Tags: Dirithromycin

Antimicrobial therapy: general principles

A wide variety of antimicrobial agents is available to treat established infections caused by bacteria, fungi, viruses, or parasites. This section will cover the general principles of antimicrobial therapy and will also include illustrative clinical problems to emphasize proper decision-making in using antimicrobials.

Toxicity of Antimicrobial Therapy

The mechanisms associated with common adverse reactions to antimicrobials include dose-related toxicity that occurs in a certain fraction of patients when a critical plasma concentration or total dose is exceeded, and toxicity that is unpredictable and mediated through allergic or idiosyncratic mechanisms. For example, certain classes of drugs such as the aminoglycosides are associated with dose-related toxicity.

Dirithromycin

Dirithromycin is a semisynthetic macrolide antibiotic that is structurally and pharmacologically related to erythromycin. Dirithromycin is hydrolyzed nonenzymatically during intestinal absorption almost entirely to erythromycyclamine, which is microbiologically active.

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Clarithromycin is used orally for the treatment of pharyngitis and tonsillitis, mild to moderate respiratory tract infections (acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, community-acquired pneumonia), uncomplicated skin and skin structure infections, and acute otitis media caused by susceptible organisms.

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Oral azithromycin also is used for the treatment of urethritis or cervicitis caused by Chlamydia trachomatis or Neisseria gonorrhoeae, and for the treatment of chancroid caused by Haemophilus ducreyi. Azithromycin is used orally for the treatment of disseminated infections caused by Mycobacterium avium complex (MAC) in patients with human immunodeficiency virus (HIV) infection and for prevention of disseminated MAC infection (both primary and secondary prophylaxis) in HIV-infected individuals. Azithromycin is used orally in children for the treatment of acute otitis media, community-acquired pneumonia, and pharyngitis or tonsillitis caused by susceptible organisms.

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Prior to initiation of erythromycin therapy, appropriate specimens should be obtained for identification of the causative organism and in vitro susceptibility tests. Use of erythromycin does not preclude the necessity for surgical procedures (such as incision and drainage) as needed. There does not appear to be a difference in clinical efficacy among the erythromycin derivatives when each is administered in appropriate doses. However, some clinicians believe that the risk of hepatotoxicity from the estolate derivative does not justify its use.

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Macrolides are a class of drugs that inhibit bacterial protein synthesis. They demonstrate excellent activity against atypical organisms (Mycoplasma, Chlamydia, and Legionella species), but have variable activity against typical pathogens (S. pneumoniae and H. influenzae). Macrolides are indicated for use in mild-to-moderate community-acquired pneumonia and are typically used as first- and second-line agents for this indication.

Macrolides

Macrolides inhibit bacterial protein synthesis. They demonstrate excellent activity against atypical organisms (Mycoplasma, Chlamydia, and Legionella species), but their activity against typical pathogens (H. influenzae and S. pneumoniae) is variable. Macrolides are indicated for use in acute exacerbations of chronic bronchitis and are typically used as first- and second-line agents for this indication.