We report a case of bronchiolitis obliterans associated with Stevens-Johnson syndrome. A 59-year-old man presented with respiratory distress that gradually worsened over 3 months. He had been diagnosed with Stevens-Johnson syndrome 3 months before admission. He had no history of previous airway disease. On physical examination, expiratory breathing sounds were not audible, and a chest X-ray revealed a hyperinflated lung. A pulmonary function test indicated a severe obstructive pattern. Computed tomography scans of inspiratory and expiratory phases of respiration showed oligemia and air trapping, and both were more prominent on expiration view than on inspiration view. The pathogenesis of bronchiolitis obliterans associated with Stevens-Johnson syndrome is largely unknown.
Anti-Bacterial Agents/therapeutic use ; Bronchiolitis Obliterans/etiology/*radiography/therapy ; Bronchoscopy ; Dyspnea/*complications ; Fatal Outcome ; Humans ; Male ; Middle Aged ; Radiography, Thoracic ; Respiratory Distress Syndrome, Adult/*etiology/therapy ; Respiratory Function Tests ; Roxithromycin/therapeutic use ; Stevens-Johnson Syndrome/*complications/drug therapy ; Tomography, X-Ray Computed/methods ; Tracheostomy

Recently, the incidence of pertussis has been increasing; however, reports on mixed infection of pertussis with other respiratory pathogens are rare in highly immunized populations. We report the case of a 10-year-old girl who presented with cough, post-tussive emesis, and fever. She was subsequently diagnosed with bronchopneumonia. Although she had received five doses of diphtheria-tetanus-acellular pertussis vaccine, polymerase chain reaction of her nasopharyngeal aspirate confirmed Bordetella pertussis infection. In addition, serologic testing for Mycoplasma pneumoniae was also positive. The patient was treated with roxithromycin without any complications. This is the first report of mixed B. pertussis and M. pneumoniae infection in Korea. To avoid under-diagnosis, pertussis should be considered in patients with chronic cough even when other respiratory pathogens have been documented.
Bordetella pertussis ; Bronchopneumonia ; Child* ; Coinfection ; Cough ; Female* ; Fever ; Humans ; Incidence ; Korea ; Mycoplasma Infections* ; Mycoplasma pneumoniae ; Mycoplasma* ; Pertussis Vaccine ; Pneumonia ; Pneumonia, Mycoplasma ; Polymerase Chain Reaction ; Roxithromycin ; Serologic Tests ; Vomiting ; Whooping Cough*

This is a study of assessing the comparative bioavailability of roxithromycin produced by two companies in 36 healthy volunteers. On the basis of informed consent, 36 healthy male volunteers received each medicine at the roxithromycin dose of 150mg in a cross-over study. There was a 1-week washout period among the doses. Plasma concentrations of roxithromycin were monitored by an LC-MS/MS for over a period of 72 hours after administration. In this study, roxithromycin was generally well tolerated. After an oral administration of roxithromycin capsule, the pharmacokinetic parameters of roxithromycin, such as AUC(0-72 h) (66 076 microg x L x h(-1) and 70 334 microg x L x h(-1) for test and reference capsule, respectively) and AUC(0-infinity) (68 153 microg x L x h(-1) and 72 362 microg x L x h(-1)) were significantly similar. For test and reference capsule, the values of C(max) were 6 631.5 microg x L(-1) and 7 033.9 microg x L(-1) respectively, of T1/2 were 15.39 +/- 4.61 h and 16.06 +/- 5.56 h, and of T(max) were 1.3 +/- 0.9 h and 1.4 +/- 0.7 h respectively. The relative bioavailability F was 94.9% +/- 22.4% of tested formulation. The values of 90% confidence interval around the ratios (test/reference) (obtained by analysis of variance, ANOVA) were 88.3%-101.2% for C(max), 86.2%-98.9% for AUC(0-72) h, being within the predefined acceptable range for the conclusion of bioequivalence. The results of statistical analysis suggest that the two formulations be bioequivalent.
Adult ; Anti-Bacterial Agents ; administration & dosage ; pharmacokinetics ; Biological Availability ; Chromatography, High Pressure Liquid ; methods ; Cross-Over Studies ; Humans ; Male ; Roxithromycin ; administration & dosage ; pharmacokinetics ; Tablets ; Tandem Mass Spectrometry ; methods ; Young Adult

OBJECTIVE: Observe the therapeutic effect of low dose Roxithromycin in treating chronic sinusitis and further discuss the mechanism of Roxithromycin facile endothelial cell apoptosis. METHOD: All 47 patients who suffer chronic sinusitis at out-patient clinic from 2006. 10 to 2008. 03 were administered low dose Roxithromycin. Follow up all the patients and get polypi at 3-month and 6-month. AO/EB was employed to detect the apoptosis of endothelial cell. RESULT: At 3-month and 6-month the improvement of ventilation are 37.25 +/- 12.21, 63.15 +/- 22.78; Decrease of nasal discharge are 42.12 +/- 13.56, 74.45 +/- 28.79; alleviation of headache are 18.98 +/- 7. 66, 34.47 +/- 14.11; Improvement of olfactory are 21.23 +/- 8.41, 38.18 +/- 16.54; Apoptotic index are (39.54 +/- 6.86)% and (62.34 +/- 8.67)%, which are significantly different (P<0.05). CONCLUSION Low dose Roxithromycin has good long term curative effect in treating chronic sinusitis. Low dose Roxithromycin can greatly urge the apoptosis of endothelial cell.
Adolescent ; Adult ; Aged ; Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Apoptosis ; Child ; Chronic Disease ; Female ; Humans ; Male ; Middle Aged ; Nasal Polyps ; complications ; drug therapy ; Roxithromycin ; administration & dosage ; therapeutic use ; Sinusitis ; complications ; drug therapy ; Young Adult

Macrolide antimicrobial agents including erythromycin, roxithromycin, clarithromycin, and azithromycin are commonly used in the treatment of respiratory tract infections in children. Newer macrolides that have structural modifications of older drug erythromycin show improved change in the spectrum of activity, dosing, and administration. However, recent studies reported that increasing use of macrolide antibiotics is the main force driving the development of macrolide resistance in streptococci. In particular, azithromycin use is more likely to select for macrolide resistance with Streptococcus pneumoniae than is clarithromycin use, a possible reflection of its much longer half life. Recently, erythromycin resistance rates of S. pneumoniae and Streptococcus pyogenes are rapidly increasing in Korea. Two main mechanisms of acquired macrolide resistance have been described, altered binding site on the bacterial ribosome encoded by the ermB gene and active macrolide efflux pump encoded by the mef gene. Relationship between the susceptibility of S. pneumoniae and the response to macrolides has been shown in studies of acute otitis media, but less clear in cases of pneumonia. This article reviews the spectrum of activity, pharmacokinetic properties, mechanisms of action and resistance, and clinical implication of resistance on the treatment of respiratory tract infections in children.
Anti-Bacterial Agents ; Anti-Infective Agents ; Azithromycin ; Binding Sites ; Child ; Clarithromycin ; Erythromycin ; Half-Life ; Humans ; Korea ; Macrolides ; Otitis Media ; Pneumonia ; Respiratory Tract Infections ; Ribosomes ; Roxithromycin ; Streptococcus pneumoniae ; Streptococcus pyogenes

PURPOSE: To estimate the prevalence of co-prescribing contraindicated drugs for elderly patients in Busan. METHODS: We used the Health Insurance Review Agency (HIRA) claims database. Study population consisted of elderly patients who visited clinics or hospitals in Busan metropolitan city from January 1, 2000 to December 31, 2001. Contraindicated drugs were defined as 162 combinations of contraindicated drugs announced by the Korea Ministry of Health and Welfare in 2004. The co-prescription of contraindicated drugs was defined as prescribing two or more contraindicated drugs in combination in the same prescription. The prevalence of co-prescribing contraindicated drugswas estimated as proportion of co-prescribed patients out of the study patients. We estimated and age-adjusted prevalence and its 95% confidence interval of co-prescription of contraindicated drugs among the elderly patients in Korean population in 2001. RESULTS: The study elderly patients were 262,952 with 2,483,227 prescriptions. Among the study patients 1,208 (4.6%) were prescribed contraindicated drugs in combination. A total of 16,255 patients were estimated as the number of co-prescribed patients among the Korean elderly in 2001. Age-standardized prevalence of co-prescription to the Korean elderly was estimated to be 45 per 10,000 persons. The most frequently prescribed combinations were cisapride & amitriptyline, roxithromycin & ergoloid mesylate, and terfenadine & erythromycin, and the frequency were 325 (16.8%), 149 (7.7%), and 132 (6.8%),respectively. CONCLUSIONS: The contraindicated drugs were co-prescribed to the elderly patients in Korea. Many of these co-prescriptions should be avoided if unnecessary. The patients should be carefully monitored if they were inevitably prescribed the contraindicated drugs.
Aged ; Amitriptyline ; Cisapride ; Drug Combinations ; Drug Utilization Review ; Ergoloid Mesylates ; Erythromycin ; Humans ; Insurance, Health ; Korea ; Prescriptions ; Prevalence ; Roxithromycin ; Terfenadine

BACKGROUND AND OBJECTIVES: Macrolide antibiotics are known to inhibit mucus hypersecretion in patients with chronic airway diseases, but its action mechanism is unclear. Several reports demonstrated that macrolides significantly inhibited gene expression of MUC2, MUC4 and MUC5AC in the airway epithelial cells, but little is known about its inhibitory effect for the other important airway mucins. In upper airway tracts, MUC5B and MUC8 are other important secreted mucin genes. Therefore, this study was aimed to investigate the effects of roxithromycin on the IL-1beta-induced gene expression and mucin production of MUC5B and MUC8 in NCI-H292 cells and cultured human nasal polyp epithelial cells. SUBJECTS AND METHOD: The effects of roxithromycin on the IL-1beta-induced MUC5B and MUC8 expression were analyzed by reverse transcription-polymerase chain reaction and enzyme-linked immunosorbent assay. RESULTS: Roxithromycin attenuated the IL-1beta-induced MUC5B and MUC8 gene expression and mucin production with a dose-dependent pattern in NCI-H292 epithelial cells and cultured human nasal polyp epithelial cells. CONCLUSION: Roxithromycin exerts direct inhibitory effects on the gene expression of MUC5B and MUC8 in airway epithelial cells. These novel findings may explain the clinical efficacy of 14-membered macrolides in the treatment of chronic airway inflammations.
Anti-Bacterial Agents ; Epithelial Cells ; Gene Expression ; Humans ; Inflammation ; Macrolides ; Mucins ; Mucus ; Nasal Polyps ; Roxithromycin

Alternaria is a common saprophyte that is not usually pathogenic in humans. However, infections by the fungus have occasionally been documented, occurring mostly in immunocompromised patients. We report a case of cutaneous alternariosis caused by Alternaria alternata in a 64-year-old woman presenting with a coin-sized, slightly elevated, dark red plaque on the right wrist without systemic immunosuppression. Macroscopic and microscopic morphology of fungal culture and histopathological differentiation offered diagnostic possibility. Systemic roxithromycin and itraconazole were administered with a dramatic resolution of the lesion.
Alternaria* ; Alternariosis* ; Female ; Fungi ; Humans ; Immunocompromised Host ; Immunosuppression ; Itraconazole ; Middle Aged ; Roxithromycin ; Wrist

The relative bioavailability of roxithromycin dispersive tablet in healthy volunteers was evaluated in this study. Its concentration in plasma was detected by high performance liquid chromatography (HPLC) after twenty healthy male volunteers were given each a single dose of 300 mg roxithromycin. The experiment data were obtained using DAS programme. The values of Cmax were 10.16+/-1.46 and 10.34+/-1.66 microg x ml(-1) at 2.33+/-0.61 and 2.28+/-0.62 h respectively; of t1/2 were 9.00+/-1.58 and 8.68+/-1.66 h respectively; of AUC0-->Tn were 143.32 +/-25. 80 and 138.93+/-22. 49 microg x h x ml(-1) respectively; of AUC0-->infinity were 158.63+/-26.86 and 153.77+/-24.75 microg x h x ml(-1) for test and reference drugs. Relative bioavailability of the tested roxithromycin was 103.63%+/-14.04%. The result showed that the two dispersive tablets are bioequivalent.
Administration, Oral ; Anti-Bacterial Agents ; blood ; pharmacokinetics ; Biological Availability ; Chromatography, High Pressure Liquid ; Humans ; Male ; Roxithromycin ; blood ; pharmacokinetics ; Tablets ; Therapeutic Equivalency ; Young Adult

We report a case of tinea barbae in a 51-year-old man, who presented with erythematous pustules on the upper lip, and a relatively well-defined pustular patch on his left cheek. Histopathologically, fungal hyphae were found in the hair shaft upon PAS staining. A fungal culture from scales and tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical Trichophyton mentagrophytes. The patient was treated with 250 mg of terbinafine, 10 mg of prednisolone and 300 mg of roxithromycin daily for the first week, then 250 mg of terbinafine combined with topical lanoconazole for 4 weeks. The skin lesions improved 5 weeks after treatment, and recurrence has not been observed.
Agar ; Cheek ; Glucose ; Hair ; Humans ; Hyphae ; Lip ; Middle Aged ; Prednisolone ; Recurrence ; Roxithromycin ; Skin ; Tinea* ; Trichophyton* ; Weights and Measures