In addition to erythromycin, macrolides now available in the United States include
azithromycin and clarithromycin. These two new macrolides are more chemically stable
and better tolerated than erythromycin, and they have a broader antimicrobial spectrum
than erythromycin against Mycobacterium avium complex (MAC), Haemophilus influenzae, nontuberculous mycobacteria, and Chlamydia trachomatis. All three macrolides have excellent activity against the atypical respiratory pathogens
(C. pneumoniae and Mycoplasma species) and the Legionella species. Azithromycin and clarithromycin have pharma-cokinetics that allow shorter
dosing schedules because of prolonged tissue levels. Both azithromycin and clarithromycin
are active agents for MAC prophylaxis in patients with late-stage acquired immunodeficiency
syndrome (AIDS), although azithromycin may be the preferable agent because of fewer
drug-drug interactions. Clarithromycin is the most active MAC antimicrobial agent
and should be part of any drug regimen for treating active MAC disease in patients
with or without AIDS. Although both azithromycin and clarithromycin are well tolerated
by children, azithromycin has the advantage of shorter treatment regimens and improved
tolerance, potentially improving compliance in the treatment of respiratory tract
and skin or soft tissue infections. Intravenously administered azithromycin has been
approved for treatment of adults with mild to moderate community-acquired pneumonia
or pelvic inflammatory diseases. An area of concern is the increasing macrolide resistance
that is being reported with some of the common pathogens, particularly Streptococcus pneumoniae, group A streptococci, and H. influenzae, The emergence of macrolide resistance with these common pathogens may limit the
clinical usefulness of this class of antimicrobial agents in the future.
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Individual reprints of this article are not available. The entire Symposium on Antimicrobial Agents will be available for purchase as a bound booklet from the Proceedings Editorial·Office at a later date.
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© 1999 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
