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Indications: �asthma �Bacillus anthracis �Clostridium perfringens �Clostridium tetani �Corynebacterium diphtheriae �Enterococcus faecalis �Haemophilus influenzae (beta-lactamase negative) �Haemophilus influenzae (beta-lactamase positive) �lower respiratory tract infections �Neisseria gonorrhoeae �Neisseria meningitidis �pneumonia �Staphylococcus aureus �Staphylococcus epidermidis �Streptococcus pneumoniae �Streptococcus pyogenes (group A beta-hemolytic streptococci) �upper respiratory tract infections �Viridans streptococci Comments: Description: Troleandomycin is an oral macrolide antibiotic. It has been used for the treatment of respiratory tract infections, but it is rarely indicated now because it is generally less effective than erythromycin. Troleandomycin's bacteriostatic activity occurs through inhibition of protein synthesis in susceptible organisms. This drug was approved by the FDA in 1958. Contraindications/Precautions: Impaired hepatic function. Drug Interactions: Drug interactions are similar to those of erythromycin (see Erythromycin monograph) Alosetron: Alosetron is metabolized by CYP1A2 and CYP3A4. Troleandomycin inhibits both of these enzymes and may decrease the metabolism of alosetron resulting in increased alosetron plasma concentrations. Coadministration of alosetron with troleandomycin has not been studied. Carbamazepine: Troleandomycin can potentiate the action of carbamazepine by interfering with hepatic metabolism of carbamazepine. Astemizole, cisapride, dofetilide, pimozide and terfenadine: Troleandomycin can inhibit hepatic metabolism resulting in elevated plasma concentrations of these agents. Elevated plasma concentrations of astemizole, cisapride, pimozide or terfenadine have been associated with QT prolongation and torsade de pointes. Ergot alkaloids (ergotamine and dihydroergotamine): Can induce ischemic reactions and severe peripheral vasospasm via an unknown mechanism; may be the result of decreased ergot metabolism. Soy isoflavones: Bacteria in the intestine produce enzymes which hydrolyze the soy isoflavones to the active isoflavonoids genistein and daidzein. Some antibiotics significantly reduce the GI flora and could essentially prevent the formation of the active components of the soy isoflavones. Theophylline and Aminophylline: Can result in increased theophylline concentrations and toxicity. Zonisamide: Zonisamide is metabolized by CYP3A4. Troleandomycin inhibits this enzyme and may decrease the metabolism of zonisamide. Coadministration of zonisamide with troleandomycin has not been studied. Adverse Reactions: Abdominal cramping, nausea/vomiting, esophagitis, rectal burning, diarrhea, anaphylaxis, cholestatic hepatitis. Available as: Capsules troleandomycin 250 mg Dosage: For the treatment of infections caused by susceptible organisms: Oral dosage: Adults: 250�500 mg PO four times per day. Continue treatment for 10 days if treating group A beta-hemolytic streptococcal infection. Children: 25�40 mg/kg/day PO divided every 6 hours. As an adjunct in the treatment of corticosteroid-dependent asthma: Oral dosage: Children: 14 mg/kg/day PO given in divided doses every 6�12 hours not to exceed 250 mg PO every 6 hours. Dose should be tapered to once daily then alternate day dosing. Patients with renal impairment: No dosage adjustment needed.
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