[Azithromycin: critical points]

The determination of the French breakpoints (< or = c, > C) were selected by the use of different criteria including bacteriological, pharmacokinetic and obviously clinical criteria. Concerning the bacteriological results, azithromycin, being an acid stable orally administered antimicrobial drug, is in vitro marginally less active than erythromycin against Gram-positive organisms including beta-haemolytic streptococci and Staphylococcus aureus. But in contrast, this azalide is more active than erytromycin against many Gram-negative pathogens, notably Neisseria gonorrhoeae, H. influenzae, Branhamella (Moraxella) catarrhalis, Ureaplasma urealyticum, and Borrelia burgdorferi. The activity of azithromycin is unaffected by the inoculum, unlike of pH, serum, and presence of CO2 for anaerobes. However, erythromycin-resistant micro-organisms are also resistant to azithromycin. Considering the pharmacokinetic criteria and the clinical results such as infections of the lower and upper respiratory tracts, skin and soft tissues, uncomplicated urethritis/cervicitis associated with N. gonorrhoeae, Chlamydia trachomatis or U. urealyticum, the preliminary breakpoints of azithromycin are defined by the following concentrations (< or = 0.12 and > 4 mg/l). Additional experimental and clinical results are required to confirm the in vitro activity against some other bacterial species (E. faecalis, L. monocytogenes, Brucella, P. multocida, or even Salmonella and Shigella).