Roxithromycin

Roxithromycin

[1 tablet 20 cents]

ADMINISTRATION ROUTES:

  • PO, NG

ALTERNATIVE NAMES:

  • Arrow Roxithromycin

ICU INDICATIONS:

  1. Empirical treatment of atypical pneumonia
  2. Treatment of infections caused by other susceptible organisms

PRESENTATION AND ADMINISTRATION:

  • PO / NG:
    Arrow Roxithromycin 150mg tablets (white), 300mg tablets (white)
    Note: – tablets may be crushed and administered via NG tube.

DOSAGE:

  • PO / NG:
    150mg twice daily OR 300mg once daily

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • PO:
    2.5mg-4mg/kg 12 hourly

CLINICAL PHARMACOLOGY:

  • Roxithromycin is a semi-synthetic macrolide antibiotic. Roxithromycin is bacteriostatic at low concentrations and bactericidal at high concentrations. It binds to the 50S subunit of the 70S ribosome, thereby disrupting bacterial protein synthesis.
  • Roxithromycin is usually active against the following organisms in vitro and in clinical infections: Streptococcus pyogenes (group A Beta-hemolytic streptococci), Alpha-hemolytic streptococci (viridans group), Staphylococcus aureus (resistant organisms may emerge during treatment), Streptococcus pneumoniae, Mycoplasma pneumoniae, Treponema pallidum, Corynebacterium diphtheriae, Corynebacterium minutissimum, Entamoeba histolytica, Listeria monocytogenes, Neisseria gonorrhoeae, Bordetella pertussis, Legionella pneumophila (agent of Legionnaires’ disease), Ureaplasma urealyticum, Chlamydia trachomatis.

CONTRAINDICATIONS:

  1. hypersensitivity to roxithromycin or other macrolide antibiotics

WARNINGS

  • Hepatic dysfunction:
    There have been reports of hepatic dysfunction, including increased liver enzymes, and hepatocellular and/or cholestatic hepatitis, with or without jaundice, occurring in patients receiving oral erythromycin products.
  • Pseudomembranous colitis:
    Pseudomembranous colitis has been reported with nearly all antibacterial agents, including roxithromycin, and may range in severity from mild to life threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents

PRECAUTIONS

  • General:
    Caution should be exercised if roxithromycin is administered to patients with impaired hepatic function, as its serum half life is increased in patients with hepatic failure. If administered to patients with severe hepatic insufficiency (e.g. hepatic cirrhosis with jaundice and/or ascites), the dose should be reduced by half to 150 mg once daily.
  • Laboratory Tests: No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions: Erythromycin interferes with the fluorometric determination of urinary catecholamines.

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Roxithromycin has a much lower affinity for cytochrome P450 than erythromycin, and consequently has fewer interactions. Interactions may be observed, however, with drugs that bind to alpha-1-acid glycoprotein, e.g. disopyramide.
  • Increases in prothrombin time (international normalised ratio (INR) have been reported in patients treated concomitantly with roxithromycin and warfarin
  • Roxithromycin may increase the absorption of digoxin leading to increased serum levels

ADVERSE REACTIONS

  • Body as a Whole: Anaphylaxis, angioedema.
  • Gastrointestinal System: Nausea, vomiting, epigastric pain, diarrhoea, hepatitis
  • Skin: Urticaria, rash, pruritus

Critical Care Drug Manual

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