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The clinical use of macrolides
1Clinique des Maladies Infectieuses, Hôpital Saint-Louis, Paris, France.
Abstract:
Macrolides are active against Streptococcus pneumoniae, Legionella spp. and Mycoplasma pneumoniae, the main causes of community-acquired pneumonia They may therefore be used for the empirical treatment of community-acquired pneumonia, although emergent resistance in Str. pneumoniae limits their use in some parts of the world. In patients with bronchitis the use of macrolides reduces the severity and duration of symptoms. Macrolides have also been used successfully in the treatment of otitis media and sinusitis; combination with sulphonamides may be desirable. They may be effective in eradicating the carrier state of Str. pyogenes, Bordetella pertussis, Corynebacterium diptheriae, and Neisseria meningitidis. Macrolides provide alternative therapy for the prophylaxis of recurrent acute rheumatic fever and of infective endocarditis after dental treatment. The cure rate with macrolides of streptococcal skin infections and of minor staphylococcal infections is equal to that achieved with penicillins. In diarrhoea due to Campylobacter jejuni, the administration of macrolides shortens the duration of the faecal excretion of organisms and may give clinical improvement in severe disease. Macrolides are the drugs of choice for infections due to Chlamydia trachomatis in pregnancy and for Haemophilus ducreyi infections. They are effective alternative therapy to benzylpenicillin for the treatment of N. gonorrhoeae and Treponema pallidum infections.
Insights
Macrolides effectively treat various bacterial infections, including pneumonia and bronchitis, and offer alternatives for conditions like sinusitis and skin infections. However, increasing Streptococcus pneumoniae resistance may limit their use in some regions.
Area of Science:
- Pharmacology
- Infectious Diseases
- Microbiology
Background:
- Macrolides are a class of antibiotics with broad-spectrum activity.
- Key bacterial pathogens targeted include Streptococcus pneumoniae, Legionella spp., and Mycoplasma pneumoniae, common causes of community-acquired pneumonia.
- Emerging antibiotic resistance, particularly in S. pneumoniae, presents a challenge to macrolide efficacy in certain geographical areas.
Purpose of the Study:
- To review the therapeutic applications of macrolides in various bacterial infections.
- To evaluate the efficacy of macrolides in treating respiratory tract infections, skin infections, and sexually transmitted diseases.
- To highlight macrolides as alternative treatment options for specific microbial infections.
Main Methods:
- Literature review of studies on macrolide antibiotic efficacy.
- Analysis of clinical data on macrolide treatment outcomes for diverse infections.
- Comparative assessment of macrolides against other antibiotic classes, such as penicillins.
Main Results:
- Macrolides demonstrate effectiveness in treating community-acquired pneumonia, bronchitis, otitis media, and sinusitis.
- They are valuable for eradicating carrier states of pathogens like Streptococcus pyogenes and Bordetella pertussis.
- Macrolides show comparable efficacy to penicillins for streptococcal and minor staphylococcal skin infections and are crucial for treating Chlamydia trachomatis and Haemophilus ducreyi infections.
Conclusions:
- Macrolides are versatile antibiotics with established roles in treating a wide array of bacterial infections.
- Their utility extends to prophylaxis and alternative therapies for specific conditions.
- Monitoring and addressing antimicrobial resistance are essential for preserving the clinical utility of macrolides.