Pneumonia azithromycin effect

Two other agents show promise in treatment of ocular toxoplasmosis. Atovaquone, primarily used for mild to moderate episodes of Pneumocystis carinii pneumonia, has been effective in small series of patients with toxoplasmosis. It appears to have activity against both tachy-zoites and tissue cysts. More recent studies on atovaquone in toxoplasmosis are limited to murine models, and no further reports on this drug therapy in humans have been published. Azithromycin, a macrolide antibiotic, is efficacious against T. gondii and can also kill tissue cysts. A randomized study of 46 patients compared the combinations of azithromycin plus pyrimethamine versus pyrimethamine plus sulfadiazine in treatment of ocular toxoplasmosis efficacy was similar, but the azithromycin/ pyrimethamine regimen caused less adverse effects. 

In a multicenter, parallel-group, double-bhnd trial in 420 evaluable patients aged 6 months to 16 years with community-acquired pneumonia, the therapeutic effect of azithromycin (once-daily for 5 days) was similar to that of co-amoxiclav in children under 5 years and to that of erythromycin tds for 10 days. Treatment-related adverse events occurred in 11% of those given azithromycin and 31% in the comparator group (8). 

The macrolide antibiotics include erythromycin, clarithromycin, azithromycin, tylosin, tilmicosin and tiamulin. Clindamycin and lincomycin are related lincosamides. Susceptible bacteria include staphylococci, streptococci, Campylobacter jejunii, Clostridium spp., R. equi, Mycoplasma pneumoniae and Chlamydia spp. Drugs in this group are only effective against a few Gram-negative bacteria in cattle, namely some strains of Pasteurella and Haemophilus spp. Macrolides and lincosamides are associated with causing colitis in horses, so their use is usually restricted to p.o. erythromycin for the treatment of R. equi infections in foals. Subantimicrobial doses of erythromycin are administered i.v. to horses for gastrointestinal prokinetic action. 

Chlamydial infections can be treated effectively with any of the macrolides. A single 1-g dose of azithromycin is recommended for patients with uncomplicated urethral, endocervical, rectal, or epididymal infections because of the ease of compliance. During pregnancy, erythromycin base, 500 mg four times daily for 7 days, is recommended as first-line therapy for chlamydial urogenital infections. Azithromycin, 1 g orally as a single dose, is a suitable alternative. Erythromycin base is preferred for chlamydial pneumonia of infancy and ophthalmia neonatorum (50 mg/kg per day in four divided doses for 10 to 14 days). Azithromycin, 1 g a week for 3 weeks, may be effective for lymphogranuloma venereum. 

Hammerschlag el al. [240] reviewed the effectiveness of azithromycin in CAP caused by C. pneumoniae in adult, pediatric, and hospitalized adults in four comparative and three noncomparative CAP trials. Azithromycin was as effective as the comparator antibiotic regimen in aU settings with 83-91 % experiencing a satisfactory clinical response. 

Use of parenteral azithromycin for the treatment of CAP was approved in the United States based on the results of two large clinical trials in hospitalized patients with CAP, including a large comparative trial where azithromycin was shown to be as effective as cefuroxime with or without erythromycin [218]. Parenteral formulation of azithromycin is currently approved in the United States for mild to moderate pneumonia in adults due to C. pneumoniae, Mycobacterium pneumoniae, Legionella pneumophila, Moraxella catarrhalis, S. aureus, or S. pneumoniae in hospitalized patients who require initial parenteral therapy. The recommended regimen is 500 mg daily for at least 2 days, followed by daily oral azithromycin to complete a 7- to 10-day course. Due to the rising rates of macrolide-resistant S. pneumoniae in some areas, physicians should avoid using I.V. azithromycin as monotherapy in patients with severe CAP, particularly in a very ill patient with multiple comorbidities with known risk factors for penicillin-resistant... 

S. pneumoniae disease. The safety and effectiveness of I.V. azithromycin in children (<16 years) have not been established. 

Azithromycin has a similar spectmm of activity but is more active against H influenzae, M catarrhalis, and neisseria. Because of its long half-life, a single dose of azithromycin is effective in the treatment of urogenital infections due to C trachomatis, and a 4-day course of treatment has been effective in community-acquired pneumonia. 

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