Roxithromycin, a new macrolide antibiotic, in the treatment of infections in the lower respiratory tract: an overview.

Roxithromycin is a new macrolide antibiotic with good absorption and a longer half-life than erythromycin. Worldwide clinical studies to evaluate its efficacy and safety in the treatment of infections of the lower respiratory tract have achieved a clinical success rate of 89% with few and mild side effects. Double-blind studies comparing roxithromycin with cephradine, erythromycin ethylsuccinate and doxycycline in pneumonia, acute exacerbations of bronchitis in patients with chronic obstructive airways disease, and acute bronchitis have been done. The clinical response to comparative regimens has been similar and ranges from 60% response with either regimen in patients with chronic airways disease to 90% response in patients with acute bronchitis or pneumonia. Roxithromycin appears to be as effective as erythromycin or doxycycline for the treatment of either Streptococcus pneumoniae or Haemophilus influenzae infections. A large double-blind trial comparing cephradine and roxithromycin in 90 cases of bacteriologically confirmed pneumococcal pneumonia in South African gold miners resulted in a 93% and 100% respective clinical response rate. The bacteriological results revealed interesting results in this same study, in that cultures from 17% of patients receiving roxithromycin and 23% of those receiving cephradine remained positive for S. pneumoniae after therapy was finished and an excellent clinical response had been obtained. Side effects in all studies have been transient and mild, with an elevated transaminase value being the most common in both roxithromycin and erythromycin or cephradine regimens. Roxithromycin appears to be a safe and effective oral antibiotic for the treatment of pneumococcal pneumonia and other infections of the lower respiratory tract, and is as effective as erythromycin, doxycycline or cephradine.