Eur Respir J. 2005 Mar;25(3):490-3.
Azithromycin in bronchiolitis obliterans complicating bone marrow
transplantation: a preliminary study.
Khalid M, Al Saghir A, Saleemi S, Al Dammas S, Zeitouni M, Al
Mobeireek A, Chaudhry N, Sahovic E.
Section of Pulmonary Medicine, Dept of Medicine, King Faisal Specialist
Hospital and Research Centre, PO Box 3354, Riyadh 11211, Saudi
Arabia.
Bronchiolitis obliterans (BO) is a serious noninfectious pulmonary
complication following allogeneic bone marrow transplantation
(BMT). Azithromycin, a macrolide antibiotic, may have a beneficial
effect in BO through its anti-inflammatory effect. The aim of
the current study was to investigate the potential effect of azithromycin
on pulmonary function tests (PFTs) in BO complicating BMT. PFTs
of 153 post-BMT patients were followed; eight patients out of
153 (12%) developed obstructive airway disease on their PFTs,
along with characteristic findings of BO on high-resolution computed
tomography of the chest. These patients were given azithromycin
500 mg q.d. for 3 days, followed by 250 mg three times a week
for 12 weeks. Clinically significant improvements were achieved
both in forced vital capacity, where the mean (95% confidence
interval) increase reported was 410 mL (0.16-0.65), which was
an average improvement of 21.57%, and in the forced expiratory
volume in one second, where the mean increase noticed was 280
mL (0.10-0.44), which was an average improvement of 20.58%. In
conclusion, the potential role of azithromycin in the treatment
of bronchiolitis obliterans is intriguing and it warrants further
testing.
Transplantation. 2004 May 15;77(9):1465-7.
Azithromycin therapy for patients with bronchiolitis obliterans
syndrome after lung transplantation.
Verleden GM, Dupont LJ.
University Hospital Gasthuisberg, Department of Respiratory Medicine
and Lung Transplantation Unit, Leuven, Belgium.
BACKGROUND: Bronchiolitis obliterans syndrome (BOS) is the leading
cause of late mortality after lung transplantation. METHODS: We
added azithromycin (AZI) (250 mg/day for 5 days, followed by 250
mg every other day) to the current immunosuppressive therapy in
eight lung transplant recipients (mean age 36 years) with established
BOS in an attempt to prevent further decline of the forced expiratory
volume in 1 sec (FEV1). RESULTS: Before the administration of
AZI, there was a gradual decline of the FEV1 (-34.4%+/-14.7%)
compared with the patients' best postoperative values. Twelve
weeks after AZI had been added, there was a significant increase
in the FEV1 (+18.3%+/-14.6%, P <0.0001, analysis of variance)
with an absolute increase of 328+/-305 mL. This increase persisted
in three patients during 9 months of follow-up. CONCLUSIONS: AZI
is a promising drug for some patients with BOS after lung transplantation.
The exact mechanism of action is unknown at the present time.
Int J Dermatol. 2004 Feb;43(2):151-4.
Therapeutic potential of azithromycin in rosacea.
Bakar O, Demircay Z, Gurbuz O.
Department of Dermatology, Marmara University School of Medicine,
Istanbul, Turkey.
BACKGROUND: Systemic antibiotics currently used in the treatment
of rosacea are sometimes associated with uncomfortable side-effects.
Therefore, a need for an effective agent with few side-effects
and good patient compliance exists. Azithromycin, a macrolide
antibiotic with prolonged mode of action, has recently been found
to be an effective alternative in the treatment of inflammatory
acne. We planned a study to evaluate the efficacy and safety of
azithromycin in rosacea. METHODS: An open-labeled study was performed
in a population of 18 patients, with Plewig-Kligman stage 2 rosacea.
Patients were given oral azithromycin for 12 weeks in decreasing
doses. RESULTS: Fourteen subjects completed the trial. The treatment
produced therapeutic benefits with regard to total scores as well
as inflammatory lesion scores. At the end of 12 weeks, there was
a 75% decrease in total scores (P < 0.001) and an 89% decrease
in inflammatory lesion scores compared with basal values. Improvement
continued during the 4 weeks after treatment. Adverse effects
were minimal and well tolerated in most patients. CONCLUSION:
Azithromycin is a promising agent in the treatment of rosacea
with its few side-effects and good patient compliance.
Int J STD AIDS. 2004 Apr;15(4):240-2.
Efficacy of azithromycin 1g single dose in the management of uncomplicated
gonorrhoea.
Habib AR, Fernando R.
Department of Genitourinary Medicine, New Cross Hospital, Wednesfield
Road, Wolverhampton WV10 0QP, UK.
This paper describes the efficacy of azithromycin 1g single dose
in the management of uncomplicated gonorrhoea either with or without
chlamydial co-infection. Three hundred and one patients were treated
for gonorrhoea between January 2000 and June 2001; 226/301 (75.1%)
were treated with azithromycin 1g stat dose while the rest were
treated with different regimens. Ninety-seven of 301 (32.2%) of
all isolated strains were found to be resistant to at least one
antibiotic where penicillin constituted the majority (23%). Chlamydial
co-infection was found in 38.2% (115/301). Only 73.1% (220/301)
attended for a test-of-cure, all but six patients had negative
gonorrhoea cultures at their reviews. Among the six failures 3/32
(9.3%) were initially on amoxicillin, 2/170 (1.2%) on azithromycin
and 1/22 (4.5%) on ciprofloxacin. Hence, azithromycin stat dose
has proved to be a cost-effective treatment for uncomplicated
gonorrhoea supported by the increased prevalence of penicillin-resistant
organisms, concomitant chlamydial infection and the high failure
rate in keeping review appointments.
Clin Infect Dis. 2003 May 15;36(10):1239-45.
Epub 2003 May 06.
Is azithromycin the first-choice macrolide for treatment of community-acquired
pneumonia?
Sanchez F, Mensa J, Martinez JA, Garcia E, Marco F, Gonzalez J,
Marcos MA, Soriano A, Torres A.
Institut Clinic dInfeccions i Immunologia, Hospital Clinic i Provincial
de Barcelona, 08026 Barcelona, Spain.
Combination treatment with a beta-lactam plus a macrolide may
improve the outcome for elderly patients with community-acquired
pneumonia (CAP). The prognoses and mortality rates for elderly
patients with CAP who receive ceftriaxone combined with a 3-day
course of azithromycin or a 10-day course of clarithromycin were
compared in an open-label, prospective study. Of 896 assessable
patients, 220 received clarithromycin and 383 received azithromycin.
There were no significant differences between groups with regard
to the severity score defined by the Pneumonia Patient Outcomes
Research Team (PORT) study group; the incidence of bacteremia
was also not significantly different. However, for patients treated
with azithromycin, the length of hospital stay was shorter (mean+/-SD,
7.4+/-5 vs. 9.4+/-7 days; P<.01) and the mortality rate was
lower (3.6% vs. 7.2%; P<.05), compared with those treated with
clarithromycin. There might be a difference in the outcome for
patients with CAP depending on the macrolide used. A shorter treatment
course with azithromycin may result in better compliance with
therapy.
Rev Soc Bras Med Trop. 2003 Jan-Feb;36(1):65-9.
Epub 2003 Apr 22.
Efficacy of azithromycin in the treatment of cutaneous leishmaniasis.
Prata A, Silva-Vergara ML, Costa L, Rocha A, Krolewiecki A, Silva
JC, de Paula EV, Pimenta Junior FG, Giraldo LE.
Department of Infectious and Parasitic Diseases, Faculdade de
Medicina do Triangulo Mineiro, Uberaba, MG, Brasil.
The present open pilot study was conducted to assess the efficacy
of azithromycin for the treatment of patients with cutaneous leishmaniasis
in Ara ua and Varzelandia, MG. Twenty-four patients with less
of six months of disease evolution were treated after clinical
examination, Montenegro test and a biopsy. The treatment schemes
consisted of oral doses of 500 mg per day for 3, 5 and 10 days
and of 1000 mg for two days. A clinical control was performed
monthly and treatment cycles were repeated when necessary until
full reepithelialization of the lesions. On the occasion of the
final evaluation, 20 patients had completed the study and 17 of
them (85%) were cured. The time to obtain a cure was 60 days ifor
6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The
three patients with treatment failure received a pentavalent antimonial
for 20 days. No adverse reactions to the medication were observed
and a 14 month follow-up did not show recurrence in any patient.
These results suggest that azithromycin can be a good therapeutic
option for the treatment of cutaneous leishmaniasis caused by
Leishmania Viannia brasiliensis.
J Oral Maxillofac Surg. 2003 Mar;61(3):310-6.
The efficacy of azithromycin in the treatment of acute infraorbital
space infection.
Al-Belasy FA, Hairam AR.
Oral Surgery Department, Faculty of Dentistry, Mansoura University,
Mansoura, Egypt.
PURPOSE: In this study, we aimed to evaluate the role of azithromycin
in the treatment of acute infraorbital space infection. MATERIALS
AND METHODS: Sixty patients (39 men and 21 women; age range, 18
to 47 years) who had acute infraorbital space infection with pain,
swelling, and general malaise were included in the study. After
initial surgical therapy, patients were randomly allocated to
receive either 500 mg azithromycin once daily for 3 days, 250
mg erythromycin stearate every 6 hours for 3 days, or no antibiotic.
Patients were assessed at the time of admission and after 1, 2,
3, and 7 days. Pain, swelling, cervical lymphadenopathy, and sublingual
temperature were assessed at each visit. Data were collected,
and all groups were compared for differences in pain and swelling
using the Mann-Whitney U test and for differences in lymphadenopathy
and sublingual temperature using Fisher's exact test. RESULTS:
At the time of admission, no 2 groups were statistically different
at the.05 level in relation to age, gender, and presenting clinical
signs or symptoms. At days 2 and 3, patients who received azithromycin
had a significant reduction in pain (P =.002 and P =.02, respectively)
and swelling (P =.001 and P =.013, respectively) compared with
those who received no antibiotic. At day 3, patients who received
erythromycin had a significant reduction in pain (P =.03) and
swelling (P =.046) compared with those who received no antibiotic.
In a comparison of the patients who received azithromycin with
those who received erythromycin, there was no significant difference
(P >.05) in the reduction of pain at any time of the study.
However, at day 2, patients who received azithromycin had a significantly
greater reduction in swelling (P =.002) than those who received
erythromycin. In relation to the percentage of the patients with
cervical lymphadenopathy and raised sublingual temperature (>37.2
degrees C), no 2 groups were statistically different at any time
of the study. After 3 days of treatment, patients who received
the antibiotics were clinically improved, and all patients (n
= 60 patients) reviewed after 7 days had resolution of their clinical
signs and symptoms. CONCLUSION: This study emphasizes the importance
of surgical drainage and proves that both azithromycin and erythromycin
are effective adjunctive treatments in the therapy of relatively
mild odontogenic orofacial infections.
Pediatr Pulmonol. 2003 Feb;35(2):139-43.
Treatment of cast bronchitis with low-dose oral azithromycin.
Schultz KD, Oermann CM.
Pulmonology Section, Department of Pediatrics, Baylor College
of Medicine, Houston, Texas, USA.
Cast or plastic bronchitis is an unusual disorder that is rarely
encountered in the pediatric population. It is characterized by
the expectoration of large, branching plugs of airway debris.
These "casts" conform to the shape of portions of the
tracheobronchial tree, and give the disorder its name. Cast bronchitis
is typically seen in association with several primary pulmonary
disorders and cyanotic congenital heart disease. It can be classified
as inflammatory or acellular, based on the histologic characteristics
of the casts. The presence of large, obstructive plugs filling
the airways of lobes or entire lungs can result in a variety of
clinical signs and symptoms, and may ultimately lead to respiratory
failure and death. Conventional treatment of cast bronchitis has
focused on the clearance of obstructing material from the airways
combined with therapy for any underlying cardiopulmonary disease.
Unfortunately, this approach has not proven very effective, and
patient mortality remains high.We report on a case in which a
patient with cast bronchitis was treated with long-term, low-dose
oral azithromycin. This therapy resulted in clinical, spirometric,
and radiographic improvement of the patient.
J Antimicrob Chemother 2002 May;49(5):875-8.
A randomized controlled trial of azithromycin versus doxycycline/ciprofloxacin
for the syndromic management of sexually transmitted infections
in a resource-poor setting.
Rustomjee R, Kharsany AB, Connolly CA, Karim SS.
Unit for Clinical and Biomedical Tuberculosis Research, Medical
Research Council, King George V Hospital, PO Box 19494, Domerton
4015.
A randomized controlled trial was carried out to assess the effectiveness
of azithromycin versus a standard regimen with doxycycline/ciprofloxacin
in the treatment of sexually transmitted infections in a resource-poor
environment. Infection with Chlamydia trachomatis was cured in
23/24 (95.8%) of women in the azithromycin arm versus 19/21 (90.5%)
in the doxycycline arm (P = 0.6), resulting in three treatment
failures. Gonorrhoea was cured in 55/56 (98.2%) women, with one
treatment failure in a patient with concomitant C. trachomatis
infection. These results indicate that a single oral dose of azithromycin
may prove to be a more effective and convenient treatment for
sexually transmitted infections in women in a resource-poor environment.
Antibiot Khimioter. 2002;47(5):12-5.
Combined treatment of persisting urogenital chlamydia infection
with sumamed and interferon alfa.
Gomberg MA.
Central Research Institute of Venerology and Dermatology, Moscow.
The results of complex treatment of 235 patients with persisting
urogenital chlamidial infection are presented. The treatment regime
included immunotropic agent interferone alfa-alpha 2b and antibiotic
azithromycin (Sumamed, "Pliva", Croatia) 1 g per day
3 times every 7 days. Chlamidial persistence diagnosis was performed
by culture method (determination of small cytoplasmic inclusions),
by the method of immune fluorescence and PCR. The treatment provided
positive influence on immune status (amount of CD4+; HLA-DR+ cell
and IgA level normalized after the treatment). In 3 months after
the treatment only 2 cases of Chlamydia trachomatis infection
recurrence were registered. Treatment efficacy achieves 94.8 per
cent.
J Postgrad Med. 2002 Jul-Sep;48(3):179-81.
Azithromycin as treatment for cryptosporidiosis in human immunodeficiency
virus disease.
Kadappu KK, Nagaraja MV, Rao PV, Shastry BA.
Department of Medicine, Kasturba Medical College Hospital, Manipal,
Karnataka-576119, India.
BACKGROUND: Cryptosporidiosis caused by the protozoa Cryptosporidium,
is the common cause of diarrhoea in Acquired Immune Deficiency
Syndrome (AIDS). AIM: To study the efficacy of short-term azithromycin
in the management of cryptosporidiosis. SETTINGS AND DESIGN: Randomised,
controlled trial. MATERIAL AND METHODS: All consecutive patients
infected with Human Immunodeficiency Virus (HIV), who were positive
for cryptosporidial oocysts were taken for this prospective randomised
study. RESULT: Short-term azithromycin treatment for cryptosporidial
diarrhoea in AIDS patients was associated with good clinical improvement
but parasitological benefit was doubtful. All 13 patients, who
had symptoms of cryptosporidiosis, symptomatically improved with
5 days of treatment with azithromycin and became asymptomatic
after 7 days of antibiotic, but stool sample was positive for
cryptosporidium even after 7 days of therapy. After 14 days of
treatment with azithromycin in 13 patients, in five patients stool
was free of cryptosporidial oocyst. The drug was well tolerated
in all the patients. CONCLUSION: Short-term azithromycin can be
used as a safe and effective treatment for symptomatic Cryptosporidiosis
but not effective in eradicating Cryptosporidial infection.
J Asthma. 2002 Apr;39(2):181-5.
Effect of azithromycin on the severity of bronchial hyperresponsiveness
in patients with mild asthma.
Ekici A, Ekici M, Erdemoglu AK.
Department of Chest Diseases, Faculty of Medicine, Kirikkale University,
Turkey.
The effect of azithromycin on bronchial hyperresponsiveness was
measured in a group of 11 patients with mild asthma. Azithromycin
250 mg orally was administered intermittently to all the patients
twice a week for eight weeks. The only other treatment was inhaled
beta2 agonist, when required. A histamine inhalation test was
performed at the beginning and at the fourth and the eighth week
of the study. The mean PC20 values increased significantly over
the initial value at the eighth week after the administration
of azithromycin (p < 0.05) but mean values for FEV1 and FEV1
percent predicted did not differ significantly. These results
suggested that eight weeks of intermittent, low-dose administration
of azithromycin in patients with mild asthma might reduce the
severity of bronchial hyperresponsiveness.
J Infect Dis. 2000 Jun;181 Suppl 3:S572-8.
Rationale and design of a secondary prevention trial of antibiotic
use in patients after myocardial infarction: the WIZARD (weekly
intervention with zithromax [azithromycin] for atherosclerosis
and its related disorders) trial.
Dunne MW.
Pfizer Central Research, Groton, CT 06340, USA.
Mounting evidence supports the contention that atherosclerosis
is an inflammatory disease. Recently a possible role for infectious
microorganisms has gathered attention. Chlamydia pneumoniae is
one possible pathogen. If C. pneumoniae is a target organism,
antibiotics with antichlamydial activity may be able to ameliorate
plaque instability. The WIZARD trial is a secondary prevention
study that is assessing the impact of a 3-month course of azithromycin
compared with placebo on the progression of clinical coronary
heart disease. The study will enroll 3300 patients who have had
a prior myocardial infarction and who have a C. pneumoniae IgG
titer of >/=1:16. The primary end point is a composite of time
to either recurrent myocardial infarction, death, a revascularization
procedure, or hospitalization for angina. This study is the first
of a series of adequately powered clinical trials that will attempt
to bridge insights from preclinical investigations to interventions
applicable to patient care.
Jpn J Antibiot. 2000 Jun;53 Suppl B:82-90.
Clinical studies of azithromycin, a new macrolide antibiotic,
for infections in the field of surgery.
Nakayama I.
3rd Department of Surgery, Nihon University School of Medicine.
The efficacy of a newly developed macrolide antibiotic, azithromycin,
for infections in the field of surgery, was investigated clinically
by means of collaborative studies conducted in 17 major institutes
and their affiliated hospitals throughout Japan. The following
results were obtained. Clinical assessment: Azithromycin was administered
at a dose of 250 mg or 500 mg once a day for 3 days. Clinical
efficacy was evaluated in 170 patients. These subjects consisted
of 81 with superficial purulent diseases, 12 with mastitis, 25
with periproctal abscess, 42 with superficial secondary infection
due to trauma, burn and operative wound, 5 with cholecystitis
or cholangitis, and 5 with other infections. The clinical efficacy
rate was 96.3% (78/81) for superficial purulent diseases, 83.3%
(10/12) for mastitis, 84.0%(21/25) for periproctal abscess, and
76.2%(32/42) for superficial secondary infection due to trauma,
burn and operative wound. The overall clinical efficacy rate was
88.8%(151/170) respectively. The bacteriological eradication rate
was 87.9%(116/132) for gram-positive bacteria, 85.0%(34/40) for
gram-negative bacteria, and 100%(63/63) for anaerobic strains
of casual bacteria, which were isolated from 140 patients. The
overall bacteriological eradication rate was 90.6%(213/235) respectively.
Adverse effects were observed in 6 of 170 patients in whom they
were evaluated. They consisted of gastrointestinal symptoms in
5 patients and exanthema in 1. Abnormal changes in clinical laboratory
test values were observed in 5 patients, and consisted of eosinophilia
in 1, elevations of S-GOT and S-GPT in 1, elevations of S-GOT,
S-GPT and gamma-GTP in 1, elevation of S-GPT in 1, and elevations
of AL-P and gamma-GTP in 1. These results suggest that azithromycin
is very useful for surgical infections in the field of surgery.
Akush Ginekol (Sofiia). 1998;37(3):58-62.
A new therapeutic approach in the treatment of genital chlamydial
infections. Azithromycin (Sumamed).
Borisov I.
Azithromycin is a member of a new class of macrolides called azalydes.
Although azithromycin resembles erythromycine there are significant
differences in antibacterial activity and pharmacokinetic profile.
Azithromycin is taken up by cells and the intracellular concentrations
are significantly higher than serum concentrations. After a single
oral dose of Ig, azithromycin has a long lasting effect--the tissue
concentrations in the uterine and cervical tissues are kept above
the minimal inhibitory concentration for Chlamydia trachomatis
for more than 10 days. In order to achieve the maximal bioavailability
and avoid side effects (gastrointestinal discomfort), azithromycin
should be taken apart from meals (one hour before or two hours
after meals). Azithromycin has no hepatotoxic potential and the
possibility for drug interactions is not apparent. It is also
recommended for use in pregnant women--FDA category B. A single
oral dose of Ig azithromycin is the reasonable choice for the
treatment of uncomplicated genital chlamydial infection.
Stomatologiia (Mosk). 1995;74(1):12-5.
The prospects for using the new macrolide antibiotic azithromycin
(Sumamed) in the combined treatment of periodontitis.
Filatova NA, Kuznetsov EA, Dmitrieva LA, Tsarev VN, Kalinin AI.
Antibacterial activity of sumamed, a macrolide antibiotic, in
respect of anaerobic microflora of the oral cavity, such as Bacteroides,
Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus,
Str. sanguis and Staph. aureus, was assessed. The drug was found
to be highly effective in respect of bacteroids (MPC90: 1,4 to
30 mg/mlMg/ml, this permitting the use of sumamed in the treatment
of 9 patients with chronic generalized periodontitis in the exacerbation
stage. Bacteriological and clinical control of the results of
therapy demonstrated the drug efficacy in respect of periodontopathogenous
flora, particularly as regards bacteroids and fusobacteria which
maintain the inflammatory process in periodontitis.
