inflammatory acne that are resistant to topical treatments. However, its use should be restricted due to an increased risk of bacterial resistance and limited to patients who cannot receive a tetracycline (ie, pregnant women). Concomitant topical therapy with benzoyl peroxide or a retinoid should be administered with systemic antibiotic therapy (eg, oral Acnetoin) and continued for maintenance after the oral antibiotic course is completed.

Bartonella spp. infections (treatment)

Based on the Infectious Diseases Society of America (IDSA) guidelines for the diagnosis and management of skin and soft tissue infections (SSTI), Acnetoin may be considered for the treatment of cutaneous bacillary angiomatosis. Guidelines state that therapy has not been systematically examined and Acnetoin appears effective based on case reports and small series.

Data from a study with a limited number of patients suggest that Acnetoin may be beneficial for the treatment of Bartonella spp infections.

Gastroparesis (management)

Based on the American College of Gastroenterology (ACG) guidelines for the management of gastroparesis, Acnetoin is effective and recommended for the management of gastroparesis.

Granuloma inguinale (donovanosis)

Based on Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, Acnetoin (base) is effective and recommended for the treatment of granuloma inguinale when azithromycin is not appropriate.

Acnetoin description


Acnetoin A is a bacteriostatic antibiotic macrolide produced by Streptomyces erythreus. Acnetoin A A is considered its major active component. In sensitive organisms, it inhibits protein synthesis by binding to 50S ribosomal subunits. This binding process inhibits peptidyl transferase activity and interferes with translocation of amino acids during translation and assembly of proteins.

Acnetoin dosage

Acnetoin Dosage

Generic name: Acnetoin STEARATE 250mg

Dosage form: tablet, film coated

See also:

The information at is not a substitute for medical advice. Always consult your doctor or pharmacist.

In most patients, Acnetoin® STEARATE Film-coated tablets are well absorbed and may be dosed orally without regard to meals. However, optimal blood levels are obtained when Acnetoin® STEARATE tablets are given in the fasting state (at least 1/2 hour and preferably 2 hours before meals).


The usual dosage is 250 mg every 6 hours; or 500 mg every 12 hours. Dosage may be increased up to 4 g per day according to the severity of the infection. However, twice-a-day dosing is not recommended when doses larger than 1 g daily are administered.


Age, weight, and severity of the infection are important factors in determining the proper dosage. The usual dosage is 30 to 50 mg/kg/day, in equally divided doses. For more severe infections this dosage may be doubled but should not exceed 4 g per day.

In the treatment of streptococcal infections of the upper respiratory tract (e.g., tonsillitis or pharyngitis), the therapeutic dosage of Acnetoin should be administered for at least ten days.

The American Heart Association suggests a dosage of 250 mg of Acnetoin orally, twice a day in long-term prophylaxis of streptococcal upper respiratory tract infections for the prevention of recurring attacks of rheumatic fever in patients allergic to penicillin and sulfonamides.4

Conjunctivitis of the Newborn Caused by Chlamydia trachomatis

Oral Acnetoin suspension 50 mg/kg/day in 4 divided doses for at least 2 weeks.4

Pneumonia of Infancy Caused by Chlamydia trachomatis

Although the optimal duration of therapy has not been established, the recommended therapy is oral Acnetoin suspension 50 mg/kg/day in 4 divided doses for at least 3 weeks.

Urogenital Infections During Pregnancy Due to Chlamydia trachomatis

Although the optimal dose and duration of therapy have not been established, the suggested treatment is 500 mg of Acnetoin by mouth four times a day or two Acnetoin 333 mg tablets orally every 8 hours on an empty stomach for at least 7 days. For women who cannot tolerate this regimen, a decreased dose of one Acnetoin 500 mg tablet orally every 12 hours, one 333 mg tablet orally every 8 hours or 250 mg by mouth four times a day should be used for at least 14 days.6

For adults with uncomplicated urethral, endocervical, or rectal infections caused by Chlamydia trachomatis when tetracycline is contraindicated or not tolerated

500 mg of Acnetoin by mouth four times a day or two 333 mg tablets orally every 8 hours for at least 7 days.6

For patients with nongonococcal urethritis caused by Ureaplasma urealyticum when tetracycline is contraindicated or not tolerated

500 mg of Acnetoin by mouth four times a day or two 333 mg tablets orally every 8 hours for at least seven days.6

Primary Syphilis

30 to 40 g given in divided doses over a period of 10 to 15 days.

Acute Pelvic Inflammatory Disease Caused by N. gonorrhoeae

500 mg Acnetoin Lactobionate-I.V. (Acnetoin lactobionate for injection, USP) every 6 hours for 3 days, followed by 500 mg of Acnetoin base orally every 12 hours, or 333 mg of Acnetoin base orally every 8 hours for 7 days.

Intestinal Amebiasis


500 mg every 12 hours, 333 mg every 8 hours or 250 mg every 6 hours for 10 to 14 days.


30 to 50 mg/kg/day in divided doses for 10 to 14 days.


Although optimal dosage and duration have not been established, doses of Acnetoin utilized in reported clinical studies were 40 to 50 mg/kg/day, given in divided doses for 5 to 14 days.

Legionnaires' Disease

Although optimal dosage has not been established, doses utilized in reported clinical data were 1 to 4 g daily in divided doses.

More about Acnetoin (Acnetoin)

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Acnetoin interactions

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What other drugs will affect Acnetoin?


Acnetoin A use in patients who are receiving high doses of theophylline may be associated with an increase in serum theophylline levels and potential theophylline toxicity. In case of theophylline toxicity and/or elevated serum theophylline levels, the dose of theophylline should be reduced while the patient is receiving concomitant Acnetoin therapy.

Concomitant administration of Acnetoin and digoxin has been reported to result in elevated digoxin serum levels. There have been reports of increased anticoagulant effects when Acnetoin and oral anticoagulants were used concomitantly. Increased anticoagulation effects due to interactions of Acnetoin with various oral anticoagulents may be more pronounced in the elderly.

Concurrent use of Acnetoin and ergotamine or dihydroergotamine has been associated in some patients with acute ergot toxicity characterized by severe peripheral vasospasm and dysesthesia.

Acnetoin A has been reported to decrease the clearance of triazolam and midazolam and thus may increase the pharmacologic effect of these benzodiazepines.

The use of Acnetoin in patients concurrently taking drugs metabolized by the cytochrome P450 system may be associated with elevations in serum levels of these other drugs. There have been reports of interactions of Acnetoin with carbamazepine, cyclosporine, tacrolimus, hexobarbital, phenytoin, alfentanil, cisapride, disopyramide, lovastatin, bromocriptine, valproate, terfenadine, and astemizole. Serum concentrations of drugs metabolized by the cytochrome P450 system should be monitored closely in patients concurrently receiving Acnetoin.

Acnetoin A has been reported to significantly alter the metabolism of nonsedating antihistamines terfenadine and astemizole when taken concomitantly. Rare cases of serious cardiovascular adverse events, including electrocardiographic QT/QTc interval prolongation, cardiac arrest, torsades de pointes, and other ventricular arrhythmias have been observed. In addition, deaths have been reported rarely with concomitant administration of terfenadine and Acnetoin.

There have been postmarketing reports of drug interactions when Acnetoin is coadministered with cisapride, resulting in QT prolongation, cardiac arrythmias, ventricular tachycardia, ventricular fibrulation, and torsades de pointes, most like due to inhibition of hepatic metabolism of cisapride by Acnetoin. Fatalities have been reported.

Patients receiving concomitant lovastatin and Acnetoin should be carefully monitored; cases of rhabdomyolysis have been reported in seriously ill patients.

Acnetoin side effects

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What are the possible side effects of Acnetoin?

Applies to Acnetoin: oral capsule, oral capsule delayed release, oral powder for suspension, oral suspension, oral tablet, oral tablet chewable, oral tablet delayed release, oral tablet enteric coated

Other dosage forms:

As well as its needed effects, Acnetoin (the active ingredient contained in Acnetoin) may cause unwanted side effects that require medical attention.

Major Side Effects

If any of the following side effects occur while taking Acnetoin, check with your doctor immediately:


Incidence not known:

Minor Side Effects

Some Acnetoin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Incidence not known:

Acnetoin contraindications

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What is the most important information I should know about Acnetoin?

You should not take Acnetoin if you are allergic to it, or if you are also using cisapride (Propulsid), dihydroergotamine (D.H.E. 45, Migranal), ergotamine (Ergomar, Cafergot, Migergot), or pimozide (Orap). Acnetoin may interact with these medicines and could cause dangerous or life-threatening heart rhythm disorders.

Before you take Acnetoin, tell your doctor if you have liver disease, myasthenia gravis, a heart rhythm disorder, a history of Long QT syndrome, or low levels of potassium or magnesium in your blood.

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Acnetoin will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking Acnetoin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Active ingredient matches for Acnetoin:


Clindamycin Topical/Nicotinamide

Unit description / dosage (Manufacturer)Price, USD
ACNETOIN 10MG TABLET 1 strip / 10 tablets each (Resilient Cosmecueticals Pvt Ltd)$ 1.22
ACNETOIN 20MG TABLET 1 strip / 10 tablets each (Resilient Cosmecueticals Pvt Ltd)$ 1.83
Acnetoin 20mg Tablet (Resilient Cosmecueticals Pvt Ltd)$ 0.18
Acnetoin Gel (Leeford Healthcare Ltd)$ 0.95

List of Acnetoin substitutes (brand and generic names):

Acnet 3% CRM / 15g (Amideep)$ 0.56
Acnetop Skin 60 ml Lotion (Novasearch Dermocare (Ultramark Healthcare Pvt Ltd))$ 0.02
Solution; Topical; Erythromycin 2% (Trima)
Acrolyn Gel (Galaxy Biotech)$ 1.19
AGROCIN 250 MG TABLET 1 strip / 10 tablets each (Agron Rem. (Agrogem))$ 0.18
AGROCIN tab 250 mg x 10's (Agron Rem. (Agrogem))$ 0.37
Agrocin 250mg Tablet (Agron Rem. (Agrogem))$ 0.02
Ointment; Ophthalmic; Erythromycin 5 mg / g (Akorn)
Solution; Topical; Erythromycin (Ichthyol)
Ointment; Topical; Erythromycin 2%
Akne-mycin/Aknemycin Plus 2 % x 25 mL
Akne-mycin/Aknemycin Plus 25 mL
Gel; Topical; Erythromycin 2% (Gepepharm)
Gel; Topical; Erythromycin 4% (Gepepharm)
Gel; Topical; Erythromycin 2%
Gel; Topical; Erythromycin 4%
Solution; Topical; Erythromycin (Wolff)
Lotion; Topical; Erythromycin 2% (Boots healthcare)
Ointment; Topical; Erythromycin 2% (Boots healthcare)
Solution; Topical; Erythromycin 2% (Boots healthcare)
Ointment; Topical; Erythromycin 2%
Gel; Topical; Erythromycin 2% (Assos)
Gel; Topical; Erythromycin 4% (Assos)


  1. DailyMed. "ASCORBIC ACID; BIOTIN; CYANOCOBALAMIN; DEXPANTHENOL; ERGOCALCIFEROL; FOLIC ACID; NIACINAMIDE; PHYTONADIONE; PYRIDOXINE HYDROCHLORIDE; RIBOFLAVIN 5'-PHOSPHATE SODIUM; THIAMINE HYDROCHLORIDE; VITAMIN A; VITAMIN E: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". (accessed September 17, 2018).
  2. DailyMed. "ERYTHROMYCIN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". (accessed September 17, 2018).
  3. PubChem. "nicotinamide". (accessed September 17, 2018).


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Information checked by Dr. Sachin Kumar, MD Pharmacology

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