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The role of newer macrolides in the treatment of community-acquired respiratory tract infection. A review of experimental and clinical data.
J Chemother. 1999 Apr; 11(2):107-18.JC

Abstract

The macrolide class of antibiotics is well established and often recommended for use in the treatment of community-acquired respiratory tract infection (RTI). The newer agents clarithromycin and azithromycin are frequently prescribed as first- or second-line therapy, and have been considered as superior to erythromycin in microbiological activity and clinical efficacy. In-vitro data show that clarithromycin and azithromycin have good activity (MIC < or = 0.5 microg/ml) against certain RTI pathogens. However the activity of both compounds is intrinsically low against Haemophilus influenzae whilst several other important RTI pathogens - notably Streptococcus pneumoniae and Streptococcus pyogenes - exhibit a high prevalence of resistance to them. In many countries, the prevalence of resistance to clarithromycin and azithromycin is still rising with cross resistance with erythromycin. Maximum serum concentrations of clarithromycin and azithromycin are lower than the MIC90s for these agents against H. influenzae and S. pneumoniae. Concentrations in tissues have been reported to be much higher than those in serum. However, the high concentrations observed in tissues are largely a reflection of high concentrations inside cells. Concentrations of clarithromycin and azithromycin in extracellular tissue fluids, where Haemophilus and streptococci are located, are in equilibrium with concentrations in the serum, and remain low. It has been suggested that phagocytes deliver azithromycin to infection sites in a targeted fashion, but the evidence in support of this hypothesis is weak. Recent clinical experience with clarithromycin and azithromycin is consistent with preclinical results, and suggests that these agents have limited efficacy against certain respiratory infections. Clarithromycin and azithromycin are the first choice treatment of atypical infections caused by intracellular pathogens. For community-acquired RTIs, where H. influenzae and S. pneumoniae are present, they may no longer be an appropriate choice for first-line therapy. Indeed, in areas where levels of drug resistant S. pneumoniae are high, their use may be questionable as second-line therapy.

Authors+Show Affiliations

Service de Medecine Interne, Institut National de la Sante et Recherche Medical, Hopital Bichat - Claude Bernard, Paris, France.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10326741

Citation

Carbon, C, and M D. Poole. "The Role of Newer Macrolides in the Treatment of Community-acquired Respiratory Tract Infection. a Review of Experimental and Clinical Data." Journal of Chemotherapy (Florence, Italy), vol. 11, no. 2, 1999, pp. 107-18.
Carbon C, Poole MD. The role of newer macrolides in the treatment of community-acquired respiratory tract infection. A review of experimental and clinical data. J Chemother. 1999;11(2):107-18.
Carbon, C., & Poole, M. D. (1999). The role of newer macrolides in the treatment of community-acquired respiratory tract infection. A review of experimental and clinical data. Journal of Chemotherapy (Florence, Italy), 11(2), 107-18.
Carbon C, Poole MD. The Role of Newer Macrolides in the Treatment of Community-acquired Respiratory Tract Infection. a Review of Experimental and Clinical Data. J Chemother. 1999;11(2):107-18. PubMed PMID: 10326741.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of newer macrolides in the treatment of community-acquired respiratory tract infection. A review of experimental and clinical data. AU - Carbon,C, AU - Poole,M D, PY - 1999/5/18/pubmed PY - 1999/5/18/medline PY - 1999/5/18/entrez SP - 107 EP - 18 JF - Journal of chemotherapy (Florence, Italy) JO - J Chemother VL - 11 IS - 2 N2 - The macrolide class of antibiotics is well established and often recommended for use in the treatment of community-acquired respiratory tract infection (RTI). The newer agents clarithromycin and azithromycin are frequently prescribed as first- or second-line therapy, and have been considered as superior to erythromycin in microbiological activity and clinical efficacy. In-vitro data show that clarithromycin and azithromycin have good activity (MIC < or = 0.5 microg/ml) against certain RTI pathogens. However the activity of both compounds is intrinsically low against Haemophilus influenzae whilst several other important RTI pathogens - notably Streptococcus pneumoniae and Streptococcus pyogenes - exhibit a high prevalence of resistance to them. In many countries, the prevalence of resistance to clarithromycin and azithromycin is still rising with cross resistance with erythromycin. Maximum serum concentrations of clarithromycin and azithromycin are lower than the MIC90s for these agents against H. influenzae and S. pneumoniae. Concentrations in tissues have been reported to be much higher than those in serum. However, the high concentrations observed in tissues are largely a reflection of high concentrations inside cells. Concentrations of clarithromycin and azithromycin in extracellular tissue fluids, where Haemophilus and streptococci are located, are in equilibrium with concentrations in the serum, and remain low. It has been suggested that phagocytes deliver azithromycin to infection sites in a targeted fashion, but the evidence in support of this hypothesis is weak. Recent clinical experience with clarithromycin and azithromycin is consistent with preclinical results, and suggests that these agents have limited efficacy against certain respiratory infections. Clarithromycin and azithromycin are the first choice treatment of atypical infections caused by intracellular pathogens. For community-acquired RTIs, where H. influenzae and S. pneumoniae are present, they may no longer be an appropriate choice for first-line therapy. Indeed, in areas where levels of drug resistant S. pneumoniae are high, their use may be questionable as second-line therapy. SN - 1120-009X UR - https://www.unboundmedicine.com/medline/citation/10326741/The_role_of_newer_macrolides_in_the_treatment_of_community_acquired_respiratory_tract_infection__A_review_of_experimental_and_clinical_data_ L2 - https://www.tandfonline.com/doi/full/10.1179/joc.1999.11.2.107 DB - PRIME DP - Unbound Medicine ER -