Course Of Azithromycin Research Articles

Chronic Lymphocytic Meningitis in an Adolescent

A 13-year-old white female complained of a 2-month history of diffuse, often intense headaches and a 1-month history of intermittent nausea, vomiting, and anorexia with intermittent low-grade fevers. An outpatient evaluation included 2 negative rapid screens for group A streptococcus, a negative heterophil antibody test, a negative rapid influenza antigen test, and a normal gall bladder ultrasound. Symptoms persisted despite a 5-day course of azithromycin. She was hospitalized secondary to worsening headaches, nausea, and the onset of diplopia. The patient lived in a rural area in Kentucky and had multiple animal exposures. Family pets included a dog and a fish, and the patient’s home was infested with mice. Just before the onset of her symptoms, the patient had explored a deserted house and found a dead opossum, but she denied touching it. She had recently visited a local stockyard and denied direct contact with the cattle, but did have contact with cow manure; her face had been splashed with manure while she was riding an all-terrain vehicle across a cow pasture. On initial evaluation, the patient had a temperature of 36.4� C, a heart rate of 80 bpm, and blood pressure of116/57 mm Hg. Her neurologic exam was remarkable for bilateral papilledema, left esotropia, left abduction deficit, mild left upper lid ptosis, and mild gait ataxia. Respiratory, cardiovascular, joint, extremity, and lymph node examinations were normal. At admission, the white blood cell (WBC) count was 7.7 3 10 3 /mL with 59% neutrophils, 29% lymphocytes, and 9% monocytes. Hemoglobin was 13.8 gm/dL, and platelets were 371 3 10 3 /mL. Electrolytes and serum transaminases, bilirubin, and albumin were within normal limits. Antibodies to human immunodeficiency virus I and II and Borrelia burgdorferi were negative. A serum rapid plasma reagin (RPR) for syphilis was also negative. Blood and urine cultures were sterile. A tuberculin skin test was negative with positive response to a Candida control. Cerebrospinal fluid (CSF) was clear and colorless with an opening pressure of 310 mm Hg. There were 440 WBCs/mL (7% neutrophils, 80% lymphocytes, 13% monocytes) and 130 red blood cells (RBCs)/mL. CSF protein was 79 mg/dL, and glucose was 38 mg/dL. Negative CSF studies included bacterial and mycobacterial cultures, acid-fast bacilli stain, VDRL, adenovirus polymerase chain reaction, and cryptococcal antigen. Magnetic resonance imaging (MRI) of the brain with and without gadolinium at the time of admission and 5 days later demonstrated no meningeal enhancement or focal lesions. Electroencephalography and echocardiography were also normal. A chest radiograph revealed no parenchymal disease or lymphadenopathy. Cefotaxime was begun empirically, but was discontinued after 4 days. An evaluation for immunodeficiency included normal quantitative immunoglobulins (IgG, 1100 mg/dL; IgM, 172 mg/dL; IgA, not done). Peripheral blood immunotyping revealed normal percentages and absolute numbers of T and B cells with normal lymphocyte response to phytohemagglutinin stimulation.

Prospective observational study of patient-reported outcomes for azithromycin versus usual care in the treatment of bacterial acute exacerbation of chronic bronchitis

Background:The 3-day course of azithromycin (AZM) 500 mg/d was introduced to the US market in June 2002. Objective:The objective of this study was to evaluate changes in health-related quality of life (HRQOL) as measured by the St. George's Respiratory Questionnaire (SGRQ) over a 1-month period in patients receiving a 3-day course of AZM for bacterial acute exacerbation of chronic bronchitis (AECB). Methods:This was a prospective, multicenter, observational study evaluating outpatient adults with AECB who received either 3 days of AZM 500 mg/d or 5- to 14-day courses of other antibiotics (usual care [UC]) as directed by the clinician. Patients completed 2 HRQOL instruments—the SGRQ and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)—at baseline, day 14, and end of study (EOS) at days 24 to 28. In addition, patients kept a diary for the first 14 days after initiating antibiotic therapy. Results:One hundred twenty-eight patients (57 AZM, 71 UC) were clinically evaluable. There were no significant differences between treatment groups in clinical presentation or baseline demographics, with the exception of a higher percentage of patients with diabetes mellitus in the UC group compared with the AZM group (16.9% vs 3.5%; P = 0.02). Both groups reported similar improvements in signs and symptoms, absenteeism, concomitant respiratory medication use, resource utilization, compliance, and treatment satisfaction as reported in the patient diary. The AZM group reported statistically significant improvement (simple contrasts for end of study vs baseline) in SGRQ measures (total score, P < 0.001; symptoms, P = 0.031; activity, P < 0.001; impacts, P < 0.001) and the SF-36 mental and physical summary components, compared with baseline (both, P < 0.001). Similarly, the UC group reported significant improvement in all SGRQ measures and in the SF-36 physical component score (P < 0.01), but not in the SF-36 mental component score, compared with baseline. At EOS, 80.0% of AZM patients and 59.0% of UC patients had a ≥4-point improvement on the SGRQ total score; however, this difference was not statistically significant in the multivariate analysis. In addition, 89.5% of AZM patients and 89.9% of UC patients were satisfied or very satisfied with their treatment (P = NS). Resource utilization was similar between the groups. Conclusions:In this observational study, patients with AECB treated with a 3-day course of AZM experienced significant improvements in HRQOL as measured by a change of ≥4 points on the SGRQ and SF-36 physical and mental component scores versus baseline.

Secondary Prevention of Atherosclerosis Through Chlamydia pneumoniae Eradication (SPACE Trial): A Randomised Clinical Trial in Patients with Peripheral Arterial Disease

BackgroundSero-epidemiological and experimental studies suggest that Chlamydia pneumoniae infections play an important role in the development of atherosclerosis. Clinical trials have shown contradictory results regarding the efficacy of antibiotics to prevent atherosclerosis-related complications in patients with coronary artery disease. Our aim was to study the effect of a short course of azithromycin on the incidence of cardiovascular events and peripheral vascular function in patients with stable peripheral arterial disease (PAD). Patients and methodsFive hundred and nine PAD-patients were randomised to receive either a 3-day course of azithromycin (500mg daily) or placebo, with 2 years of follow-up. C. pneumoniae serology was determined at baseline. Clinical endpoints were death, coronary events (myocardial infarction, unstable angina, and/or coronary revascularization procedures), cerebral events (stroke, TIA, and/or carotid endarterectomy) and peripheral arterial complications (increased PAD-symptoms with decreased ankle-brachial index (ABPI, 0.1-point decrease after 12 months), and/or peripheral revascularization procedures). ResultsFive hundred and nine patients (160 women) with an atherosclerotic risk factor profile were randomised, 257 patients to azithromycin and 252 to placebo. Four hundred and forty nine patients (88%) had intermittent claudication and 60 (12%) had critical limb ischemia. By 24-month follow up, 182 patients (36%) developed 252 complications (45 deaths, 34 coronary events, 34 cerebral events and 139 peripheral arterial complications). C. pneumoniae IgA-titres were associated with the development of cardiovascular events. Nevertheless, the number of complications (131 in the azithromycin group vs. 121 in the placebo group) and the number of patients that developed complications (98 (38%) in the azithromycin vs. 84 (33%) in the placebo group) was comparable in both treatment groups. Life table analysis showed no effect of azithromycin on survival or ABPI. ConclusionA short-term course of azithromycin offers no benefits for survival or ankle pressure in PAD-patients.

ADULT STILL'S DISEASE IN A 75‐YEAR‐OLD PATIENT

To the Editor: The majority of adult Still's disease cases tend to be in young adulthood. This disease is underdiagnosed in the elderly even with clinical and laboratory findings characteristic of adult Still's disease. In this report, a case of adult Still's disease in a 75-year-old male who presented with fever, arthritis, rash, and elevated ferritin is discussed. He is the oldest patient ever reported in North America with adult Still's disease. Although rare, adult Still's disease in advanced age needs to be considered in the evaluation of fever of unknown origin in the elderly. A 75-year-old Hispanic male presented to his internist complaining of daily fevers up to 102° and sore throat for 6 weeks. He was given two courses of azithromycin and then trimethoprim/sulfamethoxazole without benefit. The patient subsequently developed a confluent erythematous rash on the arms and torso that was intermittent and associated with his fever. He was admitted for fever of unknown origin with a worsening pruritic rash. During this hospitalization, he developed bilateral wrist, metacarpophalangeal, and proximal interphalangeal joint pain. He denied recent travel or unusual exposure. Laboratory evaluation revealed a hematocrit of 29.9, white blood cell count of 17,500, blood urea nitrogen of 35, and creatinine of 2.6, and purified protein derivative skin test and controls were anergic. Bone marrow biopsy revealed markedly hypercellular marrow suggestive of possible myeloproliferative disorder. The patient was placed on multiple antibiotics and antifungals without a decrease in the fevers. He was transferred to a university hospital for further management. Physical examination revealed a thin man with an erythematous rash on face, torso, and extremities without lymphadenopathy. The remainder of the examination revealed lung crackles at the bases and muscle weakness. Magnetic resonance imaging of both thighs and electromyograph were suggestive of myositis, but muscle biopsy and nerve conduction studies were unremarkable. Serum creatine phosphokinase (CPK) was normal, and serum aldolase was elevated. Serum ferritin was as high as 18,000 μg/L. The patient was diagnosed with adult Still's disease with myositis. He was given methylprednisolone at 1 mg/kg and intravenous immunoglobulin 400 mg/kg for 5 days with prompt resolution of fevers, arthritis, and rash. Serum ferritin, aldolase, CPK, and complement levels all returned to normal values. Corticosteroids were tapered, and 1 year later, the patient had another flare of Still's disease with high fevers, rash, and increased ferritin of 3,000 μg/L. Corticosteroids were increased, and methotrexate was added. The patient is now in clinical remission on methotrexate 20 mg per week and has been tapered off prednisone. All tests have normalized, including ferritin to 150 μg/L. Adult Still's disease is rare and of unknown etiology, usually affecting people aged 16 to 35.1 Although it is a disease of young adults, there are two case reports in the Japanese literature of adult Still's disease in the elderly.2,3 Therefore, adult Still's disease should not be overlooked in the elderly patient. Clinical manifestations of adult Still's disease are significant for arthralgia (100%), arthritis (94%), fever of 39°C or higher (97%), sore throat (92%), rash (88%), myalgia (84%), weight loss greater than 10% (76%), lymphadenopathy (63%), splenomegaly (52%), and abdominal pain (48%).4 Laboratory tests that are abnormal include an elevated erythrocyte sedimentation rate, leukocytosis, anemia, and markedly elevated ferritin levels.5 One-fifth of people with Still's disease experience long-term remission within 1 year.6 One-third of patients have a complete remission followed by one or more relapses. Relapses tend to be less severe and of shorter duration. The remaining patients have a chronic disease course.7 Approximately one-fourth of patients respond to nonsteroidal antiinflammatory drugs. Other patients may require systemic corticosteroids and disease-modifying agents such as methotrexate and biological agents that target tumor necrosis factor. Although adult Still's disease affects primarily young adults, it is a disease that can affect all ages. We have described an elderly man who was diagnosed with Still's disease after an exhaustive search for infections, malignancy, and other autoimmune diseases. Adult Still's disease tends to be overlooked in the differential diagnosis when an individual is advanced in age. It should be considered seriously at any age while examining fever of unknown origin. A patient with high, daily spiking fevers, severe myalgia, arthralgia, rash, and leukocytosis is unlikely to have anything other than adult Still's disease. Physicians should consider this diagnosis in elderly individuals with fever of unknown origin.

Azithromycin versus comparative therapy for the treatment of community acquired pneumonia

A 3-day course of azithromycin was compared with the 10 days of other antibiotics, which general practitioners routinely use as therapy for community acquired pneumonia (CAP). The study was a prospective open labelled, randomised, multicentre, comparative study from five family clinics. Patients with clinical and radiological evidence of pneumonia were included. The pneumonia resolved in 98.4% (61/62) of patients treated with azithromycin and in 87% (40/46) of patients treated with other antibiotics ( P<0.017). Restitution of normal function at home (2.3±1.2 and 4.3±2.6 days) and return to work (3.4±2.0 and 5.5±3.1 days) was more rapid among the group treated with azithromycin ( P<0.001). Three days of azithromycin was more convenient and cost effective than the comparators used to treat pneumonia.

Effects of a brief course of azithromycin on soluble cell adhesion molecules and markers of inflammation in survivors of an acute coronary syndrome: a double-blind, randomized, placebo-controlled study

Background The anti-chlamydial antibiotic, azithromycin, may improve outcome in patients who survive an acute coronary syndrome. The mechanisms are, however, poorly understood. The aims of this study were to define any relationship between Chlamydia pneumoniae seropositivity and levels of specific markers of endothelial activation (soluble cell adhesion molecules) and more general markers of inflammation (C-reactive protein [CRP] and interleukin-6 [IL-6]) and to assess whether azithromycin had any effect on such markers. Methods Patients who survived an acute coronary syndrome were randomized to receive treatment with azithromycin (n = 72) or placebo (n = 69) for 5 days. Before therapy, C pneumoniae IgA and IgG titers were checked, with serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1, soluble E-selectin (sE-selectin), soluble P-selectin, high-sensitivity CRP, and IL-6. They were rechecked 3 months later. Results There were no significant correlations between C pneumoniae titers and levels of CRP, IL-6, or soluble cell adhesion molecules. However, azithromycin treatment significantly reduced mean sICAM-1 levels ( P = .006). This effect was more marked in patients with elevated titers of C pneumoniae IgA and IgG. Soluble E-selectin levels were also reduced in patients who were seropositive, but no effects were seen on other endothelial or inflammatory markers. Conclusions After an acute coronary syndrome, a 5-day course of azithromycin reduces levels of sICAM-1, a marker of endothelial cell activation. Although these data suggest a potentially beneficial role for azithromycin, they should be interpreted with caution.

Antibiotic treatment of atherosclerosis.

Several lines of evidence have demonstrated an association between a variety of chronic bacterial infections and atherosclerotic cardiovascular disease. This has led to the proposal that antibiotic therapy might be helpful in the secondary prevention of atherosclerosis. A variety of smaller pilot studies have been reported testing this hypothesis and several large multicenter trials are also underway. The purpose of this review is to summarize the results of these studies and comment on their implications for the treatment of atherosclerosis. Most of the antibiotic studies to date have been secondary prevention studies that have targeted patients exposed to Chlamydia pneumoniae. Most have used either azithromycin or roxithromycin with treatment courses ranging from a few days to 3 months. Several small studies of coronary artery disease patients have shown significant promise for reducing cardiovascular events such as death, myocardial infarction, or admission for unstable angina. However, other studies have not been so positive. Weekly Intervention with Zithromax for Atherosclerosis and its Related Disorders, WIZARD, the largest study to date, in which stable post-myocardial infarction patients were randomized to receive a 3-month course of azithromycin or placebo, demonstrated a significant reduction in death and myocardial infarction by 6 months, but this benefit was not sustained throughout the remaining course of follow-up. The Azithromycin and Coronary Events (ACES) and Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) trials are ongoing and are testing the effect of more prolonged treatment duration. A variety of antibiotic trials for the secondary prevention of atherosclerosis have been performed. Several pilot studies have shown significant positive clinical effects, but, thus far, no large randomized trial has confirmed those findings. Some concerns over the antibiotics chosen and the duration of treatment have been raised. Other trials are underway to address some of those concerns. In the meantime, no recommendation for the use of antibiotic therapy for the secondary prevention of atherosclerosis can yet be made.

Visual Diagnosis

1. William M. Stauffer, MD, MSPH, DTM&H* 2. Angela D. Siwek, MD† 3. Deepak Kamat, MD, PhD‡ 4. Erika Kempler-Meyer, MD§ 1. *Center for International Health & International Travel Clinic, Regions Hospital, Pediatric Emergency Medicine, University of Minnesota, Minneapolis, MN 2. †Department of Pediatrics, University of Minnesota, Minneapolis, MN 3. ‡Director, Institute of Medical Education, Children’s Hospital of Michigan, Detroit, MI 4. §Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, OR A 14-year-old boy presents with rash, fever, chills, and difficulty walking due to right hip pain. The patient had been healthy until 2 weeks ago when he developed muscle pain, headaches, sore throat, cough, and decreased appetite. Ten days ago, he was started on a course of azithromycin for “bronchitis.” Rapid streptococcal antigen and mononucleosis antibody tests were negative at that time. Three days later, the antibiotic regimen was changed to a second-generation cephalosporin for a presumed urinary tract infection after red blood cells appeared in the urine. Urine nitrite and leukocyte esterase were negative. Three days later (and 4 days prior to presentation), the patient developed right shoulder pain, fever, “sores” in his mouth, blood-streaked sputum, frequent episodes of nosebleeding, “pain with deep breaths,” a rash on his lower legs, and sore and swollen feet. At that time, his white blood cell (WBC) count was 5.2×103/mcL (5.2×109/L), with a normal differential count; findings on chest radiograph were normal. The patient currently has difficulty walking due to right hip pain. He denies any history of exposure to infectious diseases. The boy’s past medical history is remarkable for a ventricular septal defect (VSD) discovered during early infancy. He has received prophylaxis against bacterial endocarditis before every dental procedure. His growth and development are normal, and he has no allergies to food or medicine. His immunizations are up to date, and current medications include cefprozil, acetaminophen with codeine, and ibuprofen. He is in eighth grade, lives with his parents, and has no siblings. He denies sexual activity and use of tobacco, alcohol, or drugs. On physical examination, the patient appears pale and weak. His temperature is 101.3°F (38.5°C), blood pressure is 135/78 mm Hg, respiratory rate is 22 breaths/min, and heart rate is 104 beats/min. Raised, red-purple, nonblanching …

The effect of ED prescription dispensing on patient compliance

The objective of this study was to evaluate whether dispensing prescriptions in the ED affects patient compliance and return visits to the hospital. Seventy-four patients who were deemed suitable candidates for outpatient therapy with a macrolide antibiotic were identified and prospectively randomized to receive either an entire course of azithromycin from the ED or a prescription for azithromycin to be filled at a local pharmacy free of charge. Pharmacy records and telephone interview were used to measure compliance with patients. Significantly fewer patients filled their prescription in the pharmacy group (74.2%) compared with the ED group, in which all patients received their medication. However, there was no difference in the self-reported compliance of completing the entire course of antibiotics between patients in the ED group (94.3%) and in the pharmacy group (96.8%). There was no significant difference between groups in return ED visits or hospital admissions. We conclude that delivery of prescriptions in the ED significantly increases the likelihood that the patient will obtain the medication prescribed. Whether the patients actually take the medication as directed is unknown. Patient’s self-report did not accurately reflect true compliance and more objective means for measuring compliance is warranted.

Secondary Prevention of Coronary Artery Disease with Antimicrobials

Over the past several decades, coronary artery disease (CAD) has become the major health problem in the Western world with more than 50% of deaths attributed to its complications. The exact causes of atherosclerosis are not clearly known, although multiple risk factors (e.g. hypertension, hyperlipidemia, diabetes mellitus, family history, and smoking) have been well described. However, these risk factors account for only about 50% of the total risk of CAD. Consequently, an ongoing search is under way to discover new risk factors for atherosclerosis as well as the basic underlying causes of progression. Although the evidence is not yet definitive, recent studies have shown that chronic infection by such bacterial organisms as Chlamydia pneumoniae, Helicobacter pylori, and a variety of dental pathogens may play a causative role in atherosclerosis. If this is true, then antimicrobial therapy may be helpful in the secondary prevention of CAD. Indeed, several small studies have already been completed testing this hypothesis. This article reviews the evidence associating these bacterial pathogens to CAD and presently available information regarding the use of antibiotics in the setting. At present, most studies evaluating the potential efficacy antimicrobials in the secondary prevention of CAD have tested the use of macrolide antibodies. Although several small preliminary studies have reported promising results favoring a clinical benefit from even short (<3 months) courses of antimicrobial therapy, the first large clinical trial, the Weekly Intervention with Zithromax for Atherosclerosis and its Related Disorders (WIZARD) study, did not show a statistically significant beneficial effect of a 3 month course of azithromycin over placebo by the end of up to 4 years follow-up. However, a statistically significant (p = 0.03) 33% reduction in death and myocardial infarction was found at 6 months, 3 months after the discontinuation of antibiotics. This robust clinical benefit, however, was not sustained over the ensuing 3.5 years of follow-up. These disappointing long-term outcomes of short-term therapy with antimicrobials may be explained by the recently discovered difficulty found in eradicating chronic vascular infections such as C. pneumoniae. It remains possible that longer term antimicrobial therapy or short-term use of more potent single agents or combinations, capable of effectively eradicating the offending organisms might provide added clinical benefit in the fight against CAD. Further studies are ongoing or planned to evaluate this potential. In the meantime, it is not presently recommended that antimicrobials be routinely prescribed for the secondary prevention of CAD.

Alternative Treatment for Streptococcal Pharyngitis

Ten days of oral penicillin has long been the standard treatment for group A β-hemolytic streptococcus (GABHS) pharyngitis. Investigators in France compared this standard regimen to shorter courses of azithromycin in a prospective, randomized trial of 501 children, aged 2 to 12 years, with symptoms of acute pharyngitis that were confirmed by throat culture. The …

Azithromycin versus amoxicillin/clavulanate in the treatment of acute sinusitis

Purpose: To compare the efficacy and tolerability of a 3-day course of azithromycin with a 10-day course of amoxicillin/clavulanic acid in the treatment of acute sinusitis in adults. Patients and Methods: One hundred adult patients with acute sinusitis were included in an open, randomized study. Clinical diagnosis of sinusitis was confirmed by nasal endoscopy, sinus radiography, and (when possible) by culture of sinus aspirate. Patients were randomized to receive azithromycin (500 mg once daily for 3 days) or amoxicillin/clavulanate (625 mg every 8 hours for 10 days). Results: A significantly faster resolution of signs and symptoms of sinusitis was observed in the azithromycin-treated patients. By the end of therapy (days 10–12), 95% of the patients in the azithromycin group and 74% in the amoxicillin/clavulanate group were cured. The remaining patients' conditions were improved. By the follow-up visit, cure was achieved in 98% of the azithromycin-treated patients, and 91 % of the amoxicillin/clavulanate-treated patients. Treatment failure was observed in three patients from the amoxicillin/clavulanate group, and relapse occurred in one patient from each group. Bacteriologic eradication was achieved in 23 of 23 and 21 of 24 patients treated with azithromycin and amoxicillin/clavulanate, respectively. Both drugs were well tolerated. Two patients (4%) from the azithromycin group and five patients (10%) from the amoxicillin/clavulanate group reported mild gastrointestinal disturbances. Conclusions: In adults with acute sinusitis, a 3-day course of azithromycin was as effective and well tolerated as a 10-day course of amoxicillin/clavulanic acid. A significantly simpler dosage regimen and faster clinical effect were the advantages of azithromycin.

Function of Human Alveolar Macrophages after a 3-day Course of Azithromycin in Healthy Volunteers

Azithromycin (AZM) is a new macrolide antibiotic with a high intracellular/extracellular concentration ratio. Immunomodulatory and antiinflammatory properties have been reported with other macrolides, especially erythromycin. The aim of the present study was to evaluate the effect of AZM on the production of proinflammatory mediators by alveolar macrophages (AM) up to 4 weeks after a 3-day course of AZM (500 mg, once a day). Nineteen non-smoking healthy male subjects were investigated with bronchoscopy and bronchoalveolar lavage. Group 1 received no treatment. Groups 2, 3, and 4 were bronchoscoped 1, 7 and 30 days, respectively, after AZM administration. AZM concentrations were simultaneously measured in plasma and in AM extracts. In serum, AZM levels were higher in group 2 (32.8±14.2 μg/l), at the lower limit of detection in group 3 (2.8±1.7 μg/l), and no longer detectable in group 4. In AM extracts, the highest concentrations were measured in group 2 (51.6±28.3 ng/μl) and in group 3 (31.8±17.2 ng/μl), and were detected up to 30 days after treatment in group 4 (2.9±2.3 ng/μl). There was no significant differences between groups for blood or BAL proinflammatory cytokines levels (TNF-α, IL-1β, IL-6), and for superoxide generation by AM. We conclude that a 3-day course of AZM 500 mg/day in healthy subjects does not alter the proinflammatory cytokine profile in blood and in AM despite the prolonged tissue impregnation by this drug.

Chronic cryptosporidiosis in patients with AIDS: stable remission and possible eradication after long-term, low dose azithromycin.

AIMS: To investigate the effectiveness of long term, low dose azithromycin treatment for chronic cryptosporidiosis in patients with AIDS. METHODS: Azithromycin was administered as initial daily treatment to 13 patients...

Treatment of gastrointestinal infections

The past year has seen the continued spread of antimicrobial drug resistance to important gastrointestinal pathogens; however, reports have offered new ways to use the available antibiotics, and new therapies and vaccines have been tried. Single-dose ciprofloxacin was as effective as doxycycline in cholera treatment. A somatostatin analogue and a 5-hydroxytryptamine receptor antagonist reduced secretory diarrhea in preliminary studies. A 5-day course of azithromycin was effective in the treatment of shigellosis. Ciprofloxacin resistance was reported in higher frequencies of Salmonella typhi, Escherichia coli, and Campylobacter jejuni isolates. Vaccine trials had partial success against cholera and shigellosis. Treatment guidelines have been claried for Clostridium difficite-associated diarrhea, yet there is still a need for better ways to treat multidrug resistant enteric infections and for more effective vaccines to prevent them.

Treatment of Atypical Pneumonia with Azithromycin: Comparison of a 5-Day and a 3-Day Course

The efficacy of a 5-day regimen consisting of 500 mg in a single dose on the first day followed by 250 mg once daily for 4 consecutive days was compared with that of a 3-day course of azithromycin given in single daily doses of 500 mg for treatment of atypical pneumonia. Adult patients hospitalized with atypical pneumonia in the years 1990 to 1993 were studied retrospectively. For each patient, the medical history, laboratory data, the results of serological tests, chest radiographs and treatment outcome were reviewed. Out of 148 patients with atypical pneumonia, 40 were treated with azithromycin for 5 days (Group 1) and 41 for 3 days (Group 2). The success rate in Group 1 was 80% (32 patients). Eight patients did not respond to treatment: 5 had significant complement fixing antibody titers to adenovirus and in 3 the etiology was unknown. The success rate in Group 2 was 88% (36 patients). Azithromycin was ineffective in all 3 patients with adenoviral pneumonia, in 1 patient with Q fever, and in 1 patient with no identified pathogen. Azithromycin is equally effective as treatment of atypical pneumonia in adult patients if given for 3 or 5 days at the same total dose.

Azithromycin: a good option for treating pharyngitis

New findings from 2 large comparative studies support the use of the antibacterial azithromycin for the treatment of pharyngitis in both adults and children. In both age groups, a short course of azithromycin proved to be as effective as a longer course of conventional therapy. In the study of adult patients with pharyngitis, azithromycin therapy was associated with faster recovery rates and reduced costs, compared with treatment with roxithromycin. The results of these investigations were presented at the 3rd International Conference on the Macrolides, Azalides, and Streptogramins [Lisbon, Portugal; January 1996].

Azithromycin vs. Amoxicillin for Erythema Migrans

Amoxicillin and doxycycline are the treatments of choice for erythema migrans. A recent small, open trial reported that a 5-day course of azithromycin, a new macrolide antibiotic, is just as effective as a 20-day course of doxycycline or amoxicillin with probenecid. Based on this finding, these investigators conducted a large, multicenter, double-blind study to compare a 20-day course of amoxicillin (500 mg three times per day) with a …

Multicenter comparison of azithromycin and amoxicillin/clavulanate in the treatment of patients with acute exacerbations of chronic obstructive pulmonary disease

This randomized, multicenter, investigator-blinded, parallel-group study compared a 5-day, once-daily course of azithromycin (two 250-mg capsules on day 1, followed by one 250-mg capsule on days 2 through 5) with a 10-day, three-times-daily course of amoxicillin/clavulanate (one 500-mg tablet) in 70 patients with acute bacterial exacerbations of chronic obstructive pulmonary disease (COPD; chronic bronchitis). At the end of therapy, all 29 (100%) efficacy-assessable patients treated with azithromycin were cured or improved, compared with 25 (93%) of 27 assessable patients given amoxicillin/clavulanate ( P = NS). Bacteriologic eradication rates were 86% ( 25 29 isolates) with azithromycin and 87% ( 20 23 isolates) with the comparative agent. Azithromycin was well tolerated; adverse events considered related or possibly related to treatment were reported in 28% of azithromycin recipients, compared with 39% of amoxicillin/clavulanate recipients ( P = NS). The 5-day, once-daily regimen of azithromycin is comparable to a standard agent in the treatment of patients with acute bacterial exacerbations of COPD.

Five-day azithromycin in the treatment of patients with community-acquired pneumonia

A pooled analysis of 10 studies was undertaken to compare the efficacy of azithromycin with that of other oral antimicrobial agents in the treatment of patients with community-acquired pneuomonia. Data from a total of 430 patients with radiographically confirmed pneumonia were analyzed; 222 received azithromycin (500 mg on day 1, then 250 mg once daily for 4 days), and 208 received other antimicrobial agents (cefaclor, erythromycin, amoxicillin, amoxicillin/clavulanic acid, or josamycin) at approved dosages. Clinical success (cure or improvement) was recorded in 88.2% of patients treated with azithromycin and 87.7% of assessable comparator patients. In patients >60 years of age, clinical success rates were lower than rates in patients ≤60 years for both treatment groups. Radiologic data also showed similar efficacy in the two treatment groups, with clearing or improvement of radiologic appearance recorded in 90.0% (171 of 190 patients) and 91.9% (158 of 172 patients) of azithromycin- and comparator-treated patients, respectively. Both treatment groups had similar bacteriologic efficacy, with eradication rates of 88.1% in the azithromycin-treated patients and 86.6% in the comparator-treated patients. Relatively low mortality rates were recorded in both groups; mortality was 0.5% (1 of 212 patients) in the azithromycin patients, and 1.5% (3 of 195 patients) in the comparator patients. All comparator patients who died were >60 years of age and taking cefaclor; no patient died as a result of pneumonia. Pneumococcal bacteremia occurred in 5 patients receiving azithromycin and 4 patients receiving comparators; clinical cure was achieved in 4 of 5 azithromycin patients and in 4 of 4 patients receiving comparators. In conclusion, azithromycin is effective in the treatment of community-acquired pneumonia in patients who are candidates for treatment with oral antibiotics. A 5-day course of azithromycin offers equivalent efficacy to 7- to 10-day, multiple daily dose treatment with other oral antimicrobial agents.