Azithromycin, treating

In a review of 12 clinical studies most of the adverse events in those taking azithromycin affected the gastrointestinal system, and were reported in 138 (8.5%) azithromycin-treated patients (29). Abdominal pain, diarrhea, nausea, and vomiting were the most frequently reported gastrointestinal adverse events. 

A recent study of travelers to Thailand comparing azithromycin or ciprofloxacin for the treatment of military personnel who acquired C. jejuni enteritis showed that all the azithromycin-treated patients were cured, while there were two clinical failures in the ciprofloxacin group [261]. Almost 50% of the 44 strains were ciprofloxacin resistant. Recently documented increases in quinolone resistance have been associated with rising levels of azithromycin resistance in Thailand 69% and 31% of 29 C. jejuni isolates were found to be resistant to ciprofloxacin and azithromycin, respectively [262]. Rising levels of azithromycin resistance may compromise the effectiveness of azithromycin for C. jejuni enteritis. 

Significant reduction in exacerhations 2, 67 and improvement in FEVl, macrolide resistance rate 88% in azithromycin-treated individuals vs. 26% in placebo... 

For treating outpatient CAP, two antibiotics are approved for a 5-day duration of therapy, levofloxacin (the 750-mg dose) and azithromycin. The duration of therapy for all other therapies is 7 to 10 days. For treatment of CAP in patients admitted to the hospital, the duration depends on whether or not blood cultures were positive. In the absence of positive blood cultures, the duration of therapy is 7 to 10 days. If blood cultures were positive, then the duration of therapy should be 2 weeks from the day blood cultures first became negative. 

M. pneumoniae, if suspected by history or positive cold agglutinins (titers greater than or equal to 1 32) or if confirmed by culture or serology, may be treated with azithromycin. Also, a fluoroquinolone with activity against these pathogens (levofloxacin) may be used in adults. 

Pregnant women infected with N. gonorrhoeae should be treated with either a cephalosporin or spectinomycin, because fluoroquinolones are contraindicated. Azithromycin or amoxicillin is the preferred treatment for presumed Chlamydia trachomatis infection. 

Ulcus molle/chancroid is treated with a single dose of either ceftriaxone i.m. or with azithromycin 1 g orally. Three days of oral ciprofloxacin 2 x 500 mg daily or 7 days of amoxicillin/clavulanic acid 3 X 500/125 mg orally or erythromycin 4 x 500 mg orally are alternatives. 

Chlamydial urethritis/cervicitis is preferably treated with a single 1 g dose of azithromycin or a seven days course of doxycycline 2 x 100 mg daily alternatively, erythomycin 4 x 500 mg daily or ofloxacin 2 x 200 mg daily, both for a week, will... 

Multiply resistant coagulase-negative staphylococci are frequently the cause of postoperative endophtalmitis and require the use of a glycopep-tide (e.g. vancomycin). For topical treatment fusidic acid eye gel, tetracycline or chloramphenicol ointment are available, and can be administered 2 t.d. for 7 days. Trachoma should be treated with an oral macrolide (e.g. a single oral dose of 20 mg/kg azithromycin) or doxycyclin for 3 weeks (for moderate to severe cases). Keratitis needs hourly administration of fortified antibiotic eye drops for 2 weeks. Endophtalmitis needs specialist treatment for 6 weeks. 

Anti-infectious agents also play a key role in the treatment of cystic fibrosis, and respiratory infections are treated with appropriate antibiotic agents.16 89 In particular, azithromycin has shown considerable... 

Trachoma can be effectively treated with a 4- to 6-week course of topical tetracycline ointment. Additionally, oral tetracycline 250 mg four times a day or doxycycline 100 mg orally twice a day for 14 days is an effective option if not contraindicated. Alternatively, azithromycin in a single oral dose (20 mg/kg) was found to be equally effective in resolving active trachoma and offers the advantage of increased compliance. Reinfection rates are high, especially in endemic areas. In patients with severe conjunctival cicatrization, surgical intervention may be required to correct trichiasis and entropion and to prevent corneal scarring. 

Azithromycin achieves high concentrations in tissues relative to those in plasma. It remains largely unmetabolised and is excreted in the bile and faeces (t) 50h). Azithromycin is used to treat respiratory tract and soft tissue infections, and sexually transmitted diseases, especially genital Chlamydia infections. Gastrointestinal effects (9%) are less than with erythromycin but diarrhoea, nausea and abdominal pain occur. In view of its high hepatic excretion use in patients with liver disease should be avoided. Interactions see erythromycin (above). 

Coexistent infection. Chlamydia trachomatis is frequently present with Neisseria gonorrhoeae tetracycline by mouth for 7 days or a single oral dose of azithromycin Ig will treat the chlamydial urethritis. 

Human babesiosis has been traditionally treated with quinine plus clindamycin, a combination that has been compared with atovaquone plus azithromycin in a randomized, multicenter, unblinded study (7). The treatments... 

In an open, prospective trial gingival hyperplasia due to ciclosporin was successfully treated with azithromycin 250 mg/day for 5 days in 30 of 35 patients, who reported esthetic satisfaction and disappearance of bleeding and pain (6). There was no change in ciclosporin concentration or renal function after azithromycin. 

Azithromycin (500 mg/day for 3 days) has been used to treat acute periapical abscesses (9). Of 150 patients treated with azithromycin 18 reported a total of 26 adverse events. Slightly more (24 out of 153) treated with co-amoxiclav reported 34 adverse events, but this difference did not reach statistical significance. Most of the adverse events (44/60) were gastrointestinal, mostly diarrhea or abdominal pain. There were no significant differences between the two groups in the severity of adverse events or in the number of withdrawals because of adverse events. 

In eight patients a single 500 mg oral dose of azithromycin was not substantially removed by continuous ambulatory peritoneal dialysis in the absence of peritonitis. Azithromycin cannot be recommended for widespread use in CAPD at present. However, the successful use of azithromycin in treating peritonitis, perhaps because of an intracellular drug transport mechanism, has been reported (44). 

A retrospective analysis of 3995 patients treated with azithromycin did not show any pharmacokinetic interactions in patients who were also taking various other drugs, including carbamazepine (1,45). 

Erythromycin is a motilin receptor agonist (2-4). Azithromycin also produced a significant increase in postprandial antral motility (5). Clarithromycin is also prokinetic, as shown in 16 patients with functional dyspepsia and Helicobacter pylori gastritis (6). For this reason, the macrolides have been used to treat gastroparesis (7). 

In 202 patients with unstable angina pectoris, roxithromycin prevented death and re-infarction for at least 6 months after initial treatment (11). However, these findings could not be confirmed in another study in 302 patients with coronary heart disease and a seropositive reaction to Chlamydia pneumoniae who were treated with azithromycin. While global tests of markers of... 

Significant increases in serum carbamazepine concentrations due to reduced clearance (97) and prolonged half-life (98,122,123) can result in confusion, somnolence, ataxia, vertigo, nausea, and vomiting in patients taking macrolides (100,124,125). Toxicity can occur rapidly after addition of the macrolide and abate quickly on withdrawal (126). However, a retrospective analysis of 3995 patients treated with azithromycin did not show any pharmacokinetic interaction in patients who were also taking carbamazepine (127,128). 

The effect of macrohdes on serum theophylline concentration and clearance has been investigated in 53 patients with moderate asthma treated with theophylline (400 mg/day) in a randomized trial reference. Erythromycin (500 mg bd) and roxithromycin (150 mg bd), but not clarithromycin (250 mg bd) or azithromycin (250 mg bd), caused increased serum theophylline concentrations and reduced clearance. 

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