Pharmacokinetic considerations regarding the treatment of bacterial sexually transmitted infections with azithromycin: a review

Kong, Fabian Yuh Shiong; Horner, Patrick J; Unemo, Magnus; Hocking, Jane

doi:10.1093/jac/dky548

Cited by 70 publications

(94 citation statements)

References 108 publications

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“…The frequency of azithromycin and ciprofloxacin resistance in several European countries in 2015-2017 is presented in Table 5 [53, [90][91][92]. Another problem is that azithromycin can be less effective in oropharyngeal than urogenital gonococcal infections [93].…”

Section: Resistance To Macrolidesmentioning

confidence: 99%

Multiresistant Neisseria gonorrhoeae: a new threat in second decade of the XXI century

Młynarczyk-Bonikowska

Majewska

Malejczyk

et al. 2019

Med Microbiol Immunol

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Neisseria gonorrhoeae is an etiologic agent of gonorrhoea, one of the most common sexually transmitted diseases caused by bacteria. For many years, infections caused by N. gonorrhoeae were considered to be relatively easy to treat; however, resistance has emerged successively to all therapeutic agents used in treatment of the disease, e.g., penicillin, ciprofloxacin or azithromycin. Currently, the global problem is the emergence and a threat of spread of N. gonorrhoeae strains resistant to extended-spectrum cephalosporins (ESC), such as injectable ceftriaxone and oral-used cefixime. Especially, dangerous are multi-resistant strains resistant simultaneously to ESC and azithromycin. Three strains with high-level resistance to azithromycin and resistant to ESC were first time isolated in 2018. Moreover, in 2018, the first ESBL was described in N. gonorrhoeae and that makes the threat of appearing the ESBL mechanism of resistance in N. gonorrhoeae more real, even though the strain was sensitive to ceftriaxone. Molecular typing revealed that variants resistant to ESC occurred also among strains belonging to epidemic clonal complex CC1 (genogroup G1407) distinguished in NG-MAST typing system. The G1407 genogroup, in particular the ST1407 sequence type, is currently dominant in most European countries. The presence of different mechanisms of drug resistance significantly affects clinical practice and force changes in treatment regimens and introduction of new drugs.

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Section: Resistance To Macrolidesmentioning

confidence: 99%

Multiresistant Neisseria gonorrhoeae: a new threat in second decade of the XXI century

Młynarczyk-Bonikowska

Majewska

Malejczyk

et al. 2019

Med Microbiol Immunol

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“…In any circumstance, even if systemic spread of the infection is the case, the primary focus must be eliminated, and this means the antibiotic drug must be able to penetrate to the primary focus in sufficient concentrations to kill or inhibit the pathogenic bacteria – also known as ‘the drug to the bug’. In accordance, a recent review underlined the importance of the distribution of azithromycin to the anatomical site of infection or the treatment of bacterial sexually transmitted diseases .…”

Section: Focus Attainmentmentioning

confidence: 94%

Antibiotic therapy as personalized medicine – general considerations and complicating factors

Moser

Lerche

Thomsen

et al. 2019

APMIS

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The discovery of antibiotic drugs is considered one of the previous century's most important medical discoveries (Medicine's 10 greatest discoveries. New Haven, CT: Yale University Press, 1998: 263). Appropriate use of antibiotics saves millions of lives each year and prevents infectious complications for numerous people. Still, infections kill unacceptable many people around the world, even in developed countries with easy access to most antibiotic drugs. Optimal use of antibiotics is dependent on the identification of primary and secondary focus, and knowledge on which pathogens to expect in a specific infectious syndrome and information on general patterns of regional antibiotic resistance. Furthermore, sampling for microbiological analysis, knowledge of patient immune status and organ functions, travel history, pharmacokinetics and ‐dynamics of the different antibiotics and possible biofilm formation are among several factors involved in antibiotic therapy of infectious diseases. The present review aims at describing important considerations when using antibacterial antibiotics and to describe how this is becoming substantially more personalized. The parameters relevant in considering the optimal use of antibiotics to treat infections are shown in Fig. 1 – leading to the most relevant antibiotic therapy for that specific patient. To illustrate this subject, the present review's focus will be on challenges with optimal dosing of antibiotics and risks of underdosing. Especially, in cases highly challenging for achieving the aimed antibiotic effect against bacterial infections – this includes augmented renal clearance (ARC) in sepsis, dosing challenges of antibiotics in pregnancy and against biofilm infections.

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“…Small studies do not differentiate between intra and extracellular concentrations, but have demonstrated significant concentrations of azithromycin in the rectum and vagina after~5 h, peaking at 24-48 h. 10,11 Tissue penetration of azithromycin is excellent, with levels up to 50-fold higher than those in serum, 9 yet it should be noted that tissue penetration may be overestimated and vulnerable to contamination by other fluids (such as blood) through sampling. 12 Azithromycin is also taken up by phagocytic cells, which deliver and release the antibiotic at the site of infection, further increasing local drug concentrations. 13 Administration of larger single doses (2 g) lead to early high levels of the drug in both serum and white cells compared with a daily dosing of 500 mg for 3 days, maximising antimicrobial concentrations early, when bacterial load is likely to be highest.…”

Section: Azithromycinmentioning

confidence: 99%

Should we still use azithromycin for gonorrhoea treatment?

Mensforth

Ross

2019

Sex. Health

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This review presents the evidence for azithromycin in the treatment of gonorrhoea, both as monotherapy and as a component of dual therapy. Uncertainties are explored regarding the efficacy of a dual treatment strategy, combining ceftriaxone and azithromycin, in the context of resistance trends and extra-genital infections. The association between microbiological testing and clinical outcome for the individual patient, and the effect of azithromycin use on other sexually transmissible infections, are considered. Finally, in the absence of imminent new antimicrobials, optimising the dose of azithromycin while maintaining tolerability is discussed.

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Pharmacokinetic considerations regarding the treatment of bacterial sexually transmitted infections with azithromycin: a review

Abstract: Pharmacokinetic considerations regarding the treatment of bacterial sexually transmitted infections with azithromycin-A review

Cited by 70 publications

References 108 publications

Multiresistant Neisseria gonorrhoeae: a new threat in second decade of the XXI century

Multiresistant Neisseria gonorrhoeae: a new threat in second decade of the XXI century

Antibiotic therapy as personalized medicine – general considerations and complicating factors

Should we still use azithromycin for gonorrhoea treatment?

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