Rulid – More effective against a wide group of bacteria

Rulid is the brand name for the antibiotic Roxithromycin, a semi-synthetic antibiotic that belongs to a group of medicines called macrolides. As an antibiotic, Rulid is used to combat bacterial infections, typically soft tissue and respiratory tract infections. It should be noted that, as with all antibiotics, Rulid is not effective against viral infections.

Below, we look in more detail at the types of infections that Rulid can be used to treat, but first we look in a little more detail at what exactly Rulid is and how it works.

What is Rulid?

As mentioned above, Rulid is an antibiotic. Antibiotics are chemotherapeutic agents that inhibit or kill bacteria. Bacteria cells are prokaryotic and therefore differ significantly from human eukaryotic cells. Prokaryotic cells are simple, primitive cells. They don’t have a nucleus or any other membrane-bound organelles. Eukaryotic cells evolved from prokaryotes and are much more complex in nature. They form the tiny units of life that make up most of the living things that we are familiar with such as plants and animals. The fact that cells are either eukaryotic or prokaryotic is important when it comes to the actions and effects of antibiotics.

There are many different classes of antibiotics, with each class exerting a different type of inhibitory effect that specifically impacts bacteria. Rulid, and its close relatives such as erythromycin, azithromycin and clarithromycin, fall into the group known as macrolides. The members of the macrolide group are all very similar in composition, chemical structure and mechanism of action.

How does Rulid work?

As a macrolide antibiotic, Rulid works by inhibiting bacterial cell protein synthesis. In technical terms, the way in which Rulid and other macrolides achieve this is to bind irreversibly to the 50S subunit of the bacterial ribosomes. Ribosomes are the protein factories of the cell, and by binding to the ribosomes, macrolides inhibit the process whereby proteins are produced under the direction of DNA. By interfering with the protein synthesis in this way the bacteria cannot grow. This action is mainly bacteriostatic - that is to say bacterial growth and reproduction are inhibited by antibiotic macrolides. However, macrolides can become bactericidal and directly kill bacteria if they are present in high enough concentrations.

Macrolides have a tendency to accumulate within white blood cells (leukocytes). Leukocytes form an essential part of the body’s immune system, defending it against both infectious diseases and foreign materials. By accumulating within leukocytes, macrolides are transported directly into the site of any bacterial infection.

You may be wondering how it is that macrolide antibiotics only affect bacteria cells and not other cells in the human body. This is where the difference between prokaryotic and eukaryotic cells plays an important role. Human cells also have ribosomes, but, because they are eukaryotic and nor prokaryotic, they are not affected by the actions of macrolide antibiotics. Eukaryotic ribosomes differ in size and structure from the ribosomes of prokaryotes.

What types of infection is Rulid used to treat?

Rulid is used to treat a wide range of bacterial infections within the body - typically those found in the respiratory tract, genitals, gastrointestinal tract, and soft tissues. It has a similar antimicrobial spectrum as erythromycin. Conditions such as sore throat and difficulty swallowing (acute pharyngitis), acute bronchitis, tonsillitis, sinusitis, pneumonia, some sexually transmitted diseases, gum infections like gingivitis and skin infections including impetigo (a bacterial infection that causes sores on the skin) all respond well to Rulid.

The fact that Rulid is appropriate for some bacterial infections and not others depends upon which strain of bacteria that has caused the infection in the first place. As is the case with other groups of antibiotics, only certain strains of bacteria are susceptible to macrolide antibiotics. These susceptible strains include:

1. Chlamydia trachomatis; Causes infections that can affect the eyes and urogenital area in both men and women. The eye infection caused by this bacterium is known as trachoma. It is a particularly nasty eye infection that leads to the formation of small granules along the conjunctiva (the thin membrane that covers both the surface of the eye and inner surface of the eyelid). Trachoma can result in ulceration, scarring and blindness. An infected pregnant mother may pass it on to her unborn child or it can be transmitted to a newborn via the birth canal during birth. In terms of urogenital problems, chlamydia trachomatis is one of the most common sexually transmitted diseases in the US, Australia and the UK. In both men and women it can cause inflammation of the urethra - the tube that carries urine form the bladder - which makes urination painful (urethritis), rectal bleeding and disease (proctitis) and infertility. In men, it may cause inflammation of the prostate gland (prostatitis) and inflammation of the epididymis - the structure at the back of the testicle in which sperm mature and are then stored (epididymitis). In women, it may give rise to inflammation of the cervix (cervicitis), pelvis inflammatory disease and ectopic pregnancy. Chlamydia trachomatis may also cause pneumonia in infants born to infected mothers depending upon how the infection is transmitted


2. Listeria monocytogenes; Responsible for listeriosis, one of the most virulent food-borne pathogens. Twenty to thirty per cent of clinical listeriosis infections result in death. In the USA alone listeria monocytogenes causes 2,500 cases of illness and 500 deaths per annum - making it the leading cause of death from food-borne pathogens ahead of both salmonella and botulism


3. Helicobacter (Campylobacter); Causes chronic low-level inflammation in the stomach lining. It is strongly associated with the development of duodenal and gastric ulcers and stomach cancer


4. Ureaplasma urealyticum; Although a normal part of the genital flora of both men and women, this bacterium is associated with a number of disease conditions including infertility, stillbirth, premature birth and non-specific urethritis (NSU)


5. Gardnerella vaginalis: Responsible for an infection of the female genital tract (sometimes called bacterial vaginosis)


6. Haemophilus Ducreyi; Responsible for chancroid, a sexually transmitted disease that is characterized by sores on the genitalia


7. Streptococcus agalactiae; Present in up to one-third of women of childbearing age. It can cause serious and even fatal group B streptococcal infections in newborns if transferred from the mother via the birth canal during birth. The current rate of infection is one in every thousand live births. Developing infection from Streptococcus agalactiae is nearly non-existent in healthy adult females, but elderly women and those with compromised immune systems such as diabetics and AIDS patients may be vulnerable to developing septicaemia and other serious infections. In rare cases, it has been known to affect women during pregnancy and maternity


8. Streptococcus pneumoniae (Pneumococcus); Is a gram positive bacterium which, despite its name, causes many different types of pneumococcal infections apart from pneumonia. For example, it is the most common cause of bacterial meningitis in adults and children. It is also responsible for infections including endocarditis, cellulitis, peritonitis, acute sinusitis, otitis media and sepsis


9. Neisseria meningitides (Meningococcus); Is a heterotrophic gram negative diplococcal bacterium which most people will have heard of in relation to meningococcal meningitis. It is also responsible for other meningococcal diseases such as meningococcal septicaemia


10. Mycoplasma pneumoniae - causes Mycoplasma pneumonia


11. Bordetella pertussis; Causes whooping cough which was once responsible for the deaths of between five and ten thousand people a year in the US alone but thanks to intensive immunization programs now hardly any deaths at all


12. Moraxella catarrhalis (Branhamella Catarrhalis);Causes respiratory tract associated infections


13. Legionella pneumophila; Responsible for Legionnaire’s disease

Advantages of Rulid

Like penicillin, macrolide antibiotics are effective against beta-hemolytic streptococci, pneumococci, staphylococci and enterococci. But one of the advantages of macrolides over penicillin is that they are effective against a slightly wider range of bacteria including mycoplasma, mycobacteria, some rickettsia and chlamydia. Macrolides also offer an effective long-term treatment for the idiopathic, Asian-prevalent lung disease diffuse panbronchiolitis - an inflammatory lung disease that can prove fatal if left untreated. Idiopathic refers to the fact that this disease arises spontaneously without any known cause.

Rulid also offers a very useful weapon in the fight against certain bacteria that have otherwise proven to be extremely difficult to treat i.e. cryptosporidium, pneumocystis carinii (PCP), toxoplasma gondii and Mycobacterium Avium (MAC).

Rulid is also more effective than erythromycin in treating certain gram-negative bacteria, particularly Legionella pneumophila. In addition, Rulid has fewer drug interactions than erythromycin.

Unlike some antibiotics, Rulid does not interact with hormonal contraceptives, prednisolone, carbamazepine, ranitidine or antacids.

Some patients are unable to take penicillins due to allergic reaction. Fortunately, macrolides are able to offer a more than suitable alternative especially as they have a slightly wider antimicrobial spectrum and are known to cause fewer allergy problems than penicillins and cephalosporins.

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Dosage

You should take 300 mg a day - one 150mg tablet in the morning and one 150mg tablet in the evening. Tablets should be swallowed with a glass of water. Like most antibiotics, Rulid should be taken for a minimum of five days to effectively treat the infection and to prevent resistance. Dosing schedules and duration should be discussed with your doctor. It is important that Rulid is taken at least fifteen minutes after meals to allow the drug to have maximum absorption in the body.

Side effects

Generally Rulid is well tolerated. It is absorbed well into the gastro-intestinal tract and few side effects have been recorded.

However, as with all medicines, Rulid may cause you some side effects. The most common side effects are gastrointestinal ones - diarrhoea, nausea, abdominal pain and vomiting. Less common side-effects include headaches, rashes, abnormal liver function values and alterations in senses of smell and taste.

If you have any concerns at all, discuss them with your health care professional.

Warnings

It is important to advise your doctor of any other medicines both prescription and over-the- counter ones that you are taking before you begin taking Rulid.

Do not take Rulid if you are already taking vaso-constrictive ergot alkaloids.

In some cases, if Rulid is administered with theophylline, an increase in the plasma concentration of theophylline has been observed. A change in dosage is not usually required but patients with high levels of theophylline at the start of Rulid treatment should have their plasma levels monitored.

Rulid also appears to interact with warfarin resulting in severe bleeding episodes.

It is not recommended that you take Rulid at the same time as:

• Terfenadine and astemizole; Certain macrolides interact with terfenadine and astemizole leading to increased serum concentrations of the latter. This may result in severe ventricular arrhythmia. Although such a reaction has not actually been demonstrated with Rulid, concomitant administration of Rulid with terfenadine or astemizole is not recommended


• Cisapride, pimozide; Other drugs such as cisapride or pimozide, which are metabolised by hepatic CYP3A isozymes have been associated with QT interval prolongation and/or cardiac arrythmias as a result of increases in their serum level subsequent to interaction with significant inhibitors of the isozyme, including some macrolide antibacterials. Although such a risk has not been verified for Rulid, combining Rulid with such drugs is not recommended.

Do not take Rulid if you are allergic to any macrolide antibiotics or any of the ingredients in Rulid.

Do not take Rulid if you are pregnant or breast feeding unless advised to do so by your doctor.

Do not take Rulid if you have severe liver problems.