Dosage adjustments have been suggested not to be required with roxithromycin in patients with severe renal insufficiency (Lebrec et al, 1988; Puri & Lassman, 1987; Periti & Mazzei, 1987). Other investigators, however, have reported significant delays in roxithromycin elimination in patients with a creatinine clearance of less than 15 milliliters/minute, and recommend doubling the dosing interval in these patients to avoid accumulation