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Erythromycin, clarithromycin, and azithromycin: are the differences real?
Clin Ther. 1996 Jan-Feb; 18(1):56-72; discussion 55.CT

Abstract

Erythromycin, clarithromycin, and azithromycin are clinically effective for the treatment of common respiratory and skin/skin-structure infections. Erythromycin and azithromycin are also effective for treatment of nongonococcal urethritis and cervicitis due to Chlamydia trachomatis. Compared with erythromycin, clarithromycin and azithromycin offer improved tolerability. Clarithromycin, however, is more similar to erythromycin in pharmacokinetic measures such as half-life, tissue distribution, and drug interactions. Misunderstandings about differences among the macrolides (erythromycin and clarithromycin) and the azalide (azithromycin) in terms of pharmacokinetics and pharmacodynamics, spectrum of activity, safety, and cost are common. The uptake and release of these compounds by white blood cells and fibroblasts account for differences in tissue half-life, volume of distribution, intracellular:extracellular ratio, and in vivo potency. Although microbiologic studies reveal that gram-positive pathogens are equally susceptible to these agents, significantly more isolates of Haemophilus influenzae are susceptible to azithromycin than to erythromycin or clarithromycin. Concentrations achieved at the infection site and duration above the minimum inhibitory concentration are as important as in vitro activity in determining in vivo activity against bacterial pathogens. Analysis of safety data indicates differences among these agents in drug interactions and use in pregnancy. Analysis of safety data reveals pharmacokinetic drug interactions for erythromycin and clarithromycin with theophylline, terfenadine, and carbamazepine that are not found with azithromycin. Both erythromycin and azithromycin are pregnancy category B drugs; clarithromycin is a category C drug. The numerous differences in pharmacokinetics, microbiology, safety, and costs among erythromycin, clarithromycin, and azithromycin can be used in the judicious selection of treatment for indicated infections.

Authors+Show Affiliations

Clinical Drug Research Center, St. Vincent Hospital, Worcester, Massachusetts, USA.

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

8851453

Citation

Amsden, G W.. "Erythromycin, Clarithromycin, and Azithromycin: Are the Differences Real?" Clinical Therapeutics, vol. 18, no. 1, 1996, pp. 56-72; discussion 55.
Amsden GW. Erythromycin, clarithromycin, and azithromycin: are the differences real? Clin Ther. 1996;18(1):56-72; discussion 55.
Amsden, G. W. (1996). Erythromycin, clarithromycin, and azithromycin: are the differences real? Clinical Therapeutics, 18(1), 56-72; discussion 55.
Amsden GW. Erythromycin, Clarithromycin, and Azithromycin: Are the Differences Real. Clin Ther. 1996 Jan-Feb;18(1):56-72; discussion 55. PubMed PMID: 8851453.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Erythromycin, clarithromycin, and azithromycin: are the differences real? A1 - Amsden,G W, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez SP - 56-72; discussion 55 JF - Clinical therapeutics JO - Clin Ther VL - 18 IS - 1 N2 - Erythromycin, clarithromycin, and azithromycin are clinically effective for the treatment of common respiratory and skin/skin-structure infections. Erythromycin and azithromycin are also effective for treatment of nongonococcal urethritis and cervicitis due to Chlamydia trachomatis. Compared with erythromycin, clarithromycin and azithromycin offer improved tolerability. Clarithromycin, however, is more similar to erythromycin in pharmacokinetic measures such as half-life, tissue distribution, and drug interactions. Misunderstandings about differences among the macrolides (erythromycin and clarithromycin) and the azalide (azithromycin) in terms of pharmacokinetics and pharmacodynamics, spectrum of activity, safety, and cost are common. The uptake and release of these compounds by white blood cells and fibroblasts account for differences in tissue half-life, volume of distribution, intracellular:extracellular ratio, and in vivo potency. Although microbiologic studies reveal that gram-positive pathogens are equally susceptible to these agents, significantly more isolates of Haemophilus influenzae are susceptible to azithromycin than to erythromycin or clarithromycin. Concentrations achieved at the infection site and duration above the minimum inhibitory concentration are as important as in vitro activity in determining in vivo activity against bacterial pathogens. Analysis of safety data indicates differences among these agents in drug interactions and use in pregnancy. Analysis of safety data reveals pharmacokinetic drug interactions for erythromycin and clarithromycin with theophylline, terfenadine, and carbamazepine that are not found with azithromycin. Both erythromycin and azithromycin are pregnancy category B drugs; clarithromycin is a category C drug. The numerous differences in pharmacokinetics, microbiology, safety, and costs among erythromycin, clarithromycin, and azithromycin can be used in the judicious selection of treatment for indicated infections. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/8851453/Erythromycin_clarithromycin_and_azithromycin:_are_the_differences_real L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(96)80179-2 DB - PRIME DP - Unbound Medicine ER -