Roxithromycin
antibiotic · macrolide
Third-party optionBy the Layer Nutrition editorial team
What this medicine is for
Roxithromycine appartient à la catégorie « antibiotique (macrolide) ». Les antibiotiques traitent les infections dues à des bactéries. Ils se prennent en cure, sur une durée définie, jusqu'au bout de la prescription.
Concrètement, pour Roxithromycine : Traite une infection bactérienne. Il s'emploie plutôt de façon ponctuelle ou en cure courte, le temps de passer un épisode.
Under which brands it is found
In France, about 8 reimbursable presentations containing Roxithromycin are recorded. It comes under various trade names and in generic form.
- Roxithromycine Arrow
- Roxithromycine Biogaran
- Roxithromycine Eg
- Roxithromycine Sandoz
- Roxithromycine Teva
- Roxithromycine Zentiva
- Roxithromycine Zydus
- Rulid
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
On the plate: potassium and magnesium
Like all macrolides, roxithromycin tends to prolong the QT interval of the heart's rhythm. And it is precisely a low blood potassium or magnesium that encourages this rhythm disturbance. Keeping these two minerals within normal ranges limits the risk, and diet is the first lever, easy to maintain day after day.
Potassium is concentrated in vegetables and fruit: sweet potato, potato, spinach, avocado, banana, dried apricot and legumes such as lentils and beans. Magnesium comes mainly from green leafy vegetables, nuts such as almonds and walnuts, pumpkin seeds, whole grains and dark chocolate.
Many of these foods provide both at once: spinach, lentils, beans and pumpkin seeds combine potassium and magnesium. Spreading them across your meals through the day covers a good share of your needs, in addition to your treatment.
How roxithromycin works
Roxithromycin belongs to the macrolide family. It binds to the 50S subunit of the bacterial ribosome, the machine that makes the bacterium's proteins. By binding there, it prevents the enzyme peptidyl transferase from lengthening the peptide chain being translated: protein synthesis stops, and the bacterium can no longer multiply.
Its action is described as bacteriostatic, because it blocks the growth of bacteria rather than destroying them outright; at high concentrations, it can become bactericidal. It also reaches bacteria that develop inside cells, such as Legionella pneumophila, whose treatment is helped by its good penetration into the body's tissues and fluids.
Why it is prescribed
Roxithromycin is used to treat infections caused by bacteria that are sensitive to its action. It is indicated for infections of the upper and lower respiratory tract, in the ear, nose and throat area, in the skin and soft tissues, as well as in certain genital infections.
The choice of antibiotic depends on the germ involved and its sensitivity. The reference pharmacological review confirms its favourable pharmacokinetic properties and its good spread into plasma, tissues and biological fluids, which explains its use in these infections caused by sensitive germs.
How to take it day to day
Roxithromycin is absorbed very rapidly, and its absorption is better when taken before a meal, on an empty stomach. Its plasma half-life is long for a macrolide, around 12 to 15 hours, with an average of about 14.6 hours in one study. This duration allows a dose to be taken once or twice a day, often 150 mg twice a day.
Taking the doses regularly maintains an effective concentration of the medicine against the bacterium. Treatment continues for the whole prescribed duration, even when symptoms improve before the end: stopping it on your own too soon exposes you to a relapse and encourages resistance. Any change is decided with the doctor or pharmacist.
The effects to know about
Roxithromycin is generally well tolerated. In an analysis of 2,917 adults, of whom 2,519 were treated with 150 mg twice a day across 17 studies, adverse effects possibly or probably linked to the treatment were noted in 4.1% of patients, that is 120 out of 2,917, and in 3.1% of elderly subjects. The most frequent are digestive: nausea, upper abdominal pain, diarrhoea and vomiting. These symptoms are partly explained by the action of macrolides on motilin, a hormone that stimulates the movement of the digestive tract.
Less frequent effects exist, such as headaches or dizziness, and others that are rarer: skin rashes, abnormalities in liver tests, altered taste or smell. The incidence of treatment-related liver test abnormalities remained low in the tolerance evaluation in adults. A systematic review of 52 randomised trials, involving more than 10,000 participants, found no deaths linked to the macrolides and tetracyclines studied, with rates of serious effects comparable to placebo and digestive disorders as the most frequent effect.
Heart and rhythm: the QT interval
Macrolides have a tendency to prolong the QT interval and the QTc, a portion of the heart's electrical cycle. This tendency is most marked for erythromycin and weakest for azithromycin, with roxithromycin sitting within this family. A QT that is too long can, in rare cases, encourage a rhythm disturbance called torsades de pointes.
Several factors increase this risk, including a low blood potassium, a hypokalaemia, a low magnesium, a hypomagnesaemia, and a hypocalcaemia. During rhythm management, potassium levels are kept between 4.5 and 5 mmol/L and magnesium levels are corrected. Keeping potassium and magnesium within normal ranges therefore limits the rhythm risk associated with medicines that prolong the QT.
Interactions and monitoring
Roxithromycin has a weaker affinity for cytochrome P450 than erythromycin, so it causes fewer interactions by this route. This ranking places macrolides according to their potential for interaction via CYP3A4: erythromycin is very prone to it, clarithromycin much less so, and azithromycin does not take part in it.
There is, however, a significant interaction with warfarin, an anticoagulant: roxithromycin can increase prothrombin time and INR, with cases of severe bleeding reported. When the two are combined, monitoring of INR is warranted. It can also increase theophylline concentrations, which invites taking this into account during monitoring.
Sources
- Macrolides
- Roxithromycin
- Macrolide pharmacokinetics and dose scheduling of roxithromycin
- Roxithromycin. An update of its antimicrobial activity, pharmacokinetic properties and therapeutic use
- An evaluation of tolerance of roxithromycin in adults
- Long-Term Safety Profiles of Macrolides and Tetracyclines: A Systematic Review and Meta-Analysis
- Torsade de Pointes
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What is roxithromycin used for?
It is an antibiotic in the macrolide family, prescribed for certain bacterial infections, particularly respiratory or ENT infections. The precise indication depends on your situation: the patient leaflet and your doctor or pharmacist are the only reliable references.
What are the side effects of roxithromycin?
The patient leaflet mainly reports digestive complaints such as nausea, abdominal pain or diarrhoea. For the full list and what to do, refer to the leaflet and talk to your doctor or pharmacist.
Can you drink alcohol while taking roxithromycin?
The answer depends on your treatment and your state of health. The patient leaflet sets out the precautions to be aware of: follow it and ask your doctor or pharmacist for advice rather than relying on a general rule.
Roxithromycin and pregnancy or breastfeeding: what you need to know
Use during pregnancy or breastfeeding calls for an individual medical assessment. Do not start, continue or stop this medicine without talking to your doctor or pharmacist, and read the patient leaflet.
Does roxithromycin interact with other medications?
Like other macrolides, it can interact with certain treatments, as the patient leaflet details. Tell your doctor or pharmacist about all the medicines you are taking before you start, so they can check compatibility.
What to consider for gut flora during or after an antibiotic like roxithromycin?
Antibiotics act on bacteria, including some bacteria of the gut microbiota, and studies link taking them to a temporary imbalance of the flora. The active ingredient most often studied in this context is a probiotic, in the form of ferments with documented strains such as Saccharomyces boulardii or Lactobacillus rhamnosus. The timing of the dose and whether such an intake is worthwhile should be discussed with your doctor or pharmacist.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.