New Relevance of

Roxithromycin An Emerging
Therapeutic Approach
Dr. D Khandke MD

Respiratory tract infections : A continuing

challenge
Respiratory tract infections continue to be a cause of
morbidity world over
Pathogens implicated
Streptococcus pneumoniae (Risk groups include young
children, elderly people, and patients with immune-deficiencies)
Haemophilus influenzae ( less common but still encountered)
Moraxella catarrhalis (bronchitis or pneumonia , infections in
COPD patients and sinusitis)

Antibiotic Resistance- A World Challenge

Antibiotics are often prescribed inappropriately and inadequately
and have thus become one of the highly abused drugs.
The increasing antibiotic resistance is mostly due to wide spread
and irrational use of antibiotics in hospitals and community.
Antibiotic resistance is one of the worlds most serious public health
concerns.
We may be faced with the dilemma of pan resistant pathogens if
antibiotic prescribing patterns are not changed

J Glob Infect Dis. 2010 Jan-Apr; 2(1): 1014.

*

Country /Year
Present study
9
South India (1995)

E (%)
14

Pn (%)
4 R 10 IM

Ct (%)
0

Cf (%)
14

Co-tri (%)
24

T (%)
24

4.6

4.6

7.3IM

36

12.6

18.3

1.7

61.7

76.7

Malaysia (1999-2003)

39.2

21.6

17.5

Eight Asian
12
countries (2002-2004)

56.1

35.1

***

11

6.7

42

15

29.3
30

21.2
5

24.07
-

0.9
****
24

28.25
77

15.05
16.9

11

South India (1996-2000)

10

North India (1999-2002)

7

Australia (1994-95)
5

USA (2000-04)
29
UAE (2004-06)

**

Comparison of resistance shown by S. pneumoniae in the present study with earlier studies
Cf = Ciprofloxacin; Co-tri = Cotrimoxazole; Ct = Cefotaxime; E = Erythromycin; Pn = Penicillin; T = Tetracycline; IM = Intermediate

Resistance to Third Generation Cephalosporins

Cephalosporins resistance is due to reduced binding affinity of the PBPs.
New AmpC -lactamases, ESBLs, and carbapenemases, inactivate third
generation cephalosporins, present a distinct threat to the continued utility
of these agents
Cefpodoxime activity against pneumococci is more variable1
High rate of non-susceptibility (64% ) to Cefpodxime in PRSP2

1. Mandell, Douglas & Bennetts. principles and practice of infectious disease 8 th edi.
2. J Formos Med Assoc. 2004 sep; 103 (9): 664-70

A new strategy to fight Antibiotic Resistance

Initial problem of bacterial resistance to antibiotics was solved by
discovery of new antibiotics.
New Drugs take huge time and cost to develop and market
It costs $ 800 million to develop a new antibiotic and get it to the
market
Pharmacologist and Nobel laureate James Black said, The most
fruitful basis for the discovery of a new drug is to start with an old
drug.
Viable solution is rational usage of antibiotics & reinvestigating
new uses for existing marketed old drugs

.
Optimization of the usage of old antibiotics remains a priority that may be
considered of similar importance to that of the assessment of new drugs

Better availability of Nitrofurantoin, Fusidic Acid, Colistin, Tobramycin, Pristinamycin,

Temocillin, Mecillinam

Do Macrolides like roxithromycin still

have a place in the management of
RTI pathogens ?

In vitro study to evaluate activity of

Roxithromycin against commonly
implicated RTI pathogens

Aim

To evaluate and compare the efficacy of Roxithromycin and

erythromycin against cefpodoxime resistant isolates of S.
Pneumoniae, H. influenzae & M. catarrhalis.

Methodology

Cefpodoxime resistant isolates collected from a tertiary

care hospital
16 isolates of S.pneumoniae, H. influenzae and M.
Catarrhalis each
Antibiotic susceptibility was tested by the disc diffusion
method

Observations

Percentage Sensitivity (%)

Antimicrobial Activity against S. pneumoniae

100
90
80
70
60
50
40
30
20
10
0

87.5
81.25

Sensitive
Resistant
Intermediate
12.5

12.5
6.25
0

Roxithromycin

Erythromycin
Antibiotics

Observations

Antimicrobial Activity against H. influenzae

Percentage sensitivity (%)

120

100

100

100
80

Sensitive

60

Resistant

40

Intermediate

20
0

0
Roxithromycin

Erythromycin
Antibiotics

Observations

Percentage sensitivity (%)

Antimicrobial Activity against M. catarrhalis

100
90
80
70
60
50
40
30
20
10
0

100

93.75

Sensitive
Resistant
Intermediate
6.25

Roxithromycin Erythromycin
Antibiotics

Key observations
The antimicrobial activity of Roxithromycin, and Erythromycin
observed against the selected Cefpodoxime-resistant
pathogens has corroborated the concept of antibiotic rotation
and efficacy of Roxithromycin against cefpodoxime resistant
pathogens.
S. pneumoniae, H. influenzae and M. catarrhalis are highly
susceptible to Roxithromycin & show intermediate response to
Erythromycin.

Summary
S.pneumoniae, H. influenzae & M. catarrhalis are most common
. pathogens causing RTIs
There is increasing evidences to show resistance development to
these pathogens
Viable solution for antibiotic resistance is rational usage of antibiotics &
reinvestigating new uses for existing marketed old drugs
Roxithromycin in vitro study observed its sensitivity against the
selected Cefpodoxime-resistant strains of S.pneumoniae, H. influenzae
& M. catarrhalis.
It also has well documented immunomodulatory or anti-inflammatory
effects

Roxithromycin can become an empiric drug for

the management of respiratory tract infections
caused by S. pneumoniae, H. influenzae and M.
catarrhalis

THANK YOU

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