Azithromycin: Single 1.5g dose in the treatment of patients with atypical pneumonia syndrome—A randomized study

Schönwald, S; Kuzman, Ilija; Oreskovic, K.; Burek, Vitomir; Škerk, Višnja; Car, Vladimir; D, Bozinović; Čulig, Josip; Radošević, Senka

doi:10.1007/bf02561528

Cited by 41 publications

(27 citation statements)

References 26 publications

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“…The extremely high potency of azithromycin against M. pneumoniae and its long half-life probably account for its ability to cure M. pneumoniae infections with very short treatment courses, and possibly even with a single 1.5-g dose, despite the relatively slow growth of the organism (367,368). Overall, azithromycin and the investigational ketolide cethromycin (ABT-773) are the most potent drugs against M. pneumoniae in terms of MICs (436).…”

Section: Treatment Of Infections Due To M Pneumoniaementioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur

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Section: Treatment Of Infections Due To M Pneumoniaementioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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“…Several published studies evaluating the utility of shortcourse oral therapy for the treatment of CAP have involved azithromycin because of its prolonged postantibiotic effect (table 2) [29][30][31][32]. In a study of adult outpatients with mild to moderate CAP, a 3-day course of azithromycin at 500 mg once daily was as effective clinically as a 10-day course of clarithromycin at 250 mg b.i.d.…”

Section: Clinical Experience With Short-course Therapy For Capmentioning

confidence: 99%

Clinical Efficacy of Newer Agents in Short-Duration Therapy for Community-Acquired Pneumonia

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2004

Clinical Infectious Diseases

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Streptococcus pneumoniae, the most important respiratory tract pathogen implicated in community-acquired pneumonia (CAP), is becoming increasingly resistant in vitro to the beta -lactams and macrolides, and fluoroquinolone resistance has been detected. A growing body of evidence suggests that prolonged antimicrobial use may contribute directly and indirectly to increased antimicrobial resistance among common respiratory pathogens. Long-term exposure to antimicrobial agents, especially less-potent agents, directly increases selection pressure for resistance. Indirectly, poor patient compliance, multiple daily dosing, and the increased risk of adverse events further complicate the resistance issue and diminish the efficacy of long-term antimicrobial use. Controlled clinical trials addressing the appropriate duration of therapy for CAP are lacking. However, available data suggest that with appropriate antibiotic selection, based on appropriate spectrum, potency, and pharmacokinetic/pharmacodynamic profile, lower respiratory tract infections in outpatients can be successfully treated in <7 days rather than the 7-14 days currently recommended.

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“…As a consequence, macrolides have been considered advantageous for the treatment of infections localized in these compartments (32,48). In a more general context, they are widely recommended for infections caused by typical intracellular pathogens such Legionella and Chlamydia, based on a large array of both in vitro (7,17) and clinical (16,19,33,38,42) data. However, direct quantitative comparisons between intracellular and extracellular activities using facultative intracellular pathogens, such as Staphylococcus aureus or Listeria monocytogenes, suggest that macrolides express only a minimal fraction of their antibacterial potential intracellularly (5,34,36), especially considering their great intracellular accumulation.…”

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confidence: 99%

Cellular Accumulation and Pharmacodynamic Evaluation of the Intracellular Activity of CEM-101, a Novel Fluoroketolide, againstStaphylococcus aureus,Listeria monocytogenes, andLegionella pneumophilain Human THP-1 Macrophages

Lemaire

Bambeke

Tulkens

2009

Antimicrob Agents Chemother

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CEM-101 is a novel fluoroketolide with lower MICs than those of telithromycin and macrolides. Our aim was to assess the cellular accumulation and intracellular activity of CEM-101 using models developed for analyzing the pharmacokinetics and pharmacological properties of antibiotics against phagocytized bacteria. We used THP-1 macrophages and Staphylococcus aureus (ATCC 25923 [methicillin (meticillin) sensitive]), Listeria monocytogenes (strain EGD), and Legionella pneumophila (ATCC 33153). CEM-101 reached cellular-to-extracellular-concentration ratios of about 350 within 24 h (versus approximately 20, 30, and 160 for telithromycin, clarithromycin, and azithromycin, respectively). This intracellular accumulation was suppressed by incubation at a pH of <6 and by monensin (proton ionophore) and was unaffected by verapamil (P-glycoprotein inhibitor; twofold accumulation increase for azithromycin) or gemfibrozil. While keeping with the general properties of the macrolide antibiotics in terms of maximal efficacy (E max ; approximately 1-log 10 -CFU decrease compared to the postphagocytosis inoculum after a 24-h incubation), CEM-101 showed significantly greater potency against phagocytized S. aureus than telithromycin, clarithromycin, and azithromycin (for which the 50% effective concentration [EC 50 ] and static concentrations were about 3-, 6-, and 15-fold lower, respectively). CEM-101 was also about 50-fold and 100-fold more potent than azithromycin against phagocytized L. monocytogenes and L. pneumophila, respectively. These differences in EC 50 s and static concentrations between drugs were minimized when data were expressed as multiples of the MIC, demonstrating the critical role of intrinsic drug activity (MIC) in eliciting the antibacterial intracellular effects, whereas accumulation per se was unimportant. CEM-101 should show enhanced in vivo potency if used at doses similar to those of the comparators tested here.

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Azithromycin: Single 1.5g dose in the treatment of patients with atypical pneumonia syndrome—A randomized study

Cited by 41 publications

References 26 publications

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Clinical Efficacy of Newer Agents in Short-Duration Therapy for Community-Acquired Pneumonia

Cellular Accumulation and Pharmacodynamic Evaluation of the Intracellular Activity of CEM-101, a Novel Fluoroketolide, againstStaphylococcus aureus,Listeria monocytogenes, andLegionella pneumophilain Human THP-1 Macrophages

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