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Roxithromycin (Rulide)
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Roxithromycin

Roxithromycin (generic name: roxithromycin; brand names include: Roximycin / Biaxsig / Roxar / Surlid) belongs to a class of drugs known as semi-synthetic macrolide antibiotics. Roxithromycin is used for the treatment of bacterial infections including infections of the ear, nose and throat, respiratory tract, skin and skin structure infections, and urinary tract infections.

Other names for this medication:
Remora, Rulid, Rulide

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Also known as:  Rulide.

Description

Each Roxithromycin tablet contains either 150mg or 300mg of the active ingredient roxithromycin. Each tablet also contains: hydroxypropylcellulose, poloxamer, povidone, colloidal anhydrous silica, magnesium stearate (470), purified talc (553), maize starch, hypromellose, anhydrous glucose, titanium dioxide (171), propylene glycol (1520). Roxithromycin does not contain gluten, sucrose, lactose, tartrazine or any other azo dyes.

Dosage

Roxithromycin is typically prescribed for a period of 7 to 14 days and patients should take the medication for as long as it has been prescribed to prevent the infection from returning even if they become asymptomatic. Patients should not however, take doses larger than has been prescribed as this can result in an overdose. Overdosing requires immediate medical intervention and may present with symptoms which include abdominal pain, nausea, diarrhea, vomiting, and a general and prolonged feeling of illness.

Overdose

Immediately telephone your doctor or pharmacist. Do this even if there are no signs of discomfort or poisoning.

Storage

Store at room temperature between 20 and 25 degrees C (68 and 77 degrees F) away from moisture, light and heat. Do not store in the bathroom. Keep in a tight, light-resistant container. Keep out of the reach of children.

Side effects

The most common side effects associated with Roxithromycin are:

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Side effect occurrence does not only depend on medication you are taking, but also on your overall health and other factors.

Contraindications

The safety of roxithromycin has not been demonstrated in patients with impaired hepatic or renal function. Caution should be exercised if roxithromycin is administered to patients with impaired hepatic or renal function. If administered to patients with severe impaired hepatic function (eg. hepatic cirrhosis with jaundice and/or ascites), consideration should be given to reducing the daily dosage to half the usual dosage.

Prolonged or repeated use of antibiotics including roxithromycin may result in superinfection by resistant organisms. In the event of superinfection, roxithromycin should be discontinued and appropriate therapy instituted.

When indicated, incision, drainage or other appropriate surgical procedures should be performed in conjunction with antibiotic therapy.

Antibiotic associated pseudomembranous colitis has been reported with many antibiotics. A toxin produced by Clostridium difficile appears to be the primary cause. The severity of the colitis may range from mild to life threatening. It is important to consider this diagnosis in patients who develop diarrhoea or colitis in association with antibiotic use (this may occur up to several weeks after cessation of antibiotic therapy). Mild cases usually respond to drug discontinuation alone. However, in moderate to severe cases, appropriate therapy with a suitable oral antibacterial agent effective against Clostridium difficile should be considered. Fluids, electrolytes and protein replacement therapy should be provided when indicated.

Roxithromycin, like erythromycin, has been shown in vitro to elicit a concentration - dependent lengthening in cardiac action potential duration. Such an effect is manifested only at supra – therapeutic concentrations. Accordingly, the recommended doses should not be exceeded. In certain conditions macrolides, including roxithromycin, have the potential to prolong the QT interval. Therefore roxithromycin should be used with caution in patients with congenital prolongation of the QT interval, with ongoing proarrhythmic conditions (ie uncorrected hypokalemia or hypomagnesaemia, clinically significant bradycardia), and in patients receiving Class IA and III antiarrhythmic agents.

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We report two cases of lupus miliaris disseminatus faciei (LMDF) in which oral tranilast was effective. In case 1, the patient was a 33-year-old woman who had developed pale red papules on her face, especially around her eyes and lower jaw, approximately 7 months previously. Examination of a skin biopsy specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. The patient was treated successively with azithromycin, roxithromycin and minocycline hydrochloride, but there was no improvement. When we tried oral tranilast therapy, flattening of the papules was observed 2 weeks after the start of treatment, and by 1 month the papules had almost disappeared. In case 2, the patient was a 39-year-old man who had broken out in erythematous papules on both upper and lower eyelids, with some accompanied by scaling, 2 years before the initial examination. Pathological specimen revealed epithelioid cell granulomas accompanied by caseous necrosis, and a diagnosis of LMDF was made. There was no improvement when treated orally with minocycline hydrochloride or doxycycline hydrochloride, and treatment was switched to oral tranilast therapy. After 1 month of treatment, the papules had almost disappeared. We concluded that oral tranilast therapy should be tried as a treatment for intractable LMDF.

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Bacterial biofilm (BF) was established and was influenced by RXM and FLRX with different concentrations. The samples were detected with scanning electron microscope and by a rapid method after BF was stained with AgNO3 solution. The synergism of antibacterial activities of RXM and FLRX to P. Aeruginosa was studied by computer image analysis and MTT method.

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Our data suggest that oral administration of roxithromycin suppresses ovalbumin-induced airway inflammation and AHR by regulating the inflammatory cytokines via MAP kinases/NF-κB pathway in inflammatory cells. Based on these results, we suggest that roxithromycin may be used as a therapeutic agent for allergy-induced asthma.

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High biodegradation efficiencies of different emerging micropollutants were obtained with nitrifying activated sludge (NAS) working at high nitrogen loading rates (NLR), that boosted the development of biomass with high nitrifying activities (>1 g N-NH(4)(+)/g VSS d). Come-tabolic biodegradation seemed to be responsible for the removal of most compounds due to the action of the ammonium monooxygenase enzyme. NAS showed a different affinity for each compound, probably due to steric hindrance, activation energy limitations or the presence of specific functional groups. Increasing loading rates of micropollutants were removed at shorter hydraulic retention times, although the biodegradation efficiencies of compounds with slow/intermediate kinetics, such as fluoxetine, erythromycin, roxithromycin and trimethoprim, diminished due to kinetic and/or stoichiometric limitations. Solids retention time, always above the minimum to avoid the washout of nitrifiers, did not enhance the biodegradation of any of the selected compounds, with the exception of diclofenac. Regarding sorption, the solid-liquid distribution coefficients (K(d)) obtained in NAS were very similar to those found in conventional activated sludge by other authors. No correlation between K(d) values and any of the operational parameters was found for the selected substances.

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After the discovery of erythromycin and other natural compounds, including oleandomycin, spiramycin, josamycin and midecamycin, much research has been devoted to synthesizing derivatives or analogues with improved chemical, biological and pharmacokinetic properties. These new macrolides are semisynthetic molecules that differ from the original compounds in their substitution pattern of the lactone ring system. The chemical structure of macrolides is characterized by a large lactone ring containing from 12 to 16 atoms to which are attached, via glycosidic bonds, one or more sugars. The lactone ring is substituted by hydroxyl or alkyl groups, one ketone at C7 in 12-membered macrolides and at C9 in 14-membered macrolides, and one aldehyde group in 16-membered macrolides. The only compound with a 15-membered ring contains a tertiary amino group. Although the 12-membered macrolides have never become important in clinical practice, in recent years numerous new 14-membered macrolide derivatives of erythromycin A have shown improved pharmacokinetics due to chemical modifications of a hydroxyl group at C6, a proton at C8, or a ketone at C9. Derivatives, such as dirithromycin, roxithromycin, clarithromycin and flurithromycin, have all been synthesized with the aim of inhibiting their decomposition under acidic conditions to inactive anhydrohemiketal derivatives. A new 15-membered macrolide, azithromycin, with a methylated nitrogen inserted into the lactone ring shows good activity against Gram-negative bacteria. The efforts expended in chemical and biochemical modifications of 16-membered macrolides have been less successful, with only a few new molecules, such as rokitamycin and miocamycin, showing improved bioavailability and activity against some resistant micro-organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

roxithromycin 300 mg

Preincubation of Haemophilus influenzae with antibiotics may influence opsonophagocytosis as studied by chemiluminescence. Two strains of H. influenzae (strain 1 [type b] and strain 2 [uncapsulated]) were pretreated with erythromycin, roxithromycin, clarithromycin, and azithromycin for 1 h in Haemophilus test medium (the last 25 min was either without serum or with 10% fresh serum or 10% decomplemented serum). Human neutrophils were stimulated with a pretreated or control inoculum at four different bacterium/neutrophil ratios and tested for luminol chemiluminescence with an LKB luminometer. The results were normalized for bacterium/neutrophil ratio and compared by the two-sided Wilcoxon test. Pretreatment of bacteria with one-half of the MICs of erythromycin, clarithromycin, and roxithromycin produced nonsignificant (P > 0.05) increases in the chemiluminescence response (means of 23% for strain 1 and 4% for strain 2). Pretreatment with azithromycin at one-half of the MIC produced an increase in the chemiluminescence response induced by serum-opsonized strain 1 (320% +/- 36% [mean +/- standard error of the mean]) and strain 2 (107% +/- 20%) (P < 0.05). This increase was concentration dependent: for strain 1, 60% +/- 18% at one-fourth of the MIC to 440% +/- 41% at the MIC; for strain 2, 10% +/- 5% at one-fourth of the MIC to 300% +/- 20% at the MIC. For strain 1, the maximal increase with azithromycin pretreatment (at the MIC) required opsonization with fresh serum. Opsonization with decomplemented serum was associated with a 53% +/- 21% increase; this increase was 28% +/- 3% in the absence of serum. For strain 2, azithromycin reduced the lag phase of the chemiluminescence response induced by the absence of serum but did not alter the chemiluminescence response in the presence of decomplemented serum. A significant contribution of soluble factors in the enhanced response observed with bacteria preincubated with azithromycin was excluded. The increase of the chemiluminescence response with azithromycin pretreatment was probably due to improvement in complement-dependent opsonization for strain 1 and to improvement in both serum-independent and serum-dependent opsonization for strain 2.

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To examine the potential anti-androgenic activity of anti-acne therapeutic agents, nadifloxacin (NDFX), RXM, all-trans retinoic acid (atRA), and glycolic acid (GA), we carried out the transient transfection assays using the CV-1 cells as a more sensitive assay system.

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Some recently introduced macrolides have several clinical advantages over erythromycin. Azithrommcin, a prototype of these new macrolides could be a good alternative for the treatment of streptococcal pharyngitis, even over penicillin, whose failure rate can be as high as 30%. The aim of this study was to evaluate the in vitro susceptibility of 120 strains of S pyogenes isolated between 1990 and 1992 (40 per year), from diverse infections (specially tonsillitis). We determined Minimal Inhibitory Concentrations (MIC) of azithromycin, clarithromycin, roxithromycin, erythromycin and penicillin using the agar dilution method and the Minimal Bactericidal Concentration (MBC) by tube dilution for azythromycin and erythromycin. The MIC 90 for the new macrolides ranged from 0.03 to 0.12 microgram/ml, and was 0.03 microgram/ml for erythromycin and penicillin (not different). All strains were susceptible to all antibiotics and the date of isolation did not influence susceptibility. The MBC for azithromycin was 0.12 microgram/ml (identical to its MIC), which demonstrates the bactericidal effect of this antibiotic. It is concluded that this in vitro data supports the potential role of these new macrolides in the treatment of streptococcal infections.

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Cytochrome P450 (CYP) 3A4 is the most prevalent metabolising enzyme in the human liver and is also a target for various drug interactions of significant clinical concern. Even though there are numerous reports regarding drug interactions involving CYP3A4, it is far from easy to estimate all potential interactions, since too many drugs are metabolised by CYP3A4. For this reason, a comprehensive framework for the prediction of CYP3A4-mediated drug interactions would be of considerable clinical importance.

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A total of 60 isolates of A. actinomycetemcomitans recovered from 43 individuals with gingivitis or periodontitis were tested. In addition, laboratory strains UP-6 and JP2 were analysed. The E-test was employed in order to determine minimal inhibitory concentrations (MIC) of antibiotics ampicillin/sulbactam, roxithromycin, azithromycin, doxycycline, metronidazole, ciprofloxacin, and moxifloxacin.

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roxithromycin dosage 2017-10-10

An open multicentre study of the efficacy and side effects of roxithromycin, a new macrolide antibiotic, in the treatment of community acquired pneumonia was undertaken. The diagnosis was verified by transtracheal aspiration. Fifty-three patients were studied. In the 49 patients evaluable the clinical efficacy rate was 92% (95% confidence limits 84-100%). Only by measurement of the fall in serum C-reactive protein was it possible Metrogel Gel 1 to detect a difference in response between pneumonia due to Streptococcus pneumoniae and Haemophilus influenzae. The drug was well tolerated clinically and laboratory abnormalities included transient eosinophilia and elevated liver enzymes in two patients.

roxithromycin capsules 2017-08-13

To determine whether the cost of prophylactic antibiotics during chemotherapy is Clindagel Review offset by cost savings due to a decreased incidence of febrile leukopenia (FL).

roxithromycin brand name 2015-01-15

Evidence seems Cephalexin Type Of Antibiotic to support an association between CP infection and an increased incidence of CAD. Additional and larger seroepidemiologic studies of this association need to be performed to establish a causal relationship between infection and CAD. Determination of the actual role of CP in CAD may decide the role of specific antichlamydial therapy in the management of this condition.

roxithromycin renal dose 2015-06-09

Roxithromycin induced apoptosis of ASMCs derived from a rat model of asthma in a dose-dependent manner via a caspase-3- and caspase-9-dependent Hiconcil Kapsulas 500 Mg mitochondrial pathway, involving the up-regulation of P27.

roxithromycin 150 mg dosage 2016-04-21

Roxithromycin (RU 28965) is a new semi-synthetic derivative of erythromycin. Its antibacterial activity is of the same order as that of other macrolides, although its MIC's against Legionella pneumophila are lower. In double-blind comparative studies there was no Novidat Tablet Used For significant difference in therapeutic effectiveness between roxithromycin and the reference antibiotics tested. However, this new macrolide exhibits exceptional pharmacological properties (prolonged half-life, excellent tissue penetration and intracellular activity), and it is very well tolerated both clinically and biochemically.

roxithromycin dosage forms 2017-11-06

Rhodococcus equi is an intracellular facultative, Gram-positive cocco-bacillary organism of increasing importance as a pulmonary pathogen in HIV-positive patients. This study was carried out to evaluate the optimal antibiotic combinations for treating such infections. Four human R. equi isolates and one reference strain were tested for their susceptibilities to 36 antibiotics. In-vitro the most active antibiotics were amikacin, gentamicin, netilmicin, erythromycin, clarithromycin, roxithromycin, ciprofloxacin, sparfloxacin, rifampicin, vancomycin, teicoplanin, doxycycline, minocycline, Augpen Antibiotic imipenem, meropenem and trimethoprim/sulphamethoxazole. The only bactericidal antibiotics were the aminoglycosides, ciprofloxacin, sparfloxacin and vancomycin. As determined by FIC indices, four combinations were synergistic: rifampicin-erythromycin, rifampicin-minocycline, erythromycin-minocycline and imipenem-amikacin. However, no antibiotic combinations were synergistic with the time-kill kinetic method at achievable serum concentrations or at ten-fold and half-fold the MICs. Frequencies of selection of antibiotic-resistant mutants determined at concentrations of five- and ten-fold the MICs ranged from less than 1 x 10(-8) for erythromycin and trimethoprim/sulphamethoxazole to 5 x 10(-4) for amikacin. These results may be of help in selecting the antibiotics for treating infected HIV-positive patients.

roxithromycin and the pill 2016-12-19

The problem of pharyngeal infections caused by beta-hemolytic streptococci of group A (BHSA) remains a challenge for both health providers and general medicine. The present paper was designed to provide the data suggesting the "reappearance" of a highly virulent BHSA infection and a rise in the frequency of its complications (such as acute rheumatic fever and toxic shock syndrome) and to substantiate the necessity of rational antibacterial therapy for the management of this pathology. The agents of choice for the treatment of acute forms of BHSA (tonsillitis and pharyngitis) include penicillins (amoxicillin, benzathine-penicillin, phenoxymethyl penicillin) and cephalosporins of the first generation (cephadroxyl) as well as macrolids (spiramycin, azithromycin, roxithromycin, midecamycin, josamycin) for the patients who do not tolerate beta Derma X Review -lactam antibiotics. Inhibitor-protected penicillins (amoxicillin, clavulanate) or cephalosporins of the second generations (cefuroxime-axetil) should be prescribed to the patients presenting with chronic recurring BHSA characterized by the rather high probability of colonization of the site of infection by beta-lactamase producing microorganisms. Lincosamine-derived antibiotics, such as lincomycin and clindamycin, are reserved for the patients with acute and chronic BHSA (tonsillitis and pharyngitis).

roxithromycin dosage dose 2016-07-18

The rapid, selective and sensitive liquid chromatographic-ion trap mass spectrometric (LC-MS(n)) method was developed and validated for determination of three major components (isovaleryspiramycins, ISV-SPMs) of a novel macrolide antibiotic bitespiramycin and their major active metabolites (spiramycins, SPMs) in rat plasma. The analytes ISV-SPMs, SPMs, internal standard roxithromycin and azithromycin were extracted from plasma samples by liquid-liquid extraction, and chromatographed on a C(18) column using two mobile phase systems. Detection was carried out on an ion trap mass spectrometer by selected reaction monitoring (SRM) mode via electrospray ionization (ESI). Three components (ISV-SPM I, II, III or SPM I, II, III) could be simultaneously determined within 6.5 min. Linear calibration curves were obtained in the concentration ranges of 4-200 ng/ml for ISV-SPM I and SPM I, 12-600 ng/ml Azyth 500mg Tablet for ISV-SPM II and SPM II, and 18-900 ng/ml for ISV-SPM III and SPM III. The intra- and inter-run precision (RSD), calculated from quality control (QC) samples were less than 8.8 and 10.4% for ISV-SPMs, and 9.3 and 11.2% for SPMs, respectively. The method was applied for the evaluation of the pharmacokinetics of bitespiramycin in rats following peroral/intravenous administration.

roxithromycin 150 mg treatment 2016-09-29

The occurrence and distribution of 14 selected antibiotics in sediments of the typical cross sections of Tiaoxi River were analyzed by UPLC/MS/MS. The 14 antibiotics includes tetracycline (TC), oxytetracycline (OTC), chlortetracycline (CTC), doxycycline (DXC), sulfadiazine (SD), sulfamethoxazole (SMZ), sulfamethazine (SMX), norfloxacin (NFC), ofloxacin (OFC), enythromycin-H2O (ETM-H2O), roxithromycin (RTM), chloramphenicol (CPC), thiamphenical (TPC) and florfenicol (FFC). The results show that almost all sediment samples are unavoidably contaminated with antibiotics (detection frequency is more than 70%), and the dominant contaminants are TC, OTC, CTC and DXC, which range from 0.1 to 55.7, 0.7 to 276.6, 6.5 to 131.6 and 6.0 to 15.6 microg x kg(-1), respectively. The concentration of TC, OTC, CTC and DXC observed Klindamicin 500 Mg are as high as 1794.2, 9287.5, 1823.6, 1 149.5 microg x kg(-1) dry weight, in the sediments of the main stream around an outfall of a pig farm respectively. This implied that waste water discharge from animal husbandry was probably one of the main sources to the contamination of these antibiotics in the sediment of Tiaoxi River. Besides the four dominant antibiotics, sulfadiazineshould also be concerned due to its high concentration of 251.6 microg x kg(-1) in the sediment around the outfall of the pig farm.