Azithromycin: Mechanisms of action and their relevance for clinical applications

Prescribing azithromycin

“…Mean concentrations in tissue are 10-100-fold higher than those reached in serum and persist for several days. 1 Azithromycin also accumulates in phagocytes, with levels up to 200 times greater than in serum, 1 but penetrates poorly into cerebrospinal fluid and peritoneal fluid.…”

“…1 In cystic fibrosis, treatment for six months is associated with improved respiratory function and reduced respiratory exacerbations.…”

“…It also has activity against Mycoplasma pneumoniae, Treponema pallidum, Chlamydia species and Mycobacterium avium complex. 1 Since the late 1990s, macrolide-resistant Streptococcus pneumoniae and Staphylococcus aureus infections have been increasing in Australia. Over 10% of S. pneumoniae infections and over 15% of S. aureus infections have been reported to be resistant to azithromycin.…”

“…9 Unlike clarithromycin, azithromycin does not interact significantly with cytochrome P450 3A4. 1 In comparison with erythromycin, it is more acid stable, which simplifies administration around food.…”

“…13 Azithromycin and other macrolides have also been proposed for use in sepsis and epidemic respiratory viral infections to prevent cytokine storm. 1 It has been used for various respiratory and non-respiratory inflammatory conditions. However, this use has been controversial due to limited direct clinical evidence for many conditions, and concerns about increased antimicrobial resistance.…”