Spiramycin: Difference between revisions
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==Administration== | ==Administration== | ||
*Type: [[macrolide]] antibiotic | *Type: [[macrolide]] antibiotic | ||
*Dosage Forms: | *Dosage Forms: 250, 500 | ||
*Routes of Administration: PO, IV | *Routes of Administration: PO, IV | ||
*Common Trade Names: | *Common Trade Names: Rovamycine | ||
==Adult Dosing== | ==Adult Dosing== | ||
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*Category B, Safe in pregnancy<ref>Stray-Pedersen B. Treatment of toxoplasmosis in the pregnant mother and newborn child. Scand J Infect Dis 1992; 84(suppl): 23-31</ref> | *Category B, Safe in pregnancy<ref>Stray-Pedersen B. Treatment of toxoplasmosis in the pregnant mother and newborn child. Scand J Infect Dis 1992; 84(suppl): 23-31</ref> | ||
===Lactation risk=== | ===[[Lactation risk]]=== | ||
*Distributed in breast milk | *Distributed in breast milk | ||
===Renal Dosing=== | ===Renal Dosing=== | ||
*Adult: | *Adult: n/a | ||
*Pediatric: | *Pediatric: n/a | ||
===Hepatic Dosing=== | ===Hepatic Dosing=== | ||
| Line 38: | Line 38: | ||
*Thrombocytopenia | *Thrombocytopenia | ||
*Cholestatic hepatitis | *Cholestatic hepatitis | ||
*GI toxicity, specifically acute colitis or other intestinal injury | *GI toxicity, specifically acute colitis, C. diff colitis, or other intestinal injury | ||
*Ulcerated esophagitis | *Ulcerated esophagitis | ||
*Worsening hepatic impairment in patients with pre-existing liver disease | |||
===Common=== | ===Common=== | ||
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==Pharmacology== | ==Pharmacology== | ||
*Half-life: 4.5-13.5h | *Half-life: 4.5-13.5h (increases with increasing age) | ||
*Metabolism: Hepatic | *Metabolism: Hepatic | ||
*Excretion: Fecal | *Excretion: Fecal (predominant), renal | ||
==Mechanism of Action== | ==Mechanism of Action== | ||
*Reversibly binds to the 50 S subunit of bacterial ribosomes, resulting in blockage of the transpeptidation or translocation reactions, inhibiting protein synthesis and subsequent cell growth | *Reversibly binds to the 50 S subunit of bacterial ribosomes, resulting in blockage of the transpeptidation or translocation reactions, inhibiting protein synthesis and subsequent cell growth<ref>Rovamycine (spiramycin) [product monograph]. Quebec, Canada: Aventis Pharma Inc; April 2018.</ref> | ||
==Comments== | ==Comments== | ||
*Not approved in US for standard use, though exceptions can be made to treat toxoplasmosis in pregnant women | *Not approved in US for standard use, though exceptions can be made to treat toxoplasmosis in pregnant women<ref>Spiramycin. Lexicomp. http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7697?searchUrl=%2Flco%2Faction%2Fsearch%3Forigin%3Dapi%26t%3Dglobalid%26q%3D6982%26nq%3Dtrue. Accessed March 5, 2020.</ref> | ||
==See Also== | ==See Also== | ||
*[[Toxoplasmosis]] | *[[Toxoplasmosis]] | ||
*[[Macrolide]] | |||
==References== | ==References== | ||
Latest revision as of 02:21, 5 March 2020
Administration
- Type: macrolide antibiotic
- Dosage Forms: 250, 500
- Routes of Administration: PO, IV
- Common Trade Names: Rovamycine
Adult Dosing
- 1-2g PO BID OR 500-1000mg PO TID. May increase to 2-2.5g BID for severe infections
- Toxoplasmosis in pregnant women:
- 1st trimester: 3g PO daily in 3-4 divided doses
- 2nd/3rd trimesters: 25-50mg pyrimethamine PO daily AND 2-3g sulfadiazine daily AND folinic acid 5mg daily for 3 weeks, alternating with 1g PO spiramycin TID for 3 weeks
Pediatric Dosing
- >20kg: 25mg/kg PO BID or 16.7mg/kg PO TID
- Subclinical congenital toxoplasmosis: 0.5-1mg/kg PO daily pyrimethamine AND 50-100mg/kg PO daily sulfadiazine x 4 weeks, alternating with 50-100mg/kg spiramycin x 6 weeks, alternating courses for 1 year
- Overt congenital toxoplasmosis: 0.5mg/kg PO pyrimethamine daily AND 50-100mg/kg sulfadiazine PO daily AND 5mg folinic acid q3d for 6 months, alternating with 50-100mg/kg spiramycin AND pyrimethamine AND sulfadiazine for 4 weeks. Repeat dosing courses x 18mo
Special Populations
Pregnancy Rating
- Category B, Safe in pregnancy[1]
Lactation risk
- Distributed in breast milk
Renal Dosing
- Adult: n/a
- Pediatric: n/a
Hepatic Dosing
- Caution in hepatic impairment
Contraindications
- Allergy to class/drug
Adverse Reactions
Serious
- Cardiac toxicity, specifically QT prolongation
- Thrombocytopenia
- Cholestatic hepatitis
- GI toxicity, specifically acute colitis, C. diff colitis, or other intestinal injury
- Ulcerated esophagitis
- Worsening hepatic impairment in patients with pre-existing liver disease
Common
- Injection site pain
- Nausea/vomiting, diarrhea, abdominal pain
Pharmacology
- Half-life: 4.5-13.5h (increases with increasing age)
- Metabolism: Hepatic
- Excretion: Fecal (predominant), renal
Mechanism of Action
- Reversibly binds to the 50 S subunit of bacterial ribosomes, resulting in blockage of the transpeptidation or translocation reactions, inhibiting protein synthesis and subsequent cell growth[2]
Comments
- Not approved in US for standard use, though exceptions can be made to treat toxoplasmosis in pregnant women[3]
See Also
References
- ↑ Stray-Pedersen B. Treatment of toxoplasmosis in the pregnant mother and newborn child. Scand J Infect Dis 1992; 84(suppl): 23-31
- ↑ Rovamycine (spiramycin) [product monograph]. Quebec, Canada: Aventis Pharma Inc; April 2018.
- ↑ Spiramycin. Lexicomp. http://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/7697?searchUrl=%2Flco%2Faction%2Fsearch%3Forigin%3Dapi%26t%3Dglobalid%26q%3D6982%26nq%3Dtrue. Accessed March 5, 2020.