Dirithromycin
Author: michaelrussell
Author: michaelrussell
HOW SUPPLIED
Tablets (enteric-coated): 250 mg
ACTION
Inhibits bacterial RNA-dependent protein synthesis by binding to the 50S subunit of the ribosome.
INDICATIONS & DOSAGE
Acute bacterial exacerbations of chronic bronchitis due to Moraxella (Branharnella) catarrhalis, Streptococcus pneumoniae, or Haemophilus influenzae; secondary bacterial infection of acute bronchitis due to M. catarrhalis or S. pneumoniae; uncomplicated skin and skin-structure infections due to Staphylococcus aureus (methicillin-susceptible strains) or S. pyogenes-
Adults and children ages 12 and older: 500 mg P.O. daily with food (or within 1 hour after eating) for 5 to 7 days.
Community-acquired pneumonia due to Legionella pneumophila, Mycoplasma pneumoniae, or S. pneumoniae
Adults and children ages 12 and older: 500 mg P.O. daily with food (or within 1 hour after eating) for 14 days.
Pharyngitis or tonsillitis due to S. pyogenes-
Adults and children ages 12 and older: 500 mg P.O. daily with food (or within 1 hour after eating) for 10 days.
ADVERSE REACTIONS
CNS: headache, dizziness, vertigo, asthenia, insomnia.
GI: abdominal pain, nausea, diarrhea, vomiting, dyspepsia, flatulence.
Hepatic: increased liver enzyme levels.
Hematologic: increased platelet, eosinophil, and neutrophil counts.
Metabolic: hyperkalemia.
Respiratory: increased cough, dyspnea.
Skin: rash, pruritus, urticaria.
Other: pain, decreased bicarbonate levels, increased CK level.
INTERACTIONS
Drug-drug. Antacids, Hz-antagonists: may slightly increase the absorption of dirithromycin when it is administered immediately after these drugs. Do not give together.
Theophylline: may alter steady-state plasma levels of theophylline. Theophylline plasma levels must be monitored. Dosage adjustments may be needed.
Note: Alfentanil, oral anticoagulants, bromocriptine, carbamazepine, cyclosporine, digoxin, disopyramide, ergotamine, hexobarbital, lovastatin, phenytoin, triazolam, and valproate have been reported to interact with erythromycin products. It's unknown whether these same drugs interact with dirithromycin. Until further data are available, use caution during coadministration.
Drug-food. Any food: increased absorption. Drug should be administered with food.
EFFECTS ON DIAGNOSTIC TESTS
None reported.
CONTRAINDICATIONS
Contraindicated in patients with hypersensitivity to drug, erythromycin, or other macrolide antibiotics.
SPECIAL CONSIDERATIONS
* Use cautiously in patients with hepatic insufficiency and in breast-feeding women. Liver function test results must be monitored.
* Safety of drug in children under age 12 hasn't been established.
* Culture and sensitivity results must be obtained to ensure organism is sensitive to dirithromycin. Drug isn't recommended for empiric use.
* Drug shouldn't be used in patients with known, suspected, or potential bacteremias because serum levels are inadequate to provide antibacterial coverage of organisms within the bloodstream.
* Drug should be administered with food or within 1 hour of food intake.
* Patient should be monitored for superinfection. Drug may cause overgrowth of nonsusceptible bacteria or fungi.
Patient teaching
* Take drug as prescribed, even after feeling better.
* Take drug with food or within 1 hour after eating and do not cut, chew, or crush the tablet.
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