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Bacteriological efficacies of three macrolides compared with those of amoxicillin-clavulanate against Streptococcus pneumoniae and Haemophilus influenzae.
Antimicrob Agents Chemother. 1998 Dec; 42(12):3193-9.AA

Abstract

Comparative antibacterial efficacies of erythromycin, clarithromycin, and azithromycin were examined against Streptococcus pneumoniae and Haemophilus influenzae, with amoxicillin-clavulanate used as the active control. In vitro, the macrolides at twice their MICs and at concentrations achieved in humans were bacteriostatic or reduced the numbers of viable S. pneumoniae slowly, whereas amoxicillin-clavulanate showed a rapid antibacterial effect. Against H. influenzae, erythromycin, clarithromycin, and clarithromycin plus 14-hydroxy clarithromycin at twice their MICs produced a slow reduction in bacterial numbers, whereas azithromycin was bactericidal. Azithromycin at the concentrations achieved in the serum of humans was bacteriostatic, whereas erythromycin and clarithromycin were ineffective. In experimental respiratory tract infections in rats, clarithromycin (equivalent to 250 mg twice daily [b.i.d.]) and amoxicillin-clavulanate (equivalent to 500 plus 125 mg b.i.d., respectively) were highly effective against S. pneumoniae, but azithromycin (equivalent to 500 and 250 mg once daily) was significantly less effective (P < 0.01). Against H. influenzae, clarithromycin treatment (equivalent to 250 or 500 mg b.i.d.) was similar to no treatment and was significantly less effective than amoxicillin-clavulanate treatment (P < 0.01). Azithromycin demonstrated significant in vivo activity (P < 0.05) but was significantly less effective than amoxicillin-clavulanate (P < 0.05). Overall, amoxicillin-clavulanate was effective in vitro and in vivo. Clarithromycin and erythromycin were ineffective in vitro and in vivo against H. influenzae, and azithromycin (at concentrations achieved in humans) showed unreliable activity against both pathogens. These results may have clinical implications for the utility of macrolides in the empiric therapy of respiratory tract infections.

Authors+Show Affiliations

SmithKline Beecham Pharmaceuticals, Collegeville, Pennsylvania 19426-09891, USA. Valerie_Berry@sbphrd.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

9835514

Citation

Berry, V, et al. "Bacteriological Efficacies of Three Macrolides Compared With Those of Amoxicillin-clavulanate Against Streptococcus Pneumoniae and Haemophilus Influenzae." Antimicrobial Agents and Chemotherapy, vol. 42, no. 12, 1998, pp. 3193-9.
Berry V, Thorburn CE, Knott SJ, et al. Bacteriological efficacies of three macrolides compared with those of amoxicillin-clavulanate against Streptococcus pneumoniae and Haemophilus influenzae. Antimicrob Agents Chemother. 1998;42(12):3193-9.
Berry, V., Thorburn, C. E., Knott, S. J., & Woodnutt, G. (1998). Bacteriological efficacies of three macrolides compared with those of amoxicillin-clavulanate against Streptococcus pneumoniae and Haemophilus influenzae. Antimicrobial Agents and Chemotherapy, 42(12), 3193-9.
Berry V, et al. Bacteriological Efficacies of Three Macrolides Compared With Those of Amoxicillin-clavulanate Against Streptococcus Pneumoniae and Haemophilus Influenzae. Antimicrob Agents Chemother. 1998;42(12):3193-9. PubMed PMID: 9835514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bacteriological efficacies of three macrolides compared with those of amoxicillin-clavulanate against Streptococcus pneumoniae and Haemophilus influenzae. AU - Berry,V, AU - Thorburn,C E, AU - Knott,S J, AU - Woodnutt,G, PY - 1998/12/3/pubmed PY - 1998/12/3/medline PY - 1998/12/3/entrez SP - 3193 EP - 9 JF - Antimicrobial agents and chemotherapy JO - Antimicrob Agents Chemother VL - 42 IS - 12 N2 - Comparative antibacterial efficacies of erythromycin, clarithromycin, and azithromycin were examined against Streptococcus pneumoniae and Haemophilus influenzae, with amoxicillin-clavulanate used as the active control. In vitro, the macrolides at twice their MICs and at concentrations achieved in humans were bacteriostatic or reduced the numbers of viable S. pneumoniae slowly, whereas amoxicillin-clavulanate showed a rapid antibacterial effect. Against H. influenzae, erythromycin, clarithromycin, and clarithromycin plus 14-hydroxy clarithromycin at twice their MICs produced a slow reduction in bacterial numbers, whereas azithromycin was bactericidal. Azithromycin at the concentrations achieved in the serum of humans was bacteriostatic, whereas erythromycin and clarithromycin were ineffective. In experimental respiratory tract infections in rats, clarithromycin (equivalent to 250 mg twice daily [b.i.d.]) and amoxicillin-clavulanate (equivalent to 500 plus 125 mg b.i.d., respectively) were highly effective against S. pneumoniae, but azithromycin (equivalent to 500 and 250 mg once daily) was significantly less effective (P < 0.01). Against H. influenzae, clarithromycin treatment (equivalent to 250 or 500 mg b.i.d.) was similar to no treatment and was significantly less effective than amoxicillin-clavulanate treatment (P < 0.01). Azithromycin demonstrated significant in vivo activity (P < 0.05) but was significantly less effective than amoxicillin-clavulanate (P < 0.05). Overall, amoxicillin-clavulanate was effective in vitro and in vivo. Clarithromycin and erythromycin were ineffective in vitro and in vivo against H. influenzae, and azithromycin (at concentrations achieved in humans) showed unreliable activity against both pathogens. These results may have clinical implications for the utility of macrolides in the empiric therapy of respiratory tract infections. SN - 0066-4804 UR - https://www.unboundmedicine.com/medline/citation/9835514/Bacteriological_efficacies_of_three_macrolides_compared_with_those_of_amoxicillin_clavulanate_against_Streptococcus_pneumoniae_and_Haemophilus_influenzae_ L2 - http://aac.asm.org/cgi/pmidlookup?view=long&amp;pmid=9835514 DB - PRIME DP - Unbound Medicine ER -