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The macrolides: erythromycin, clarithromycin, and azithromycin.
Mayo Clin Proc. 1999 Jun; 74(6):613-34.MC

Abstract

In addition to erythromycin, macrolides now available in the United States include azithromycin and clarithromycin. These two new macrolides are more chemically stable and better tolerated than erythromycin, and they have a broader antimicrobial spectrum than erythromycin against Mycobacterium avium complex (MAC), Haemophilus influenzae, nontuberculous mycobacteria, and Chlamydia trachomatis. All three macrolides have excellent activity against the atypical respiratory pathogens (C. pneumoniae and Mycoplasma species) and the Legionella species. Azithromycin and clarithromycin have pharmacokinetics that allow shorter dosing schedules because of prolonged tissue levels. Both azithromycin and clarithromycin are active agents for MAC prophylaxis in patients with late-stage acquired immunodeficiency syndrome (AIDS), although azithromycin may be the preferable agent because of fewer drug-drug interactions. Clarithromycin is the most active MAC antimicrobial agent and should be part of any drug regimen for treating active MAC disease in patients with or without AIDS. Although both azithromycin and clarithromycin are well tolerated by children, azithromycin has the advantage of shorter treatment regimens and improved tolerance, potentially improving compliance in the treatment of respiratory tract and skin or soft tissue infections. Intravenously administered azithromycin has been approved for treatment of adults with mild to moderate community-acquired pneumonia or pelvic inflammatory diseases. An area of concern is the increasing macrolide resistance that is being reported with some of the common pathogens, particularly Streptococcus pneumoniae, group A streptococci, and H. influenzae. The emergence of macrolide resistance with these common pathogens may limit the clinical usefulness of this class of antimicrobial agents in the future.

Authors+Show Affiliations

Division of Infectious Diseases and Internal Medicine, Mayo Clinic Jacksonville, Florida, USA.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

10377939

Citation

Alvarez-Elcoro, S, and M J. Enzler. "The Macrolides: Erythromycin, Clarithromycin, and Azithromycin." Mayo Clinic Proceedings, vol. 74, no. 6, 1999, pp. 613-34.
Alvarez-Elcoro S, Enzler MJ. The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clin Proc. 1999;74(6):613-34.
Alvarez-Elcoro, S., & Enzler, M. J. (1999). The macrolides: erythromycin, clarithromycin, and azithromycin. Mayo Clinic Proceedings, 74(6), 613-34.
Alvarez-Elcoro S, Enzler MJ. The Macrolides: Erythromycin, Clarithromycin, and Azithromycin. Mayo Clin Proc. 1999;74(6):613-34. PubMed PMID: 10377939.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The macrolides: erythromycin, clarithromycin, and azithromycin. AU - Alvarez-Elcoro,S, AU - Enzler,M J, PY - 1999/6/23/pubmed PY - 1999/6/23/medline PY - 1999/6/23/entrez SP - 613 EP - 34 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 74 IS - 6 N2 - In addition to erythromycin, macrolides now available in the United States include azithromycin and clarithromycin. These two new macrolides are more chemically stable and better tolerated than erythromycin, and they have a broader antimicrobial spectrum than erythromycin against Mycobacterium avium complex (MAC), Haemophilus influenzae, nontuberculous mycobacteria, and Chlamydia trachomatis. All three macrolides have excellent activity against the atypical respiratory pathogens (C. pneumoniae and Mycoplasma species) and the Legionella species. Azithromycin and clarithromycin have pharmacokinetics that allow shorter dosing schedules because of prolonged tissue levels. Both azithromycin and clarithromycin are active agents for MAC prophylaxis in patients with late-stage acquired immunodeficiency syndrome (AIDS), although azithromycin may be the preferable agent because of fewer drug-drug interactions. Clarithromycin is the most active MAC antimicrobial agent and should be part of any drug regimen for treating active MAC disease in patients with or without AIDS. Although both azithromycin and clarithromycin are well tolerated by children, azithromycin has the advantage of shorter treatment regimens and improved tolerance, potentially improving compliance in the treatment of respiratory tract and skin or soft tissue infections. Intravenously administered azithromycin has been approved for treatment of adults with mild to moderate community-acquired pneumonia or pelvic inflammatory diseases. An area of concern is the increasing macrolide resistance that is being reported with some of the common pathogens, particularly Streptococcus pneumoniae, group A streptococci, and H. influenzae. The emergence of macrolide resistance with these common pathogens may limit the clinical usefulness of this class of antimicrobial agents in the future. SN - 0025-6196 UR - https://www.unboundmedicine.com/medline/citation/10377939/The_macrolides:_erythromycin_clarithromycin_and_azithromycin_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(11)64140-2 DB - PRIME DP - Unbound Medicine ER -