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Related Experiment Videos

Pneumococcal macrolide resistance--myth or reality?

G W Amsden1

  • 1The Clinical Pharmacology Research Center, Research Institute, and the Department of Pharmacy, Bassett Healthcare, Cooperstown, New York 13326, USA. guy.amsden@bassett.org

The Journal of Antimicrobial Chemotherapy
|August 25, 1999
PubMed
Summary

Rising macrolide and azithromycin resistance necessitates re-evaluating antibiotic use. Clinicians should consider minimum inhibitory concentration (MIC) values and in-vivo pharmacokinetics/pharmacodynamics for better patient outcomes and extended antibiotic utility.

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Area of Science:

  • Microbiology
  • Pharmacology
  • Infectious Diseases

Background:

  • Increasing incidence of macrolide and azithromycin resistance due to prolific use.
  • Current susceptibility reports (Susceptible, Intermediate, Resistant) are insufficient for guiding treatment.
  • Need to re-evaluate antibiotic selection beyond in-vitro data.

Purpose of the Study:

  • To advocate for the use of minimum inhibitory concentration (MIC) values over generic susceptibility reports.
  • To emphasize comparing MIC values with in-vivo pharmacokinetics and pharmacodynamics for macrolides and azithromycin.
  • To propose revised clinical breakpoints for optimizing macrolide and azithromycin therapy.

Main Methods:

  • Recommending agar dilution MIC testing for accurate susceptibility data.

Related Experiment Videos

  • Comparing MIC values with infection site and phagocytic cell concentrations.
  • Suggesting specific clinical MIC breakpoints for oral macrolides (4-8 mg/L) and azithromycin (<= 32 mg/L).

    • Main Results:

    • Azithromycin demonstrates better cellular penetration and pharmacodynamics against resistant pneumococci compared to other macrolides.
    • Differences in pharmacokinetics may lead to earlier clinical impact of resistance on erythromycin and clarithromycin versus azithromycin.
    • Proposed breakpoints can optimize drug pharmacodynamics against pathogens.

    Conclusions:

    • Accurate MIC determination and comparison with pharmacokinetic/pharmacodynamic data are crucial for effective macrolide/azalide selection.
    • Revised clinical breakpoints can improve treatment outcomes and extend antibiotic usefulness.
    • Judicious antibiotic prescribing practices are essential to combat resistance trends and preserve antibiotic efficacy.