Roxithromycin: Advanced Macrolide Therapy for Bacterial Infections
Roxithromycin
| Product dosage: 150mg | |||
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Synonyms
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Roxithromycin is a semi-synthetic macrolide antibiotic derived from erythromycin, designed to offer enhanced pharmacokinetic properties and a broad spectrum of antibacterial activity. It functions by inhibiting bacterial protein synthesis through binding to the 50S ribosomal subunit, effectively treating a range of community-acquired infections. Its improved acid stability and tissue penetration make it a reliable choice for respiratory, skin, and soft tissue infections, particularly where penicillin intolerance exists. This agent is valued for its convenient once- or twice-daily dosing and generally favorable tolerability profile.
Features
- Semi-synthetic 14-membered ring macrolide antibiotic
- Broad-spectrum activity against Gram-positive and some Gram-negative bacteria, atypical pathogens, and certain anaerobes
- High oral bioavailability and extended half-life allowing for less frequent dosing
- Stable in gastric acid, enabling reliable absorption without food interference
- Extensive tissue distribution, including lung, skin, and tonsillar tissue
- Metabolized primarily in the liver and excreted largely via bile and feces
Benefits
- Effectively treats common community-acquired respiratory infections such as bronchitis, pneumonia, and sinusitis
- Provides reliable coverage for skin and soft tissue infections caused by susceptible organisms
- Convenient dosing regimen supports patient adherence and reduces treatment complexity
- Generally well-tolerated with a lower incidence of gastrointestinal side effects compared to older macrolides
- Suitable alternative for patients with penicillin allergies in indicated infections
- Demonstrated anti-inflammatory properties in some contexts, potentially aiding symptom resolution
Common use
Roxithromycin is commonly prescribed for mild to moderate bacterial infections including acute bacterial exacerbations of chronic bronchitis, community-acquired pneumonia, pharyngitis, tonsillitis, sinusitis, otitis media, skin and soft tissue infections such as erysipelas and impetigo, and uncomplicated genitourinary infections caused by susceptible organisms. It is also used for infections due to atypical pathogens like Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila.
Dosage and direction
The standard adult dosage is 300 mg per day, administered either as a single daily dose or divided as 150 mg twice daily. For more severe infections, the dose may be increased to 300 mg twice daily. Treatment duration typically ranges from 5 to 10 days depending on infection type and severity. Roxithromycin should be taken before meals for optimal absorption, though it may be taken with food if gastrointestinal upset occurs. Dosage adjustments are necessary in patients with severe hepatic impairment. Pediatric dosing is based on body weight, generally 2.5β5 mg/kg twice daily.
Precautions
Use with caution in patients with pre-existing liver disease due to hepatic metabolism and excretion. Monitor for signs of hepatotoxicity during prolonged therapy. Caution is advised in patients with known QT prolongation or those taking other QT-prolonging drugs. Use during pregnancy only if clearly needed and after careful risk-benefit assessment. Breastfeeding should be reconsidered during treatment due to excretion in milk. May exacerbate weakness in patients with myasthenia gravis. Superinfection with resistant organisms, including Clostridioides difficile, may occur.
Contraindications
Hypersensitivity to roxithromycin, erythromycin, or any other macrolide antibiotics. Concomitant use with ergot derivatives, terfenadine, astemizole, cisapride, or pimozide due to risk of serious cardiac arrhythmias. Severe hepatic impairment without appropriate dose adjustment. History of hepatitis or jaundice associated with prior macrolide use.
Possible side effect
Common side effects include nausea, abdominal pain, diarrhea, vomiting, and headache. Less frequently, rash, itching, dizziness, and alterations in taste may occur. Elevated liver enzymes and rarely hepatitis or cholestatic jaundice have been reported. Prolonged use may lead to oral or vaginal candidiasis. Isolated cases of QT prolongation, ventricular arrhythmias, and hearing loss (usually reversible) have been observed at high doses or in susceptible individuals.
Drug interaction
Potent inhibitors of CYP3A4 may increase roxithromycin levels. May increase concentrations of theophylline, digoxin, warfarin, cyclosporine, and some statins. Concomitant use with other QT-prolonging agents increases arrhythmia risk. Antacids and H2-receptor antagonists do not significantly affect absorption. May reduce efficacy of oral contraceptives; additional non-hormonal contraception is advised. Interaction with colchicine may increase colchicine toxicity.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.
Overdose
Symptoms may include severe nausea, vomiting, diarrhea, and transient hearing loss. QT prolongation and ventricular arrhythmias are possible in significant overdose. Management is supportive; gastric lavage may be considered if presented early. There is no specific antidote. Hemodialysis is not effective due to high protein binding and extensive tissue distribution.
Storage
Store at room temperature (15β30Β°C) in a dry place, protected from light and moisture. Keep in the original container tightly closed. Do not use after the expiration date printed on the packaging. Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider for personalized recommendations. Dosage and suitability depend on individual patient factors, infection type, and local resistance patterns. The prescriber should verify current susceptibility data before initiating therapy.
Reviews
Clinical studies and post-marketing surveillance indicate roxithromycin is effective and well-tolerated in approved indications. It demonstrates high clinical success rates in respiratory tract infections, with cure rates typically exceeding 85% in compliant patients. Gastrointestinal side effects are reported less frequently than with erythromycin. Many clinicians appreciate its convenient dosing schedule and reliable tissue penetration. However, increasing macrolide resistance in some regions necessitates careful patient selection and susceptibility testing where possible.