Macrolides distribution

The macrolides distribute well and tissue concentrations may be higher than serum concentrations. Erythromycin concentrates and is active in leukocytes because of its high lipid solubility and ion trapping. The of erythromycin is 3.7-7.21/kg in adult horses and foals. The protein binding is low. The hepatic clearance of the macrolides may be slower in animals of up to 1 month of age than in adult animals. 

Another basic drug where minor structural modification results in a dramatic increase in volume of distribution is the macrolide antibiotic, azithromycin. The traditional agent in this class is erythromycin, which contains one basic nitrogen, in the sugar side-chain. 

The macrolides are orally absorbed but they are acid-labile. They therefore need to be administered in acid-resistant capsules or as acid-resistant esters. The macrolides are widely distributed into all fluids except the CNS. Protein binding is about 90%. They are eliminated via biliary excretion with extensive enterohepatic circulation. Elimination half-lives vary from 1.4 h for erythromycin to 40-60 h for azithromycin. 

Mecfianism of Action A macrolide that reversiblybindstobacterial ribosomes, inhibiting bacterial protein synthesis. Therapeutic Effect Bacteriostatic. Pharmacokinetics Variably absorbed from the GI tract (depending on dosage form used). Protein binding 70%-90%. Widely distributed. Metabolized in the liver. Primarily eliminated in feces by bile. Not removed by hemodialysis. Half-life 1.4-2 hr (increased in impaired renal function). 

In general, the macrolides are administered orally but sometimes also paren-terally. All the members of this group are well absorbed and are distributed extensively in tissues, especially in the lungs, liver, and kidneys, with high tissue to plasma ratios. They are retained in the tissues for long periods after the levels in the blood have ceased to be detectable. Elimination of all macrolides occurs primarily through hepatic metabolism, which accounts for approximately 60% of an administered intravenous dose the remainder is excreted in active form in the urine and bile. With oral and intramuscular administration, urinary excretion decreases, but biliary excretion and hepatic metabolism increase proportionally. Milk has often macrolide concentrations severalfold greater than in plasma (7). 

Erythromycin distributes widely in the body with residue levels in tissues generally exceeding those in serum. Both hepatic and renal routes of elimination of erythromycin are significant and it undergoes enterohepatic circulation. Elimination of erythromycin in relatively high levels in the feces may follow its oral administration. As with almost all macrolides, the principal metabolic pathway of erythromycin is by A-desmethylation of the desosamine sugar (107). 

Azithromycin. Azithromycin is another recently developed macrolide antibiotic. After oral administration on an empty stomach, azithromycin is rapidly absorbed and widely distributed throughout the body. Because azithromycin has an extended half-life, once-daily dosing is effective and encourages patient compliance. 

Macrolides are lipophilic and accumulate within certain cells and tissues at concentrations that exceed serum levels many-fold, resulting in large volumes of distribution. However, high tissue/serum ratios alone do not guarantee intracellular bioavailability or antimicrobial activity [235], High... 

Lina G, Quaglia A, Reverdy ME, Leclercq R, Vandenesch F, Etienne J. Distribution of genes encoding resistance to macrolides, lincosamides, and streptogramins among staphylococci. Antimicrob Agents Chemother 1999 43(5) 1062-6. 

Distribution Macrolides widely distribute into tissue and obtain high intracellular levels. 

Among the many antibiotics isolated from the actinomycetes isthe group of chemically related compounds called the mac-mlides. In I9S0, picromycin, the first of this group to be identified as a macrolide compound, was first reported. In 1952. erythromycin and carbomycin were reported us new antibiotics, and they were followed in subsequent years by other macrolides. Currently, more than 40 such compounds ate known, and new ones are likely to appear in the future. Of all of these, only two, erythromycin and oleandomycin, have been available consistently for medical use in the United States. In recent years, interest has shifted away from novel macrolides isolated from soil samples (e.g.,. spiramycin, josamycin, and rosamicin), all of which thus far have proved to be clinically inferior to erythromycin and semisynthetic derivatives of erythromycin (e.g., clarithromycin and azithromycin), which have superior pharmacokinetic properties due to their enhanced acid stability and improved distribution properties. 

While broad spectrum anthelmintics (macrolide endectocides, benzimidazole carbamates, tetrahydropyrimidines) largely overlap in the range of endoparasites (mainly nematodes) they affect, the various anthelmintic classes (based on chemical structure) differ in mechanism of action, degree of activity and in pharmacokinetic properties (bioavailability, tissue distribution and... 

The chemical nature and related physicochemical properties largely govern the distribution and elimination, which refers to biotransformation (metabolism) and excretion, of antimicrobial agents. The majority of antimicrobial agents are weak organic electrolytes, either weak acids (penicillins, cephalosporins, sulphonamides) or weak bases (aminoglycosides, lincosamides, macrolides, diaminopyrimidines, metronidazole), while fluoroquinolones, tetracyclines and rifampin are amphoteric compounds, and chloramphenicol and its... 

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