Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study

Malhotra-Kumar, Surbhi; Lammens, Christine; Coenen, Samuel; Herck, Koen Van; Goossens, Herman

doi:10.1016/s0140-6736(07)60235-9

Cited by 470 publications

(314 citation statements)

References 35 publications

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“…This may lead to clinical failure in acute infection [73]. Macrolide use is the most important driver of macrolide resistance, with azithromycin selecting quantitatively more resistant organisms and clarithromycin selecting a higher-resistance-coding gene mutation [22]. The risk of macrolide resistance in nontuberculous mycobacteria that may be prevalent in cystic fibrosis populations should also be explored [74].…”

Section: Discussionmentioning

confidence: 99%

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Long-term macrolide therapy in chronic inflammatory airway diseases

Crosbie¹,

Woodhead²

2009

European Respiratory Journal

120

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In addition to direct antibacterial actions, 14-and 15-member-ring macrolides have immune modulating effects that appear to be the reason for clinical benefit in diffuse panbronchiolitis.A literature search was conducted for studies of the clinical effectiveness of macrolides in other chronic lung conditions.A number of studies were identified that showed short-term beneficial outcomes or the potential for such outcomes in cystic fibrosis, bronchiectasis, chronic obstructive pulmonary disease, asthma and post-transplant obliterative bronchiolitis. The studies were limited by small patient numbers, different outcome measures and short-term follow-up, and were not designed to assess potentially harmful effects.Further large prospective and long-term studies are required in order to identify potential benefit and harm before these agents can be recommended routinely for these conditions.

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Section: Discussionmentioning

confidence: 99%

“…In addition to the potential benefit, use of these agents also has the potential for harm. In addition to many of the usual risks from antimicrobial therapy, macrolides also have clinically significant effects on cardiac conduction [21] and may be important promoters of antimicrobial resistance [22].…”

mentioning

confidence: 99%

Long-term macrolide therapy in chronic inflammatory airway diseases

Crosbie¹,

Woodhead²

2009

European Respiratory Journal

120

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“…Recently, the pharyngeal carriage of streptococci and the proportion of macrolide-resistant isolates was studied in healthy volunteers after exposure to either of the two macrolides azithromycin or clarithromycin over 180 days (Malhotra-Kumar et al, 2007). An increase in resistant strains was seen for both groups compared with a placebo group immediately after treatment.…”

Section: Impact Of Antimicrobial Agents On the Spread And Stabilizatimentioning

confidence: 99%

Long-term impacts of antibiotic exposure on the human intestinal microbiota

et al. 2010

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Although it is known that antibiotics have short-term impacts on the human microbiome, recent evidence demonstrates that the impacts of some antibiotics remain for extended periods of time. In addition, antibiotic-resistant strains can persist in the human host environment in the absence of selective pressure. Both molecular-and cultivation-based approaches have revealed ecological disturbances in the microbiota after antibiotic administration, in particular for specific members of the bacterial community that are susceptible or alternatively resistant to the antibiotic in question. A disturbing consequence of antibiotic treatment has been the long-term persistence of antibiotic resistance genes, for example in the human gut. These data warrant use of prudence in the administration of antibiotics that could aggravate the growing battle with emerging antibioticresistant pathogenic strains.

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“…We know from a trial in volunteers that antibiotic-resistant oral streptococci persist for o180 days as a consequence of antibiotic exposure [27]. In that study, follow-up was for f28 days, so was unable to capture either possible harm from resistance or benefits from reducing bacterial colonisation and possible subsequent inflammation.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

Butler¹,

Kelly²,

Hood³

et al. 2011

European Respiratory Journal

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We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1-5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61-1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p50.68) or green (coefficient -0.01; p50.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p50.19).Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.

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Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: a randomised, double-blind, placebo-controlled study

Cited by 470 publications

References 35 publications

Long-term macrolide therapy in chronic inflammatory airway diseases

Long-term macrolide therapy in chronic inflammatory airway diseases

Long-term impacts of antibiotic exposure on the human intestinal microbiota

Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection

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