Zithromax scientific update |
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Eur J Clin Microbiol Infect Dis. 2010 Jun 3. [Epub ahead of print]
Fry NK, Duncan J, Vaghji L, George RC, Harrison TG.
Respiratory and Systemic Infection Laboratory, Health Protection Agency Centre for Infections, 61 Colindale Avenue, London, NW9 5EQ, UK, Norman.Fry@HPA.org.uk.
Antimicrobial susceptibility testing of historical and recent clinical isolates of Bordetella pertussis in the United Kingdom using the Etest method.
Reports of the development of antimicrobial resistance by Bordetella pertussis to macrolides in the United States and Taiwan, together with a recent increase in pertussis notifications and laboratory-confirmed cases in England and Wales in 2008, prompted the examination of historical and recent clinical isolates from patients for evidence of such resistance in our collection. Isolates submitted to our laboratory as part of the enhanced surveillance scheme for pertussis, from 2001 to 2009, were tested against three agents, erythromycin, clarithromycin and azithromycin, by the Etest (bioMérieux) method. All isolates (n = 583) were fully susceptible to all three agents tested (minimum inhibitory concentrations [MICs] 256 microg/ml. Although no evidence of resistance was found in the strains tested from the United Kingdom, screening for antimicrobial resistance of B. pertussis may be warranted in cases that are unresponsive to macrolide treatment and to provide early warning of such emergence in the future.
Patient Prefer Adherence. 2010 May 13;4:69-76.
McLean S, Sheikh A.
Centre for Population Health Sciences: GP Section, Allergy and Respiratory Research Group, University of Edinburgh, Medical School, Edinburgh, United Kingdom.
Effectiveness, tolerability and safety of azithromycin 1% in DuraSite for acute bacterial conjunctivitis.
PURPOSE: Bacterial eye infections are commonly treated with topical antibiotics, despite limited evidence of effectiveness. Azithromycin 1% in DuraSite((R)) is a new formulation of azithromycin in a gel polymer designed for use in acute bacterial conjunctivitis. METHODS: We conducted systematic searches of the Cochrane Database of Clinical Trials, PubMed and Google Scholar to find randomized controlled trials of "azithromycin DuraSite((R))". These searches of published literature were supplemented with searches for unpublished trials and trials in progress. RESULTS: We found six reports of randomized controlled trials investigating the role of azithromycin 1% in DuraSite((R)) for the management of acute bacterial conjunctivitis. The quality of these trials was judged to be moderate to high. These trials assessed effectiveness, tolerability and safety outcomes, but we found no trials looking at cost-effectiveness. DuraSite((R)) is a relatively stable formulation and so azithromycin 1% in DuraSite((R)) has a simpler dosing schedule than other available topical antibiotics. It appears to be similar to other topical antibiotics in its effectiveness, but minor side effects are quite common. CONCLUSION: Acute bacterial conjunctivitis is a relatively mild, typically self-limiting, infection. Antibiotics should seldom be required. If, however, a decision to prescribe antibiotics is made, azithromycin 1% in DuraSite((R)) is likely to be broadly comparable in its effectiveness to most other antibiotics used to treat acute bacterial conjunctivitis. Further research is needed to determine its cost-effectiveness.
Sao Paulo Med J. 2010 Jan;128(1):48.
Altamimi S, Khalil A, Khalaiwi KA, Milner R, Pusic M, Al Othman MA.
Short versus standard duration antibiotic therapy for acute streptococcal pharyngitis in children.
BACKGROUND: The standard duration of treatment for acute group A beta hemolytic streptococcus (GABHS) pharyngitis with oral penicillin is 10 days. Shorter duration antibiotics may have comparable efficacy. OBJECTIVES: To summarize the evidence regarding the efficacy of two to six days of newer oral antibiotics (short duration) compared to 10 days of oral penicillin (standard duration) in treating children with acute GABHS pharyngitis. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, issue 4), which contains the Acute Respiratory Infections Group's Specialized Register; the Database of Abstracts of Reviews of Effects (DARE); MEDLINE (1966 to October 2007); OLDMEDLINE (1950 to December 1965); and EMBASE (January 1990 to November 2007). SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing short duration oral antibiotics to standard duration oral penicillin in children aged 1 to 18 years with acute GABHS pharyngitis. DATA COLLECTION AND ANALYSIS: Two review authors scanned the titles and abstracts of retrieved citations and applied the inclusion criteria. We retrieved included studies in full and extracted data. Two review authors independently assessed trial quality. MAIN RESULTS: Twenty studies were included with 13,102 cases of acute GABHS pharyngitis. Compared to standard duration treatment, the short duration treatment had shorter periods of fever (mean difference (MD) -0.30 days, 95% CI -0.45 to -0.14) and throat soreness (MD -0.50 days, 95% CI -0.78 to -0.22); lower risk of early clinical treatment failure (OR 0.80, 95% CI 0.67 to 0.94); no significant difference in early bacteriological treatment failure (OR 1.08, 95% CI 0.97 to 1.20), or late clinical recurrence (OR 0.95, 95% CI 0.83 to 1.08). However, the overall risk of late bacteriological recurrence was worse in the short duration treatment (OR 1.31, 95% CI 1.16 to 1.48), although no significant differences were found when studies of low dose azithromycin (10mg/kg) were eliminated (OR 1.06, 95% CI 0.92 to 1.22). Three studies reported long duration complications with no statistically significant difference (OR 0.53, 95% CI 0.17 to 1.64). AUTHORS' CONCLUSIONS: Three to six days of oral antibiotics had comparable efficacy compared to the standard duration 10 day oral penicillin in treating children with acute GABHS pharyngitis. In countries with low rates of rheumatic fever, it appears safe and efficacious to treat children with acute GABHS pharyngitis with short duration antibiotics. In areas where the prevalence of rheumatic heart disease is still high, our results must be interpreted with caution.
Antimicrob Agents Chemother. 2010 May 24. [Epub ahead of print]
Gunell M, Kotilainen P, Jalava J, Huovinen P, Siitonen A, Hakanen AJ.
Antimicrobial Resistance Unit and Gastrointestinal Infections Unit, Department of Infectious Disease Surveillance and Control, National Institute for Health and Welfare, Turku and Helsinki, Finland, and Department of Medicine, Turku University Hospit
In vitro activity of azithromycin against nontyphoidal Salmonella enterica.
The in vitro activity of azithromycin was investigated among 1237 nontyphoidal Salmonella enterica isolates collected from Finnish patients between 2003 and 2008. Only 24 (1.9 %) of the tested isolates and 15 (5.1 %) of the 294 isolates with reduced fluoroquinolone susceptibility had azithromycin MICs >/=32 mug/ml. These data show that azithromycin has a good in vitro activity against nontyphoidal S. enterica, and thus, it may be a good candidate for clinical treatment studies of salmonellosis.
J Avian Med Surg. 2010 Mar;24(1):35-45.
Guzman DS, Diaz-Figueroa O, Tully T Jr, Ciembor P, Morgan T, Walden M, Poston RP, Flammer K, Mitchell MA, Ritchie B.
Department of Veterinary Clinical Sciences, Louisiana State University, School of Veterinary Medicine, Baton Rouge, LA 70803, USA.
Evaluating 21-day doxycycline and azithromycin treatments for experimental Chlamydophila psittaci infection in cockatiels (Nymphicus hollandicus).
To determine the efficacy of 21-day therapy with azithromycin and doxycycline in the treatment of experimental infection with Chlamydophila psittaci in cockatiels (Nymphicus hollandicus), 30 birds randomly assigned to 3 treatment groups and 1 control group were inoculated with C psittaci by combined intranasal and ocular routes. Morbidity, mortality, and results of polymerase chain reaction testing confirmed that infection was successful. Birds in group 1 (n = 8) received azithromycin at 40 mg/kg PO q48h for 21 days; in group 2 (n = 8), doxycycline at 35 mg/kg PO q24h for 21 days; in group 3 (n = 8), doxycycline at 35 mg/kg PO q24h for 45 days; and, in group 4 (controls; n = 6), no treatment. Six birds died either before or within 2 days of initiating treatment: 4 in the 3 treatment groups and 2 in the control group. Clinical signs resolved and mortality ceased 2-6 days after treatment was initiated in all treatment groups, whereas birds in the control group exhibited clinical signs for the duration of the study. Plasma doxycycline concentrations were measured during the treatment period and exceeded 1 microg/mL at all time points. The absence of clinical signs and mortality in the treatment groups, even after inducing an immunocompromised state with dexamethasone (3 mg/kg IM q24h for 5 days), starting on day 70 postinoculation, suggested that treatment resulted in elimination of the pathogen. After euthanasia of the remaining 24 birds, 23 of the carcasses were submitted for necropsy. Spleen and liver samples from the birds in all treatment and control groups were polymerase chain reaction negative for C psittaci nucleic acid, and organisms were not detected by Gimenez stain. No gross or histologic differences were observed in the livers and spleens of treated and untreated infected birds. Lesions consistent with avian chlamydiosis (hystiocytosis) were seen in all birds and were considered residual. In this study, a 21-day course of either doxycycline or azithromycin was effective in eliminating C psittaci infection in experimentally inoculated cockatiels. Additional studies are necessary to evaluate the efficacy of these treatments in naturally infected cockatiels as well as other species of birds.
Cornea. 2010 May 20. [Epub ahead of print]
Foulks GN, Borchman D, Yappert M, Kim SH, McKay JW.
From the *Departments of Ophthalmology and Vision Science; and daggerChemistry, University of Louisville, Louisville, KY.
Topical Azithromycin Therapy for Meibomian Gland Dysfunction: Clinical Response and Lipid Alterations.
PURPOSE:: Meibomian gland dysfunction (MGD) is a common clinical problem that is often associated with evaporative dry eye disease. Alterations of the lipids of the meibomian glands have been identified in several studies of MGD. This prospective, observational, open-label clinical trial documents the improvement in both clinical signs and symptoms of disease and spectroscopic behavior of the meibomian gland lipids after therapy with topical azithromycin ophthalmic solution. METHODS:: Subjects with symptomatic MGD were recruited. Signs of MGD were evaluated with a slit lamp. Symptoms of MGD were measured by the response of subjects to a questionnaire. Meibum lipid, lipid-lipid interaction strength, and conformation and phase transition parameters were measured using Fourier transform infrared spectroscopy. RESULTS:: In subjects with clinical evidence of MGD, changes in ordering of the lipids and resultant alteration of phase transition temperature were identified. Topical therapy with azithromycin relieved signs and symptoms and restored the lipid properties of the meibomian gland secretion toward normal. CONCLUSIONS:: Improvement in phase transition temperature of the meibomian gland lipid with the determined percent trans rotomer composition of the lipid strongly suggests that the ordering of the lipid molecules is altered in the disease state (MGD) and that azithromycin can improve that abnormal condition toward normal in a manner that correlates with clinical response to therapy.
Zhonghua Er Ke Za Zhi. 2009 Dec;47(12):946-9.
Wang W, Shen KL.
Department of Internal Medicine, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
[Mycoplasma pneumonia associated with cerebral infarction in 3 children] [Article in Chinese]
OBJECTIVE: To study the clinical features and diagnostic methods of mycoplasma pneumonia complicated with cerebral infarction. METHOD: Data of 3 children with mycoplasma pneumonia who developed cerebral infarction, including clinical manifestations and imaging were collected, analyzed and the literature was reviewed. RESULT: All the cases were pre-school or school-aged children, who developed the respiratory infection initially, the neurological symptoms were acute hemiparesis, with or without convulsion. The IgM antibody to Mycoplasma pneumoniae (Mp) was positive. Pulmonary imaging showed unilateral consolidation with atelectasis and pleural exudate. Neuroimaging showed occlusion of middle cerebral artery and infarction of its territory. After giving azithromycin, anti-coagulative and thrombolytic treatments, the neurological deficits recovered to some extent. CONCLUSION: Mycoplasma pneumonia were diagnosed based on respiratory symptoms and pulmonary imaging, the accompanied cerebral infarction was confirmed by neurological and neuroimaging findings.
Braz J Infect Dis. 2009 Jun;13(3):218-20.
Belda Jr W, Di Chiacchio NG, Di Chiacchio N, Romiti R, Criado PR, Velho PE.
Department of Dermatology, São Paulo University. walterbelda@uol.com.br
A comparative study of single-dose treatment of chancroid using thiamphenicol versus Azithromycin.
A study was conducted in São Paulo, Brazil, to compare azithromycin with thiamphenicol for the single-dose treatment of chancroid. In all, 54 men with chancroid were tested. The etiology was determined by clinical characterization and direct bacterioscopy with Gram staining. None of the patients had positive serology or dark-field examination indicating active infection with Treponema pallidum. Genital infections due to Neisseria gonorrhoeae and herpes simplex virus were excluded by polymerase chain reaction testing. For 54 patients with chancroid, cure rates with single-dose treatment were 73% with azithromycin and 89% with thiamphenicol. HIV seropositivity was found to be associated with treatment failure (p=0.001). The treatment failed in all HIV positive patients treated with azithromycin (p=0.002) and this drug should be avoided in these co-infected patients. In the view of the authors, thiamphenicol is the most indicated single-dose regimen for chancroid treatment.
Vojnosanit Pregl. 2009 Dec;66(12):1010-4.
Andrijević I, Matijasević J, Povazan D, Kojicić M, Batranović U.
Institut za plućne bolesti Vojvodine, Sremska Kamenica, Srbija. ipb@eunet.rs
[Severe form of Legionnaires' disease in an immunocompetent patient] [Article in Serbian]
BACKGROUND: Legionnaires' disease (LD) is a pneumonia caused by Legionella pneumophila (LP). The disease occurs more often in immunocompromised persons and can be manifested by severe pneumonia, multiple organ failure and has a high mortality. CASE REPORT: Immunocompetent patient, male, 53-year old, with severe form of LB had fever, cough, weakness and diarrhea as the initial symptoms of the disease. Laboratory results showed increased number of leukocytes, increased values of acute phase proteins, liver enzymes and hyponatremia. Computed tomography of the chest showed the marked inflammatory lessions on both sides. Pathohistological analysis of the samples retrieved by bronchoscopy pointed to a pneumonia, and diagnosis of LD was confirmed by positive urine test for LP antigen. Later, the disease was complicated by acute adult respiratory distress syndrome (ARDS). Treatment with antibiotics (erythromycin, rifampicin, azithromycin) combined with ARDS treatment led to a clinical recovery of the patient together with complete resolution of inflammatory lesions seen on chest radiography. CONCLUSION: In severe pneumonias it is necessary to consider LD in differential diagnosis, perform tests with aim of detecting LP and apply adequate antibiotic treatment in order to accomplish positive outcome of the therapy and prevent complications.
Nihon Rinsho Meneki Gakkai Kaishi. 2009 Dec;32(6):511-4.
Nanke Y, Kobashigawa T, Yago T, Ichikawa N, Kamatani N, Kotake S.
Institute of Rheumatology, Tokyo Women's Medical University.
Case of Chlamydia-associated arthritis.
We report a case of Chlamydia-associated arthritis in a 40-year-old man. The patient experienced four episodes of Chlamydia trachomatis urtethritis within a few years. During the present episode, polyarthritis developed a few days after Chlamydia trachomatis urethritis was noted. The patient was diagnosed as having Chlamydia-associated arthritis. Loxoprofen sodium and azithromycin were started. Antibiotics induced clinical improvement of urethritis, although arthritis persisted for 3 months. HLA-B27 was negative, but both HLA-B35 and B40 were positive. Thus, we speculate that positivity for both HLA-B35 and HLA-B40 contributed to the persistence of arthritis in this case. During the course, the levels of Th1, Th17 and regulatory T cells in the peripheral blood were increased on flowcytometry. Thus, we speculate that Th17 may play, at least in part, an important role of the pathogenesis in this case.
BMC Oral Health. 2009 Dec 8;9:33.
Condé SA, Bastos MG, Vieira BJ, Aarestrup FM.
Department of Clinical Dental, Federal University of Juiz de Fora/UFJF - Juiz de Fora/Brazil, Dom André Arcoverde Foundation, Valença, Brazil. simoneprobst@ibest.com.br
Down-regulation of transforming growth factor beta-2 expression is associated with the reduction of cyclosporin induced gingival overgrowth in rats treated with roxithromycin: an experimental study.
BACKGROUND: Gingival overgrowth (GO) is a common side effect of the chronic use of cyclosporine (CsA), an immunosuppressant widely used to prevent rejection in transplant patients. Recent studies have reported elevated levels of specific cytokines in gingival overgrowth tissue, particularly TGF-beta, suggesting that this growth factor plays a role in the accumulation of extracellular matrix materials. The effectiveness of azithromycin, a macrolide antibiotic, in the regression of this undesirable side effect has also been demonstrated. METHODS: In this study, we created an experimental model for assessing the therapeutic effect of roxithromycin in GO and the expression of transforming growth factor beta (TGF-beta2) through immunohistochemistry. We used four groups of rats totaling 32 individuals. GO was induced during five weeks and drug treatment was given on the 6th week as follows: group 1 received saline; group 2 received CsA and was treated with saline on the 6th week; group 3 received CsA and, on the 6th week, ampicilin; and group 4 received CsA during 5 weeks and, on the 6th week, was treated with roxithromycin. RESULTS: The results demonstrated that roxithromycin treatment was effective in reducing cyclosporine-induced GO in rats. Both epithelial and connective tissue showed a decrease in thickness and a significant reduction in TGF-beta2 expression, with a lower number of fibroblasts, reduction in fibrotic areas and decrease in inflammatory infiltrate. CONCLUSION: The present data suggest that the down-regulation of TGF-beta2 expression may be an important mechanism of action by which roxithromycin inhibits GO.
Zhonghua Yan Ke Za Zhi. 2009 Jun;45(6):503-8.
Guan HJ, Cheng ZP, Yin L, Wu YY, Hu N, Zhang JF, Shi HH.
Department of Ophthalmology, Affiliated Hospital of Nantong University, Nantong 226001, China.
[The diagnosis and treatment of rapidly growing non-tuberculous mycobacterial keratitis] [Article in Chinese]
OBJECTIVE: To study the clinical features, diagnosis and treatment of non-tuberculous mycobacterial keratitis (NTMK). METHODS: It was retrospective case series study. Twelve eyes in 12 patients with NTMK following corneal foreign body trauma in 2007 were studied retrospectively including the case histories, clinical findings, laboratory examinations, diagnosis, treatment and prognosis. The main laboratory examination included corneal scrapings by culturing, polymerase chain reaction (PCR) and transmission electron microscopy (TEM), corneal lesions by histopathologic examinations and TEM. The patients received local and systemic antibiotics therapy, lesion cleaning followed by cauterization with tincture of iodine (5%) and (or) keratoplasty. RESULTS: All cases had a history of corneal trauma, there was corneal metallic foreign body removal at one hospital in 11 cases, corneal reed trauma in 1 case. The characteristic signs involved grayish-blue crystalloid keratopathy, multifocal infiltrates, satellites, radiatiform changes in the Descement's membrane. The results of laboratory examinations of the scrapings of the cornea infection were as follows: all cultures (12/12) were positive for rapidly growing mycobacteria, and isolates from 5 patients were all diagnosed as mycobacterium chelonae subspecies abscess; acid-fast staining revealed positive bacilli in all the 4 patients; seven of 8 patients were positive for bacterium by PCR. Transmission electron microscopy in all the 3 specimens showed many slender rod-shaped or short coarse-shaped bacteria which were phagocytized by monocytes, and some necrotic tissue. Infections in 10 eyes were resolved by combined treatment regimen including a combination of antimicrobial agents (amikacin, rifampin, gatifloxation, ciprofloxacin, azithromycin and/or ofloxacin, etc.) and local lesion cleaning followed by cauterization with 5% tincture of iodine within 2-5 months; two cases resolved by keratoplasty which poorly responded to antibiotic therapy for 6 months. CONCLUSIONS: NTMK is a rare, recalcitrant opportunistic infection which can occur in an epidemic fashion following corneal foreign body trauma. The diagnosis of NTMK is difficult, and may easily be misdiagnosed as fungal keratitis. Acid-fast staining, TEM, especially bacterial culture can help to obtain definitive diagnosis. NTMK has a long response period to medical management. The majority of patients can be cured by local and systemic antibiotics therapy, and the recalcitrant infections could be resolved by keratoplasty.
Arch Bronconeumol. 2008 Dec;44(12):679-84.
Girón RM, Máiz L, Barrio I, Martínez MT, Salcedo A, Prados C.
Unidad de Fibrosis Quística, Hospital de la Princesa, Madrid, España. med00286@nacom.es
[Nontuberculous mycobacterial infection in patients with cystic fibrosis: a multicenter prevalence study]
OBJECTIVE: To determine the prevalence of nontuberculous mycobacterial infection in patients with cystic fibrosis. PATIENTS AND METHODS: We performed a prospective study in which patients with cystic fibrosis were followed for 2 years; the patients were recruited from specialized units and were all over 6 years old. Sputum samples collected every 6 months were stained with auramine-rhodamine and cultures were prepared with a liquid and a solid medium. When stains or cultures were positive for nontuberculous mycobacteria, 1 or 2 additional sputum samples were obtained from the patients, who were monitored closely to assess the need for specific treatment. We assessed the following clinical variables: age, sex, presence of pancreatic insufficiency, use of aerosol antibiotic therapy, and long-term azithromycin and inhaled or oral corticosteroid therapies. RESULTS: A total of 220 patients (119 women) with a mean age of 22.62 years (range, 6-74 years) were enrolled; of these 23.6% were receiving azithromycin. We prepared 1303 sputum samples for mycobacterial growth (range per patient, 4-68 samples); 65 samples from a total of 17 patients (7.72%) were positive: 17 by auramine-rhodamine staining and 48 by culture. Eighty-eight culture samples were contaminated and Mycobacterium tuberculosis was not isolated in any of the cases. The mycobacteria isolated were M avium complex (n=10), M abscessus (n=6), and M fortuitum (n=1). Two or more positive cultures were obtained in 9 patients, 5 of whom experienced clinical deterioration and were prescribed specific treatment. No significant differences in clinical variables were found between patients with nontuberculous mycobacteria and those without. CONCLUSIONS: The prevalence of nontuberculous mycobacterial infection in patients with cystic fibrosis was not very high (7.72%), perhaps because azithromycin interfered with the growth of these bacteria. Patients with repeat isolations of mycobacteria should be monitored closely.
Lett Appl Microbiol. 2008 Oct;47(4):309-14.
Banche G, Roana J, Allizond V, Andreotti S, Malabaila A, Li Vigni N, Mandras N, Scalas D, Tullio V, Carlone NA, Savoia D, Gaido E, Barbui A, Cuffini AM.
Department of Public Health and Microbiology, University of Turin, Turin, Italy.
In vitro compared activity of telithromycin and azithromycin against northwest Italian isolates of Streptococcus pyogenes and Streptococcus pneumoniae with different erythromycin susceptibility.
AIMS: This study compared the in vitro activity of telithromycin with that of azithromycin against 438 Streptococcus pyogenes and 198 Streptococcus pneumoniae, isolated over the period 2005-2007 from specimens of different human origin obtained in three Piemonte Region's hospitals. METHODS AND RESULTS: The determination of antimicrobial activity was evaluated by the microdilution broth method and the erythromycin-resistant (Ery-R) phenotypes by the triple-disc test. Exactly 78.8% of S. pyogenes and 69.2% of S. pneumoniae were erythromycin-susceptible (Ery-S). Concerning S. pyogenes, telithromycin was active against M and inducible MLS(B), subtype-C, phenotypes but not against constitutive MLS(B) strains. Telithromycin acted well against all S. pneumoniae, irrespective of their mechanism of macrolide-resistance. On the contrary, the Ery-R isolates, both S. pyogenes and S. pneumoniae, were resistant to azithromycin. CONCLUSIONS: Our results indicate that macrolide resistance in streptococci still persist in northwest Italy (21.2% of S. pyogenes and 308% of S. pneumoniae) and that telithromycin is confirmed as being extremely active even against recent clinical Ery-R streptococcal isolates. SIGNIFICANCE AND IMPACT OF THE STUDY: The present study emphasizes that an active surveillance of the phenotype distribution and antibacterial resistance in streptococci is essential in guiding the effective use of empirical treatment option for streptococcal infections, also at regional level.
Clin Ther. 2008 Nov;30(11):2005-14.
Torkildsen G, O'Brien TP.
Andover Eye Associates, Andover, Massachusetts, USA.
Conjunctival tissue pharmacokinetic properties of topical azithromycin 1% and moxifloxacin 0.5% ophthalmic solutions: a single-dose, randomized, open-label, active-controlled trial in healthy adult volunteers.
BACKGROUND: Effective ocular tissue concentrations and prolonged residence times of antibacterial agents are important in treating both acute and chronic diseases. Conjunctival biopsy allows the determination of specific tissue concentration data for topical ophthalmic agents. Drug concentration analysis at various time points following instillation allows interpretation of the residence time and a rationale for dosing frequency. OBJECTIVE: This study compared the pharmacokinetic parameters of 2 currently available topical ocular antibiotics-azithromycin ophthalmic solution 1% and moxifloxacin ophthalmic solution 0.5%-in the conjunctiva of healthy volunteers after a single topical administration. METHODS: This single-dose, randomized, open-label, active-controlled clinical trial was conducted at ORA Clinical Research and Development, North Andover, Massachusetts. Subjects were randomly assigned to receive a single dose of azithromycin or moxifloxacin and to undergo biopsy sampling at 30 minutes or 2, 12, or 24 hours after administration. Concentrations of azithromycin and moxifloxacin were determined using liquid chromatography tandem mass spectrometry. Adverse events (AEs) were assessed at all visits using visual acuity measurements, slit-lamp biomicroscopy, and direct questioning. RESULTS: Forty-eight subjects (mean age, 40.0 years; 48% female; 96% white, 2% black, and 2% Asian) underwent conjunctival biopsy. Mean (SD) concentrations of azithromycin in conjunctival tissue (lower limit of quantitation [LLOQ], 1 microg/g for 1-mg biopsy specimen) were 131 (89), 59 (19), 48 (24), and 32 (20) microg/g at 30 minutes and 2, 12, and 24 hours, respectively (median values, 117, 69, 46, and 30 microg/g). Mean concentrations concentrations of moxifloxacin in conjunctival tissue (LLOQ, 0.05 microg/g for 1-mg biopsy sample) were 1.92 (2.03), 3.77 (8.98), 0.02 (0.04), and 0.01 (0.02) microg/g at 30 minutes and 2, 12, and 24 hours, respectively (median values, 1.12, 0.12, <0.05, and <0.05 microg/g). Thirteen subjects (6 in the azithromycin group and 7 in the moxifloxacin group) experienced 20 AEs, 11 of which were considered possibly related to study treatment, and 15 of which were ocular (most commonly conjunctival hemorrhage). CONCLUSIONS: In this single-dose study of 2 currently available topical ocular antibiotics in healthy volunteers, therapeutic concentrations were achieved with both agents. Both treatments were well tolerated in the population studied.
Enferm Infecc Microbiol Clin. 2008 Dec;26(10):621-8.
Isla A, Canut A, Rodríguez-Gascón A, Planells P, Beltrí-Orta P, Salmerón-Escobar JI, Labora A, Pedraz JL.
Laboratorio de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad del País Vasco, Spain.
[Antibiotic therapy in odontogenic infections in children and adolescents: pharmacokinetic/pharmacodynamic analysis]
INTRODUCTION: The objective of this study was to evaluate the efficacy of the most commonly used antimicrobial treatments in odontogenic infections in children and adolescents on the basis of pharmacokinetic/ pharmacodynamic (PK/PD) criteria. METHODS: Unbound drug plasma concentration-time curves were simulated with mean population pharmacokinetic parameters of amoxicillin, co-amoxiclav, cefuroxime axetil, spiramycin, clindamycin, azithromycin, and metronidazole. For drugs showing time-dependent antibacterial killing, the time above MIC90 of the pathogens studied was calculated (T>MIC). For drugs with concentration-dependent bactericidal activity, the area under the concentration-time curve (AUC)/MIC90 ratio was calculated. RESULTS: Adequate efficacy indexes (T>MIC>40%) against all the microorganisms examined with the exception of Veillonella spp. were obtained with co-amoxiclav (80 mg/kg/day). Clindamycin (40 mg/kg/day) obtained adequate PK/PD indexes except for Lactobacillus, Actinobacillus actinomycetemcomitans, penicillin-resistant Peptostreptococcus, and Eikenella corrodens. High-dose amoxicillin yielded unsatisfactory results against many bacterial species. Azithromycin and metronidazole showed inadequate efficacy indexes against the majority of pathogens studied (AUC/MIC90<25). CONCLUSION: When antibiotic therapy is needed for odontogenic infections in children and adolescents, the most active empirical therapeutic choice is co-amoxiclav with high doses of amoxicillin. Clindamycin can be used as an alternative option. These results should be confirmed in clinical trials, in which the PK/PD approach could be useful for the design and assessment of results.
Zhonghua Er Ke Za Zhi. 2008 Oct;46(10):732-8.
Wang W, Shen KL, Zeng JJ.
Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
[Clinical studies of children with bronchiolitis obliterans]
OBJECTIVE: Bronchiolitis obliterans (BO) is a chronic airflow obstruction syndrome associated with inflammatory lesions of the small airways. The etiology, pathogenesis, effective treatment and prognosis of this disorder remain uncertain by now. There has been no large scale clinical research on BO in China. This study aimed to analyze the clinical characteristics of BO in children. METHODS: Clinical analysis was done on data of 42 patients (31 boys and 11 girls, aged from 7 months to 12 years and 2 months) with bronchiolitis obliterans diagnosed and treated in Beijing Children's Hospital from April 2001 to August 2007. The diagnostic criteria included typical clinical manifestations, specific pulmonary CT imaging and lung function tests. RESULTS: All the patients presented with persistent cough and wheezing. Crackles and wheezing were heard in most cases. Thirty-two (76.2%) cases were post-infectious BO, among whom 8 (25%) were supposed to be adenovirus pneumonia, 7 (21.9%) measles pneumonia and 2 (6.2%) respiratory syncytial virus infection. In 4 (9.5%) cases BO occurred after Steven-Johnson syndrome, and 1 (2.4%) after bone marrow transplantation. The constrictive obstruction in small airway occurred in 35 cases (89.7%), while mixed pattern in 4 (10.3%). Pulmonary CT revealed mosaic perfusion in 34 cases (81.0%), bronchiectasis in 14 cases (33.3%), bronchial wall thickening in 14 cases (33.3%), atelectasis in 4 cases (9.5%) and Swyer-James syndrome in 2 cases (4.8%). All the cases received oral corticosteroid and low doses of erythromycin or azithromycin, with corticosteroid and bronchodilator inhalation or oral montelukast. Follow up time was from 1 month to 5 years. Besides 2 cases in whom the disease was ameliorated in clinical presentation, pulmonary imaging and function, the rest experienced deterioration and one died. CONCLUSION: In most of the patients BO occurred following infections. The specific clinical presentations, imaging and pulmonary function are sufficiently informative for diagnosis. Most of the cases enrolled in this study had a poor outcome.
Antibiot Khimioter. 2007;52(7-8):21-31.
Dvoretskiĭ LI, Dubrovskaia NV, Grudinina SA, Filimonova OIu, Sidorenko SV, Iakovlev SV.
[Levofloxacin and macrolides in chronic bronchitis exacerbation: comparative analysis of the treatment efficacy and nonrelapsing periods]
Clinical and bacteriological efficacies of levofloxacin versus clarithromycin and azithromycin were evaluated in 41 patients with chronic bronchitis infectious exacerbation in the Respiratory-Recovery Centre of Polyclinic No. 7. The effect of the drugs on the nonrelapsing period was estimated as well. With the use of levofloxacin there was observed a more rapid elimination of the clinical signs of the exacerbation as compared to the use of the macrolides. Levofloxacin provided a more pronounced and stable eradication of the main pathogens of the exacerbation as compared to the macrolide antibiotic. Long-term monitoring for 12 months after discontinuation of the treatment showed that the nonrelapsing period in the patients treated with levofloxacin was higher and the frequency of the relapses and their intensity were lower in comparison to the group of the patients treated with the macrolides.
Dermatol Online J. 2007 Oct 13;13(4):4.
Bardazzi F, Savoia F, Parente G, Tabanelli M, Balestri R, Spadola G, Dika E.
Department of Specialistic and Experimental Clinical Medicine, Division of Dermatology,University of Bologna, Italy.
Azithromycin: a new therapeutical strategy for acne in adolescents.
AIM: To study the efficacy, safety, and compliance of 500 mg azithromycin thrice weekly for 8 weeks to treat acne vulgaris in adolescents. METHODS: An open-label, non-comparative study was carried out for 8 weeks. Fifty-two teenagers with moderate to severe papulo-pustular acne vulgaris were enrolled. Azithromycin, 500 mg orally thrice weekly for 8 weeks, was prescribed. No topical treatment was permitted. At the baseline visit, patients were scheduled to return at two-weekly intervals for 8 weeks. Efficacy was gauged by the percentage clearance of papulo-pustular acne lesions. All patients were also evaluated at four months post-treatment. RESULTS: A majority of patients (47/52) showed remarkable improvement in the first 4 weeks with a more than 20 percent reduction of their inflammatory papulo-pustular lesions. Maximum clearance was observed in 32 patients at 8 weeks. Slow improvement with eruptions of new lesions was seen in 6 patients. Adverse events, such as heartburn and nausea, were reported by 3 patients. All patients completed the 8-week study period. The beneficial effect was maintained at 4 months after the conclusion of treatment. CONCLUSIONS: Azithromycin, 500 mg thrice weekly for 8 weeks, appears to be a safe and effective treatment for acne vulgaris in adolescents, with excellent patient compliance.
Turk J Pediatr. 2007 Oct-Dec;49(4):390-6.
Biner B, Celtik C, Oner N, Küçükuğurluoğlu Y, Güzel A, Yildirim C, Adali MK.
Department of Pediatrics, Trakya University Faculty of Medicine, Edirne, Turkey.
The comparison of single-dose ceftriaxone, five-day azithromycin, and ten-day amoxicillin/clavulanate for the treatment of children with acute otitis media.
The aim of the study was to evaluate the efficacy of short-course antimicrobial therapies [single intramuscular dose of ceftriaxone (50 mg/kg, not exceeding 1 g), 5 days of azithromycin (10 mg/kg on day 1, then 5 mg/kg daily on days 2-5) and the traditional 10-day course of amoxicillin/clavulanate (90/6.4 mg/kg/day in 2 doses)] in children with acute otitis media (AOM). The study was conducted as a prospective, comparative, open randomized trial between February 2001 and April 2003, and 104 children were enrolled, with a mean age of 3.8 (2.3) years. The clinical and otoscopic assessments of the children were made on days 0, 3, 11 and 30 after admission, and tympanometry was performed on day 30. The patients were diagnosed and followed with a scoring system. Clinical success was achieved in 29/34 patients (85.3%) in the ceftriaxone group, 27/31 patients (87.1%) in the azithromycin group and 34/39 children (87.2%) in the amoxicillin/clavulanate group. The rate of persistence of middle-ear fluid did not differ between the three groups (p>0.05). During the one-month period, no recurrent case was observed. The most common drug-related adverse effects were associated with the gastrointestinal system. In conclusion, for the treatment of children with AOM, the clinical success of single-dose intramuscular ceftriaxone and of five-day azithromycin treatments was comparable to that of the traditional 10-day therapy with high-dose amoxicillin/clavulanate.
Int J Nanomedicine. 2007;2(4):551-9.
Blasi F, Aliberti S, Tarsia P.
Institute of Respiratory Diseases, University of Milan, IRCCS Fondazione Policlinico-Mangiagalli-Regina Elena Milano, Italy. francesco.blasi@unimi.it
Clinical applications of azithromycin microspheres in respiratory tract infections.
Few adequately designed clinical trials have addressed optimal treatment duration in lower respiratory tract infections. Drugs possessing favourable pharmacokinetic and pharmacodynamic profiles may obtain early bacterial eradication allowing shorter treatment duration. This may be associated with a number of advantages including reduced resistance induction, increased compliance, lesser adverse events, and cost containment. Recently, a novel 2.0 g single dose of azithromycin microspheres has been compared with 7-day levofloxacin 500 mg or extended release clarithromycin in over 400 patients with community-acquired pneumonia. Clinical cure and bacteriological eradication rates, hospitalizations, and deaths were similar between azithromycin and comparators. Azithromycin 2.0 g microspheres proved as effective as 7 days of levofloxacin 500 mg in acute exacerbation of chronic bronchitis patients across all degrees of obstruction severity. In both settings Azithromycin microspheres obtained clinical cure in most patients harbouring macrolide-resistant Streptococcus pneumoniae strains. The drug was well tolerated in clinical studies and in healthy volunteers with modest and transitory adverse events. An undoubted advantage of single-dose azithromycin administration is the facility in ensuring that patients complete their prescribed course of therapy. A further advantage of single-dose therapy is the potential for use as directly-observed therapy, which may be useful in specific clinical conditions.
Int J Immunopathol Pharmacol. 2007 Oct-Dec;20(4):847-9.
Boner AL, Peroni D, Bodini A, Delaini G, Piacentini G.
Department of Pediatrics, University of Verona, Italy.
Azithromycin may reduce cholestasis in primary sclerosing cholangitis: a case report and serendipitous observation.
The newer macrolides have been shown to exert additional anti-inflammatory effects. We report the possible effect of azithromycin on primary sclerosing cholangitis in a patient treated with the drug for severe asthma. A 45-year-old woman with Crohn?s disease and primary sclerosing cholangitis, also suffering from severe asthma, was treated with azithromycin 500 mg OD for 3 consecutive days a week because of the clinical suspicion of bronchiectasis and the severity of her asthma. When the therapy was discontinued, her urine again became darker, pruritus reappeared with the usual severity and laboratory parameters, evaluated after 6 weeks without azithromycin, also worsened. For these reasons macrolide treatment was re-established. Cholestasis-related symptoms and the dark colour of the urine were again reduced 6 weeks later and laboratory parameters were again reversed. We are therefore tempted to speculate that azithromycin may have an effect on primary sclerosing cholangitis on the basis of its anti-inflammatory properties.
Clin Ther. 2007 Dec;29(12):2690-8.
Marple BF, Roberts CS, de Caprariis PJ, Reisman A.
Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA. bradley.marple@utsouthwestern.edu
Onset of symptom resolution in adults with acute bacterial rhinosinusitis treated with a single dose of azithromycin extended release compared with 10 days of levofloxacin: a retrospective analysis of a randomized, double-blind, double-dummy trial.
BACKGROUND: A previous study found that a single 2-g dose of azithromycin extended release (AZ-ER) was as efficacious as 10 days of levofloxacin (LFX) 500 mg QD in adults with acute bacterial rhinosinusitis (ABRS). The speed with which patients experience resolution of ABRS symptoms has not been reported. OBJECTIVE: The purpose of this study was to evaluate the resolution of ABRS symptoms after a single 2-g dose of AZ-ER compared with 10 days of LFX. METHODS: This was a retrospective analysis of data from a published international, randomized, double-blind, double-dummy clinical trial conducted between January 21, 2003, and February 20, 2004, that included 534 adult (age >or=18 years) outpatients with ABRS. All patients entering the study were required to have purulent nasal discharge, purulent drainage in the posterior pharynx, or purulent discharge from the maxillary sinus orifice and at least 1 of 3 other protocol-defined cardinal symptoms of ABRS (sinus pain, pressure, or tenderness) for >or=7 days. In addition, they were required to have at least 2 of the following 6 noncardinal symptoms at baseline: cough, fever, headache, nasal congestion, postnasal discharge, and leukocytosis. All patients who received medication were assessed for the occurrence of adverse events at study visits during and after therapy. At the ontreatment visit (between days 3 and 5), baseline symptoms were reassessed as resolved, improved, same, new, or worse. Resolution of symptoms was calculated as the proportion of patients with 3 or 4 cardinal symptoms either resolved (if present at baseline) or not new (if absent at baseline). Concomitant medications other than antibiotics were allowed as needed for symptomatic treatment. RESULTS: Demographic characteristics were similar at baseline between the AZ-ER and LFX treatment arms (mean age, 38.4 and 39.5 years, respectively), although more women were randomized to receive LFX (62.9%) than AZ-ER (53.3%) (P = 0.025). More than 90% of patients in both arms had >or=3 ABRS symptoms at baseline. At the on-treatment visit, resolution of >or=3 ABRS symptoms was achieved in 88 of 270 AZ-ER patients (32.6%) and 61 of 261 LFX patients (23.4%) (P = 0.018). Resolution of individual symptoms in the AZ-ER and LFX groups at 3 to 5 days was as follows: sinus pain (92/253[36.4%] and 77/251 [30.7%]; P = NS), sinus pressure (97/243 [39.9%] and 68/244 [27.9%]; P = 0.005), sinus tenderness (83/218 [38.1%] and 73/214 [34.1%]; P = NS), and nasal discharge (57/270 [21.0%] and 49/264 [18.6%]; P = NS). Treatment-related adverse events were reported by 63 of 270 AZ-ER patients (23.3%) and 41 of 268 LFX patients (15.3%). Gastrointestinal disturbances were the most common adverse events, including nausea (4.4% and 3.4%) and abdominal pain (2.6% and 0.4%).
Clin Infect Dis. 2003 May 15;36(10):1239-45. Epub 2003 May 06.
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.
Is azithromycin the first-choice macrolide for treatment of community-acquired pneumonia?
A study was conducted to find out whether azithromycin is the first-choice macrolide for treatment of community-acquired pneumonia. Recent studies proved that combination treatment with a beta-lactam plus a macrolide may improve the outcome for aged patients with community-acquired pneumonia. The researchers find out that azithromycin is more effective for the treatment of community-acquired pneumonia.
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.
Int J STD AIDS. 2004 Apr;15(4):240-2.
Habib AR, Fernando R.
Department of Genitourinary Medicine, New Cross Hospital, Wednesfield Road, Wolverhampton WV10 0QP, UK.
Efficacy of azithromycin 1g single dose in the management of uncomplicated gonorrhoea.
Here the writer describes the effectiveness azithromycin 1g single dose in the management of uncomplicated gonorrhoea. Azithromycin 1g single dose was given to uncomplicated gonorrhoea patients with or without chlamydial co-infection. It is found that azithromycin stat dose is the cost-effective treatment for uncomplicated gonorrhoea.
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.
Int J Dermatol. 2004 Feb;43(2):151-4.
Bakar O, Demircay Z, Gurbuz O.
Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey.
Therapeutic potential of azithromycin in rosacea.
This articles gives an idea about the therapeutic potential of azithromycin in rosacea. Azithromycin is widely used in the treatment of inflammatory acne. Azithromycin is now became a promising agent in the treatment of rosacea with a very few side effects and good patient compliance.
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.
Transplantation. 2004 May 15;77(9):1465-7.
Verleden GM, Dupont LJ.
University Hospital Gasthuisberg, Department of Respiratory Medicine and Lung Transplantation Unit, Leuven, Belgium.
Azithromycin therapy for patients with bronchiolitis obliterans syndrome after lung transplantation.
A short discussion on azithromycin therapy for patients with bronchiolitis obliterans syndrome after lung transplantation. Aazithromycin is an effective medication for some patients with Bronchiolitis obliterans syndrome after lung transplantation. More studies are going on in this area to find out the exact mechanism of action.
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.
Eur Respir J. 2005 Mar;25(3):490-3.
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.
Azithromycin in bronchiolitis obliterans complicating bone marrow transplantation: a preliminary study.
A basic study on the use of azithromycin in bronchiolitis obliterans. The anti-inflammatory effect of azithromycin can provide some positive effects in the patients. Previous studies proved that the use of azithromycin in the treatment of bronchiolitis obliterans is intriguing and further studies are need to find out the exact action.
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.
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