Roxithromycin is a semi-synthetic macrolide antibiotic derived from erythromycin, designed to offer broad-spectrum antibacterial activity with an improved pharmacokinetic profile. It is commonly prescribed for respiratory, skin, and soft tissue infections caused by susceptible microorganisms. Its extended half-life allows for convenient twice-daily dosing, enhancing patient compliance. Roxithromycin works by inhibiting bacterial protein synthesis, effectively halting the growth and spread of pathogens.

Features

• Broad-spectrum activity against Gram-positive and some Gram-negative bacteria
• Improved acid stability compared to erythromycin, allowing for consistent oral absorption
• Long elimination half-life (approximately 12 hours)
• High tissue penetration, particularly in the lungs, tonsils, and skin
• Available in 150 mg and 300 mg tablet formulations

Benefits

• Effectively treats common community-acquired respiratory infections such as bronchitis, pneumonia, and pharyngitis
• Reduces symptom duration and severity in skin and soft tissue infections like erysipelas and impetigo
• Convenient dosing schedule supports adherence to treatment regimens
• Generally well-tolerated with a lower incidence of gastrointestinal side effects compared to older macrolides
• Suitable for patients with penicillin allergies where macrolides are indicated

Common use

Roxithromycin is indicated for the treatment of mild to moderate infections caused by susceptible strains of microorganisms. Common uses include upper and lower respiratory tract infections such as acute bacterial pharyngitis, tonsillitis, sinusitis, acute bronchitis, and community-acquired pneumonia. It is also employed for skin and soft tissue infections, including folliculitis, furunculosis, and cellulitis. Additionally, it may be used in dental infections and as part of eradication therapy for Helicobacter pylori in combination with other agents.

Dosage and direction

The standard adult dosage is 300 mg per day, administered either as a single dose or in two divided doses of 150 mg each. For severe infections, the dose may be increased to 300 mg twice daily. Treatment duration typically ranges from 5 to 10 days, depending on the type and severity of the infection. Roxithromycin should be taken on an empty stomach, at least 15 minutes before a meal or between meals, to optimize absorption. Dosage adjustments may be necessary in patients with hepatic impairment.

Precautions

Patients with a history of liver disease should use roxithromycin with caution, as macrolides are metabolized hepatically and may exacerbate pre-existing conditions. Electrolyte imbalances, particularly hypokalemia or hypomagnesemia, should be corrected prior to initiation due to the potential risk of QT interval prolongation. Use during pregnancy should only be considered if the potential benefits outweigh the risks, as safety data are limited. Breastfeeding mothers should consult a healthcare provider, as roxithromycin is excreted in breast milk.

Contraindications

Roxithromycin is contraindicated in patients with known hypersensitivity to macrolide antibiotics. It should not be used concurrently with ergot derivatives, cisapride, terfenadine, or astemizole due to the risk of serious cardiac arrhythmias. Patients with a history of QT prolongation, symptomatic bradycardia, or uncompensated heart failure should avoid this medication. Concomitant use with colchicine is contraindicated in patients with renal or hepatic impairment.

Possible side effect

Common side effects include gastrointestinal disturbances such as nausea, vomiting, diarrhea, and abdominal pain. Less frequently, patients may experience headache, dizziness, or skin rash. Elevated liver enzymes have been reported in some cases. Rare but serious adverse effects include Clostridium difficile-associated diarrhea, QT prolongation, and hepatotoxicity. Allergic reactions, though uncommon, may present as urticaria, angioedema, or anaphylaxis.

Drug interaction

Roxithromycin may interact with drugs metabolized by CYP3A4, potentially increasing their plasma concentrations. Concurrent use with statins (e.g., simvastatin, atorvastatin) may elevate the risk of myopathy or rhabdomyolysis. It may enhance the effects of warfarin, necessitating closer monitoring of INR levels. Concomitant administration with theophylline or digoxin may require dosage adjustments due to altered pharmacokinetics. Avoid use with pimozide or quinidine due to additive cardiotoxicity.

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, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling the dose to compensate for a missed one is not recommended, as it may increase the risk of adverse effects.

Overdose

Symptoms of overdose may include severe nausea, vomiting, diarrhea, and transient hearing loss. QT prolongation and ventricular arrhythmias are possible in significant overdoses. Management is primarily supportive and symptomatic; gastric lavage may be considered if ingestion was recent. There is no specific antidote. Cardiac monitoring is advised in cases of suspected overdose, particularly in patients with underlying heart conditions.

Storage

Store roxithromycin tablets at room temperature (15–30°C), in a dry place, protected from light and moisture. Keep the medication out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.

Disclaimer

This information is intended for educational purposes and does not replace professional medical advice. Always consult a qualified healthcare provider for diagnosis, treatment decisions, and personalized dosage recommendations. The prescribing physician should be informed of all concomitant medications and underlying health conditions.

Reviews

Clinical studies and post-marketing surveillance indicate that roxithromycin is effective and well-tolerated in the majority of patients. It is regarded as a valuable option for outpatient management of common bacterial infections, particularly in regions with high prevalence of macrolide-susceptible pathogens. Some prescribers note its utility in cases where beta-lactam antibiotics are unsuitable. Long-term safety data support its use within recommended durations.