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López‐Alcalde J, Rodriguez‐Barrientos R, Redondo‐Sánchez J, Muñoz‐Gutiérrez J, Molero García JM, Rodríguez‐Fernández C, Heras‐Mosteiro J, Marin‐Cañada J, Casanova‐Colominas J, Azcoaga‐Lorenzo A, Hernandez Santiago V, Gómez‐García M. Short-course versus long-course therapy of the same antibiotic for community-acquired pneumonia in adolescent and adult outpatients. Cochrane Database Syst Rev 2018; 9:CD009070. [PMID: 30188565 PMCID: PMC6513237 DOI: 10.1002/14651858.cd009070.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a lung infection that can be acquired during day-to-day activities in the community (not while receiving care in a hospital). Community-acquired pneumonia poses a significant public health burden in terms of mortality, morbidity, and costs. Shorter antibiotic courses for CAP may limit treatment costs and adverse effects, but the optimal duration of antibiotic treatment is uncertain. OBJECTIVES To evaluate the efficacy and safety of short-course versus longer-course treatment with the same antibiotic at the same daily dosage for CAP in non-hospitalised adolescents and adults (outpatients). We planned to investigate non-inferiority of short-course versus longer-term course treatment for efficacy outcomes, and superiority of short-course treatment for safety outcomes. SEARCH METHODS We searched CENTRAL, which contains the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE, Embase, five other databases, and three trials registers on 28 September 2017 together with conference proceedings, reference checking, and contact with experts and pharmaceutical companies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing short- and long-courses of the same antibiotic for CAP in adolescent and adult outpatients. DATA COLLECTION AND ANALYSIS We planned to use standard Cochrane methods. MAIN RESULTS Our searches identified 5260 records. We did not identify any RCTs that compared short- and longer-courses of the same antibiotic for the treatment of adolescents and adult outpatients with CAP.We excluded two RCTs that compared short courses (five compared to seven days) of the same antibiotic at the same daily dose because they evaluated antibiotics (gemifloxacin and telithromycin) not commonly used in practice for the treatment of CAP. In particular, gemifloxacin is no longer approved for the treatment of mild-to-moderate CAP due to its questionable risk-benefit balance, and reported adverse effects. Moreover, the safety profile of telithromycin is also cause for concern.We found one ongoing study that we will assess for inclusion in future updates of the review. AUTHORS' CONCLUSIONS We found no eligible RCTs that studied a short-course of antibiotic compared to a longer-course (with the same antibiotic at the same daily dosage) for CAP in adolescent and adult outpatients. The effects of antibiotic therapy duration for CAP in adolescent and adult outpatients remains unclear.
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Affiliation(s)
- Jesús López‐Alcalde
- Universidad Francisco de Vitoria (UFV) MadridFaculty of MedicineCtra. Pozuelo‐Majadahonda km. 1,800MadridSpain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS)Clinical Biostatistics UnitCtra. Colmenar, km. 9.100MadridSpain28034
| | - Ricardo Rodriguez‐Barrientos
- Gerencia Asistencial de Atención Primaria, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC)Unidad de apoyo a la InvestigaciónJátiva Nº23 2ºcMadridSpain28007
| | - Jesús Redondo‐Sánchez
- Gerencia Asistencial Atención PrimariaCentro de Salud Ramon y CajalJabonería 67MadridSpain28921
| | - Javier Muñoz‐Gutiérrez
- Gerencia Asistencial Atención PrimariaCentro de Salud Buenos AiresPio FelipeMadridSpain28038
| | - José María Molero García
- Gerencia Asistencial Atención PrimariaCentro de Salud San AndrésAlberto Palacios, nº 22MadridMadridSpain28021
| | | | - Julio Heras‐Mosteiro
- Rey Juan Carlos UniversityDepartment of Preventive Medicine and Public Health & Immunology and MicrobiologyAvda. Atenas s/nAlcorcónMadridSpain28922
| | - Jaime Marin‐Cañada
- Gerencia Asistencial Atencion Primaria de MadridCentro de Salud Villarejo de SalvanesCalle Hospital 7Villarejo de SalvanesMadridSpain28590
| | - Jose Casanova‐Colominas
- Gerencia Asistencial de Atención PrimariaCentro de Salud Ciudad de los PeriodistasValencia de don Juan 1028034 MadridMadridSpain28034
| | - Amaya Azcoaga‐Lorenzo
- Gerencia Asistencial Atención PrimariaCentro de Salud Los PintoresC/Prolongación Cordoba s/nParlaMadridSpain29981
| | - Virginia Hernandez Santiago
- University of St AndrewsDivision of Population and Behavioural Sciences, School of MedicineNorth HaughDundeeUKKY16 9TF
| | - Manuel Gómez‐García
- Gerencia Asistencial Atención PrimariaCentro de Salud MirasierraC/ Mirador de la Reina nº 117MadridSpain28035
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Cornett E, Novitch MB, Kaye AD, Pann CA, Bangalore HS, Allred G, Bral M, Jhita PK, Kaye AM. Macrolide and fluoroquinolone mediated cardiac arrhythmias: clinical considerations and comprehensive review. Postgrad Med 2017; 129:715-724. [DOI: 10.1080/00325481.2017.1362938] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Elyse Cornett
- Departments of Anesthesiology and Pharmacology, Toxicology & Neuroscience, LSU Health Shreveport, Shreveport, LA, USA
| | | | - Alan D. Kaye
- Department of Anesthesiology, LSU-Health Science Center-New Orleans, New Orleans, LA, USA
| | - Chris A. Pann
- Department of Molecular & Cellular Biology, College of Science & Mathematics, California Polytechnic State University, San Luis Obispo, CA, USA
| | | | - Gregory Allred
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Matthew Bral
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | | | - Adam M. Kaye
- Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, CA, USA
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van Hecke O, Wang K, Lee JJ, Roberts NW, Butler CC. Implications of Antibiotic Resistance for Patients' Recovery From Common Infections in the Community: A Systematic Review and Meta-analysis. Clin Infect Dis 2017; 65:371-382. [PMID: 28369247 PMCID: PMC5850316 DOI: 10.1093/cid/cix233] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/14/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Antibiotic use is the main driver for carriage of antibiotic-resistant bacteria. The perception exists that failure of antibiotic treatment due to antibiotic resistance has little clinical impact in the community. METHODS We searched MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and Web of Science from inception to 15 April 2016 without language restriction. We included studies conducted in community settings that reported patient-level data on laboratory-confirmed infections (respiratory tract, urinary tract, skin or soft tissue), antibiotic resistance, and clinical outcomes. Our primary outcome was clinical response failure. Secondary outcomes were reconsultation, further antibiotic prescriptions, symptom duration, and symptom severity. Where possible, we calculated odds ratios with 95% confidence intervals by performing meta-analysis using random effects models. RESULTS We included 26 studies (5659 participants). Clinical response failure was significantly more likely in participants with antibiotic-resistant Escherichia coli urinary tract infections (odds ratio [OR] = 4.19; 95% confidence interval [CI] = 3.27-5.37; n = 2432 participants), Streptococcus pneumoniae otitis media (OR = 2.51; 95% CI = 1.29-4.88; n = 921 participants), and S. pneumoniae community-acquired pneumonia (OR = 2.15; 95% CI = 1.32-3.51; n = 916 participants). Clinical heterogeneity precluded primary outcome meta-analysis for Staphylococcus aureus skin or soft-tissue infections. CONCLUSIONS Antibiotic resistance significantly impacts on patients' illness burden in the community. Patients with laboratory-confirmed antibiotic-resistant urinary and respiratory-tract infections are more likely to experience delays in clinical recovery after treatment with antibiotics. A better grasp of the risk of antibiotic resistance on outcomes that matter to patients should inform more meaningful discussions between healthcare professionals and patients about antibiotic treatment for common infections.
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Affiliation(s)
- Oliver van Hecke
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Kay Wang
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Joseph J Lee
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Nia W Roberts
- Bodleian Health Care Libraries, Knowledge Centre, Oxford, United Kingdom
| | - Chris C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford
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Zuckerman JM, Qamar F, Bono BR. Review of macrolides (azithromycin, clarithromycin), ketolids (telithromycin) and glycylcyclines (tigecycline). Med Clin North Am 2011; 95:761-91, viii. [PMID: 21679791 DOI: 10.1016/j.mcna.2011.03.012] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The advanced macrolides, azithromycin and clarithromycin, and the ketolide, telithromycin, are structural analogs of erythromycin. They have several distinct advantages when compared with erythromycin, including enhanced spectrum of activity, more favorable pharmacokinetics and pharmacodynamics, once-daily administration, and improved tolerability. Clarithromycin and azithromycin are used extensively for the treatment of respiratory tract infections, sexually transmitted diseases, and Helicobacter pylori-associated peptic ulcer disease. Telithromycin is approved for the treatment of community-acquired pneumonia. Severe hepatotoxicity has been reported with the use of telithromycin.
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Affiliation(s)
- Jerry M Zuckerman
- Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USA.
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Zuckerman JM, Qamar F, Bono BR. Macrolides, ketolides, and glycylcyclines: azithromycin, clarithromycin, telithromycin, tigecycline. Infect Dis Clin North Am 2010; 23:997-1026, ix-x. [PMID: 19909895 DOI: 10.1016/j.idc.2009.06.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The advanced macrolides, azithromycin and clarithromycin, and the ketolide, telithromycin, are structural analogs of erythromycin. They have several distinct advantages when compared with erythromycin, including enhanced spectrum of activity, more favorable pharmacokinetics and pharmacodynamics, once-daily administration, and improved tolerability. Clarithromycin and azithromycin are used extensively for the treatment of respiratory tract infections, sexually transmitted diseases, and Helicobacter pylori-associated peptic ulcer disease. Telithromycin is approved for the treatment of community-acquired pneumonia. Severe hepatotoxicity has been reported with the use of telithromycin.
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Affiliation(s)
- Jerry M Zuckerman
- Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USA.
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Karageorgopoulos DE, Falagas ME. New antibiotics: optimal use in current clinical practice. Int J Antimicrob Agents 2009; 34 Suppl 4:S55-62. [DOI: 10.1016/s0924-8579(09)70569-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2:S27-72. [PMID: 17278083 PMCID: PMC7107997 DOI: 10.1086/511159] [Citation(s) in RCA: 4067] [Impact Index Per Article: 239.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Peck KR. Treatment of Community-Acquired Pneumonia in Korea. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.10.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kyong Ran Peck
- Division of Infectious Diseases, Syunkyunkwan University School of Medicine, Korea.
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Fogarty CM, Buchanan P, Aubier M, Baz M, van Rensburg D, Rangaraju M, Nusrat R. Telithromycin in the treatment of pneumococcal community-acquired respiratory tract infections: a review. Int J Infect Dis 2006; 10:136-47. [PMID: 16183318 DOI: 10.1016/j.ijid.2005.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Revised: 01/12/2005] [Accepted: 01/13/2005] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES A pooled analysis of 14 Phase III studies was performed to establish the clinical and bacteriologic efficacy of telithromycin 800 mg once daily in the treatment of pneumococcal community-acquired respiratory tract infections (RTIs). METHODS Data were examined from 5534 adult/adolescent patients with community-acquired pneumonia (CAP), acute exacerbations of chronic bronchitis (AECB), or acute bacterial sinusitis, who had received telithromycin for 5-10 days or a comparator antibacterial. RESULTS Streptococcus pneumoniae was identified in 704/2060 (34.2%) bacteriologically evaluable patients. The respective per-protocol clinical cure rates for telithromycin and comparators were 94.3% and 90.0% (CAP); 81.5% and 78.9% (AECB); 90.1% and 87.5% (acute sinusitis); 92.7% and 87.6% (all indications). Clinical cure rates were 28/34 (82.4%) and 5/7, respectively, for penicillin-resistant infections, and 44/52 (84.6%) and 11/14, respectively, for erythromycin-resistant infections. Of 82 patients with pneumococcal bacteremia, 74 (90.2%) were clinically cured after telithromycin treatment, including 5/7 and 8/10 with penicillin- or erythromycin-resistant strains, respectively. Adverse events considered possibly related to study medication were reported by 1071/4045 (26.5%) telithromycin and 505/1715 (29.4%) comparator recipients. These events were generally of mild/moderate severity, and mainly gastrointestinal in nature. CONCLUSIONS As S. pneumoniae is the leading bacterial cause of community-acquired RTIs, and antibacterial resistance is increasing among this species, these findings support the use of telithromycin as first-line therapy in this setting.
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Affiliation(s)
- Charles M Fogarty
- Spartanburg Pharmaceutical Research, 126 Dillon Street, Spartanburg, SC 29307, USA
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Tran MP. Telithromycin: a novel agent for the treatment of community-acquired upper respiratory infections. Proc (Bayl Univ Med Cent) 2005; 17:475-9. [PMID: 16200139 PMCID: PMC1200691 DOI: 10.1080/08998280.2004.11928017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The ketolides are a new subclass of macrolides, and telithromycin is the first of these agents to be approved. Modifications to the basic macrolide structure result in enhanced activity against penicillin- and erythromycin resistant respiratory pathogens. It is therefore an option in the treatment of mild to moderate community-acquired respiratory infections, such as pneumonia, acute exacerbations of chronic bronchitis, pharyngitis/tonsillitis, and sinusitis. Telithromycin also offers the advantages of once-daily dosing and a shorter course of therapy in certain infections. Comparative clinical trials, although limited and involving only a small number of resistant organisms, showed the equivalence of telithromycin to existing therapies, although telithromycin generally had a higher frequency of mild to moderate gastrointestinal adverse effects. Further clinical and safety data, especially in patients with resistant organisms, are needed.
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Affiliation(s)
- Mai P Tran
- Department of Pharmacy Services, Baylor University Medical Center, Dallas, Texas 75246, USA
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Ciervo CA, Shi J. Pharmacokinetics of telithromycin: application to dosing in the treatment of community-acquired respiratory tract infections. Curr Med Res Opin 2005; 21:1641-50. [PMID: 16238904 DOI: 10.1185/030079905x65466] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Telithromycin is the first ketolide anti bacterial approved for treating community-acquired pneumonia, acute exacerbations of chronic bronchitis, and acute bacterial sinusitis in adults. The purpose of this article is to review the main pharmacokinetic properties of telithromycin and their application to the treatment of these infections. METHODS Sources of information were identified through a Medline search (up to March 2005). MAIN FINDINGS The absolute oral bioavailability of telithromycin is approximately 57%, which is unaffected by food intake. At the recommended 800 mg once-daily oral dosing regimen, telithromycin reaches a steady-state concentration of approximately 2 microg/mL in plasma and has an elimination half-life of approximately 10 hours. Telithromycin shows extensive tissue distribution and penetrates effectively into bronchopulmonary tissue and epithelial lining fluid. Since elimination of telithromycin occurs via multiple pathways--the highest proportion (70%) through metabolism--impairment of a single pathway has a limited impact on telithromycin exposure. Dose adjustments are unnecessary in elderly patients or in individuals with hepatic impairment or mild to moderate renal impairment. A reduced dose could be recommended in patients with severe renal impairment. Telithromycin is metabolized primarily in the liver, approximately half of which is via the cytochrome P450 (CYP) 3A4 system. Telithromycin AUC(0-24 h) increased by 1.5- to 2.0-fold in the presence of itraconazole and ketoconazole. Administration of telithromycin with drugs metabolized via CYP3A4 may result in increased exposure to the co-administered drug, as shown for simvastatin (5.3-fold) and midazolam (6-fold). Co-administration of telithromycin minimally increases (1.2- to 1.4-fold) exposure to theophylline, digoxin, and metoprolol. Although telithromycin does not affect the pharmacokinetics of warfarin, consideration should be given to monitoring prothrombin times/INR in patients receiving telithromycin and oral anticoagulants simultaneously. CONCLUSION Overall, the pharmacokinetic/pharmaco dynamic properties of telithromycin indicate that this ketolide antibacterial is a valuable and convenient treatment option for community-acquired respiratory tract infections.
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Affiliation(s)
- Carman A Ciervo
- University of Medicine and Dentistry of New Jersey, School of Osteopathic Medicine, Stratford, NJ 08084, USA.
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Abstract
Atypical bacteria responsible for infections in children are mainly Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila. Atypical pneumonia is a frequent disease in children. Until recently, the outcome was thought to be rather benign and antibiotherapy to have only a minor impact on the prognosis. Recent studies have demonstrated that M. pneumoniae and C. pneumoniae were involved in a variety of infections, including acute upper airway disease, otitis and pharyngitis under five. Antibiotherapy was proven able to decrease the rate of complications and recurrence, notably episodes of wheezing and exacerbations of asthma. Atypical bacteria infections may be severe in immunocompromised children and children with underlying disease such as sickle cell anaemia. Whenever bacteriological documentation is lacking, one of the critical issues in choosing an antibiotic is to consider its activity against Streptococcus pneumoniae, especially in lower respiratory tract infections. The main available molecules are reviewed and discussed, with a special emphasis on ketolides, a newer family of molecules active on both atypical bacteria and S. pneumoniae.
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Affiliation(s)
- H Haas
- Service de pédiatrie, hôpital Archet-CHU de Nice, 151 route Saint-Antoine-de-Ginestière, 06200 Nice, France.
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Counts M. Telithromycin—A Ketolide Antibiotic for the Treatment of Outpatients With Community-acquired Respiratory Tract Infections. CLIN NURSE SPEC 2005; 19:121-3. [PMID: 15897765 DOI: 10.1097/00002800-200505000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Mona Counts
- Primary Care Center of Mount Morris, Pennsylvania State University, USA.
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Lipsky MS. Ketolides in the treatment of community-acquired respiratory tract infections: A review. Curr Ther Res Clin Exp 2005; 66:139-53. [PMID: 24672119 DOI: 10.1016/j.curtheres.2005.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2005] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The increasing prevalence of resistance to established antibiotics among key respiratory bacterial pathogens highlights a need for new antibacterial agents for the treatment of community-acquired respiratory tract infections (RTIs). Ketolides are a new class of antibiotics specifically developed for the treatment of RTIs. OBJECTIVE The aim of this review was to present the current status of treatment of RTIs with ketolides, focusing on telithromycin-the first ketolide to be approved by the US Food and Drug Administration for clinical use. METHODS TO GATHER EVIDENCE ON THE CURRENT STATUS OF KETOLIDES, A LITERATURE SEARCH WAS CONDUCTED USING MEDLINE (YEARS: 1990-2005; key terms: ketolides, telithromycin, and HMR3647). RESULTS Telithromycin shows strong in vitro activity against the major respiratorypathogens, including strains resistant to other antibiotics, as well as the atypical respiratory pathogens. The pharmacokinetic properties of telithromycin are compatible with once-daily dosing. Clinical trials have demonstrated that telithromycin 800 mg QD for 5 to 10 days is effective in the treatment of acute bacterial sinusitis, acute bacterial exacerbations of chronic bronchitis, and mild to moderate community-acquired pneumonia. Overall, telithromycin is well tolerated by patients. Drug-drug interactions are similar to those reported for macrolides. CONCLUSION Evidence to date indicates that telithromycin is an effective andwell-tolerated empiric treatment for community-acquired RTIs.
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Affiliation(s)
- Martin S Lipsky
- Office of the Regional Dean, University of Illinois, College of Medicine, Rockford, Illinois, USA
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Pelton SI, Hammerschlag MR. Overcoming current obstacles in the management of bacterial community-acquired pneumonia in ambulatory children. Clin Pediatr (Phila) 2005; 44:1-17. [PMID: 15678226 DOI: 10.1177/000992280504400101] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dunbar LM, Carbon C, van Rensburg D, Tellier G, Rangaraju M, Nusrat R. Efficacy of Telithromycin in Community-Acquired Pneumonia Caused by Atypical and Intracellular Pathogens. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2005. [DOI: 10.1097/01.idc.0000152469.72975.4b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zuckerman JM. Macrolides and ketolides: azithromycin, clarithromycin, telithromycin. Infect Dis Clin North Am 2004; 18:621-49, xi-. [PMID: 15308279 DOI: 10.1016/j.idc.2004.04.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The advanced macrolides, azithromycin and clarithromycin, and the ketolide telithromycin are structural analogues of erythromycin. They have several distinct advantages when compared with erythromycin including enhanced spectrum of activity, more favorable pharmacokinetics and pharmacodynamics, once daily administration, and improved tolerability. This article reviews the pharmacokinetics, antimicrobial activity, clinical use, and adverse effects of these antimicrobial agents.
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Marrie TJ. Therapeutic implications of macrolide resistance in pneumococcal community-acquired lower respiratory tract infections. Int J Clin Pract 2004; 58:769-76. [PMID: 15372850 DOI: 10.1111/j.1368-5031.2004.00152.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Macrolide anti-bacterials are widely used for the empirical treatment of lower respiratory tract infections (RTIs) due to their activity against Streptococcus pneumoniae and other common respiratory pathogens and good safety/tolerability profile. However, the prevalence of macrolide resistance, particularly pneumococcal macrolide resistance, is increasing all around the world. The mechanisms underlying macrolide resistance include efflux pump, methylase activity and, less commonly, ribosomal mutation, which produce differing levels of resistance. Growth in macrolide resistance has been linked to the increased use of these agents, and several risk factors for the development of resistance have been identified. There are emerging data to suggest that in vitro macrolide resistance may increase the likelihood of treatment failure in patients with lower RTIs. However, at present, treatment failure is rare and randomised; intervention-based trials investigating the impact of anti-bacterial resistance on clinical outcomes are lacking. Strategies to promote appropriate use of macrolides and other anti-bacterials are needed, both to maximise therapeutic impact and to minimise the development of resistance. Furthermore, there is a need for alternative anti-bacterial agents which have high efficacy against respiratory pathogens (including resistant strains) and a low potential to induce resistance.
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Affiliation(s)
- T J Marrie
- Department of Medicine, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, Canada.
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Abstract
PURPOSE OF REVIEW Community-acquired pneumonia, because of its substantial treatment costs, incidence, and mortality, is an aggressively researched diagnosis. In this review, we highlight new developments in the diagnosis, etiology, pathophysiology, treatment, and prevention of community-acquired pneumonia published since April 2002. RECENT FINDINGS The combined end points of improved patient care and conservation of health care resources have prompted several studies examining current professional society community-acquired pneumonia guidelines. In general, patients treated with the recommended third-generation cephalosporin and macrolide or an antipneumococcal fluoroquinolone when indicated have fared better, including reduced overall costs, inpatient days, and mortality, than those receiving alternative treatments. Etiologic identification efforts by traditional methods, blood and sputum cultures, are being questioned owing to poor success rates and, even when positive, are being underused or ignored in antibiotic selection and patient management. Newer diagnostic tests are becoming commercially available, along with tests for biologic markers that have been only recently identified as contributors to, or prognosticators of, community-acquired pneumonia. Because antibiotic resistance remains a major obstacle to successful patient treatment, prevention or mitigation of community-acquired pneumonia is gaining increasing popularity through more aggressive pneumococcal and influenza vaccination of at risk groups, even before hospital discharge from a community-acquired pneumonia admission. SUMMARY Although prevention is our best defense, current community-acquired pneumonia treatment guidelines are effective for treatment and cost containment. However, they should be scrutinized in light of clinical utilization data now entering the literature regarding their testing recommendations. Providers should consider encouraging focused culturing of sicker patients and those with significant comorbidities.
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Affiliation(s)
- Donald W Alves
- Division of Emergency Medicine, Department of Surgery, University of Maryland Medical School, Baltimore, MD, USA.
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Dubreuil L, Elkharrat D, Bru JP. Prise en charge des infections respiratoires basses communautaires aux urgences : place de Ketek® (télithromycine). Med Mal Infect 2004; 34:51-6. [PMID: 15617327 DOI: 10.1016/j.medmal.2003.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L Dubreuil
- Laboratoire de microbiologie, faculté de pharmacie, BP 83, 59006 Lille, France.
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Mandell LA, Bartlett JG, Dowell SF, File TM, Musher DM, Whitney C. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003; 37:1405-33. [PMID: 14614663 PMCID: PMC7199894 DOI: 10.1086/380488] [Citation(s) in RCA: 670] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2003] [Accepted: 10/07/2003] [Indexed: 02/04/2023] Open
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