Indications And Dose
Symptomatic treatment of acute exacerbations of chronic bronchitis ▶BY MOUTH ▶Adult: 300 mg twice daily for up to 10 days
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Drug reference
Symptomatic treatment of acute exacerbations of chronic bronchitis ▶BY MOUTH ▶Adult: 300 mg twice daily for up to 10 days
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History of peptic ulceration (may disrupt the gastric mucosal barrier)
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Scottish Medicines Consortium (SMC) decisions SMC No. 415/07 The Scottish Medicines Consortium (November 2007) has advised that erdosteine (Erdotin ®) is not recommended for use within NHS Scotland for the symptomatic treatment of acute exacerbations of chronic bronchitis as the economic case was not demonstrated.
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▶Common or very common Epigastric pain. taste altered ▶Uncommon Allergic dermatitis. angioedema. common cold. diarrhoea. dyspnoea. headache. nausea. vomiting
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Manufacturer advises avoid—no information available.
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Manufacturer advises avoid—no information available.
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Manufacturer advises caution in mild to moderate hepatic failure; avoid in severe hepatic failure. Dose adjustments Manufacturer advises max. 300 mg daily in mild to moderate hepatic failure.
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Avoid if eGFR less than 25 mL/minute/1.73 m2—no information available.
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There can be variation in the licensing of different medicines containing the same drug. Capsule ▶Erdotin (Galen Ltd) Erdosteine 300 mg Erdotin 300mg capsules | 20 capsule P £5.00 DT = £5.00 3.1 Cystic fibrosis Cystic fibrosis Description of condition Cystic fibrosis is a genetic disorder affecting the lungs, pancreas, liver, intestine, and reproductive organs. The main clinical signs are pulmonary disease, with recurrent infections and the production of copious viscous sputum, and malabsorption due to pancreatic insufficiency. Other complications include hepatobiliary disease, osteoporosis, cystic fibrosis-related diabetes, and distal intestinal obstruction syndrome. Aims of treatment The aim of treatment includes preventing and managing lung infections, loosening and removing thick, sticky mucus from the lungs, preventing or treating intestinal obstruction, and providing sufficient nutrition and hydration. Lung function is a key predictor of life expectancy in people with cystic fibrosis and optimising lung function is a major aim of care. Non-drug treatment Specialist physiotherapists should assess patients with cystic fibrosis and provide advice on airway clearance, nebuliser use, musculoskeletal disorders, physical activity, and urinary incontinence. The importance of airway clearance techniques should be discussed with patients and their parents or carers and appropriate training provided. Patients should be advised that regular exercise improves both lung function and overall fitness. Drug treatment Treatment for cystic fibrosis lung disease is based on the prevention of lung infection and the maintenance of lung function. g In patients with cystic fibrosis, who have clinical evidence of lung disease, the frequency of routine review should be based on their clinical condition, but adults should be reviewed at least every 3 months. More frequent review is required immediately after diagnosis. h For information on the management of patients during the COVID-19 pandemic, see COVID-19 p. 656. Mucolytics g Patients with cystic fibrosis who have evidence of lung disease should be offered a mucolytic. Dornase alfa p. 308 is the first choice mucolytic. If there is an inadequate response, dornase alfa and hypertonic sodium chloride p. 289, or hypertonic sodium chloride alone should be considered. Mannitol dry powder for inhalation p. 310 is recommended as an option when dornase alfa p. 308 is unsuitable (because of ineligibility, intolerance, or inadequate response), when lung function is rapidly declining, and if other osmotic drugs are not considered appropriate (see mannitol National funding/access decisions p. 310). h Lumacaftor with ivacaftor p. 309 is not recommended for treating cystic fibrosis within its marketing authorisation (see lumacaftor with ivacaftor National funding/access decisions p. 309). Pulmonary infection Staphylococcus aureus g Patients who are not taking prophylaxis and have a new Staphylococcus aureus infection can be given an oral anti- Staph. aureus antibacterial, if they are clinically well. If they are clinically unwell and have pulmonary disease, oral or intravenous (depending on infection severity) broad- spectrum antibacterials with activity against Staph. aureus should be given (consult local protocol). A long-term antibacterial should be considered to suppress chronic Staph. aureus respiratory infections in patients whose pulmonary disease is stable. In patients with chronic Staph. aureus respiratory infections who become clinically unwell with pulmonary disease, oral or intravenous (depending on infection severity) broad-spectrum Respiratory system antibacterials with activity against Staph. aureus should be given. In those patients with new evidence of meticillin- resistant Staphylococcus aureus (MRSA) respiratory infection (with or without pulmonary exacerbation), specialist microbiological advice should be sought. Antibacterials should not be routinely used to suppress chronic MRSA in patients with stable pulmonary disease. If a patient with cystic fibrosis and chronic MRSA respiratory infection becomes unwell with a pulmonary exacerbation or shows a decline in pulmonary function, specialist microbiological advice should be sought. h Pseudomonas aeruginosa g If a patient with cystic fibrosis develops a new Pseudomonas aeruginosa infection, eradication therapy with a course of oral antibacterial should be started (by intravenous injection, if they are clinically unwell), in combination with an inhaled antibacterial. An extended course of oral and inhaled antibacterial should follow (consult local protocol). If eradication therapy is not successful, sustained treatment with an inhaled antibacterial should be offered. Nebulised colistimethate sodium p. 588 should be considered as first-line treatment (but see also colistimethate sodium by dry powder inhalation National funding/access decisions p. 588). In patients with chronic Ps. aeruginosa infection (when treatment has not eradicated the infection) who become clinically unwell with pulmonary exacerbations, an oral antibacterial or a combination of two intravenous antibacterial drugs of different classes (depending on infection severity) should be used. Changing antibacterial regimens should be considered to treat exacerbations (consult local protocol). Nebulised aztreonam p. 571, nebulised tobramycin, or tobramycin dry powder for inhalation p. 546 (see tobramycin National funding/access decisions p. 546) should be considered for those who are deteriorating despite regular inhaled colistimethate sodium p. 588. h Burkholderia cepacia complex g Patients who develop a new Burkholderia cepacia complex infection, should be given eradication therapy with a combination of intravenous antibacterial drugs (specialist microbiological advice should be sought on the choice of antibacterials). h There is no evidence to support using antibacterials to suppress chronic Burkholderia cepacia complex infection in patients with cystic fibrosis who have stable pulmonary status. g Specialist microbiological advice should be sought for patients with chronic Burkholderia cepacia complex infection (when treatment has not eradicated the infection) and who become clinically unwell with a pulmonary disease exacerbation. An inhaled antibacterial should be considered for those who have chronic Burkholderia cepacia complex infection and declining pulmonary status; treatment should be stopped if there is no observed benefit. h Haemophilus influenzae g Haemophilus influenzae infection in the absence of clinical evidence of pulmonary infection should be treated with an appropriate oral antibacterial drug. In those who are unwell with clinical evidence of pulmonary infection, an appropriate antibacterial should be given by mouth or intravenously depending on the severity of the illness (consult local protocol). h Non-tuberculous mycobacteria g Non-tuberculous mycobacterial eradication therapy should be considered for patients with cystic fibrosis who are clinically unwell and whose pulmonary disease has not responded to other recommended treatments. Specialist microbiological advice should be sought on the choice of Respiratory system antibacterial and on the duration of treatment. h Aspergillus fumigatus complex g Treatment with an antifungal drug should only be considered to suppress chronic Aspergillus fumigatus complex respiratory infection in patients with declining pulmonary status. Specialist microbiological advice should be sought on the choice of antifungal drug. h Unidentified infections g An oral or intravenous (depending on the exacerbation severity) broad-spectrum antibacterial should be used for patients who have a pulmonary disease exacerbation and no clear cause. If a causative pathogen is identified, an appropriate treatment should be selected (consult local protocol). h Immunomodulatory drugs g Long-term treatment with azithromycin p. 566 [unlicensed indication], at an immunomodulatory dose, should be offered to patients with deteriorating lung function or repeated pulmonary exacerbations. In those patients with continued deterioration in lung function or continuing pulmonary exacerbations, long-term azithromycin should be discontinued and the use of an oral corticosteroid considered. h Nutrition and exocrine pancreatic insufficiency g The cystic fibrosis specialist dietitian should offer advice on optimal nutrition. Pancreatin p. 103 should be offered to patients with exocrine pancreatic insufficiency. Dose should be adjusted as needed to minimise any symptoms or signs of malabsorption (see Exocrine pancreatic insufficiency p. 103). An acid- suppressing drug, such as an H2 receptor antagonist or a proton pump inhibitor [unlicensed indications] can be considered for patients who have persistent symptoms or signs of malabsorption. A short-term trial of an appetite stimulant (for example up to 3 months) [unlicensed indication] can be considered in adult patients if attempts to increase calorie intake are not effective. h Distal intestinal obstruction syndrome g Oral or intravenous fluids should be offered to ensure adequate hydration for patients with distal intestinal obstruction syndrome. Meglumine amidotrizoate with sodium amidotrizoate solution (orally or via an enteral tube) should be considered as first-line treatment for distal intestinal obstruction syndrome. An iso-osmotic polyethylene glycol and electrolyte solution (macrogols) (orally or via an enteral tube) can be considered as a second- line treatment. Surgery is a last resort, if prolonged treatment with a polyethylene glycol solution is not effective. Suspected distal intestinal obstruction syndrome should be managed in a specialist cystic fibrosis centre. h Liver disease g If liver function blood tests are abnormal in patients with cystic fibrosis, ursodeoxycholic acid p. 96 [unlicensed indication] can be given until liver function is restored. h Bone mineral density g Patients should be monitored for cystic fibrosis-related low bone mineral density. h Cystic fibrosis-related diabetes g Patients should be monitored for cystic fibrosis-related diabetes. h Useful Resources Cystic fibrosis: diagnosis and management. National Institute for Health and Care Excellence. NICE guideline 78. October 2017 www.nice.org.uk/guidance/NG78 MUCOLYTICS
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300 mg twice daily for up to 10 days
First-line fragment. Read the complete Indications and Dose section above.
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