Dirithromycin: a new macrolide

Area of Science:

• Pharmacology
• Infectious Diseases
• Microbiology

Background:

• Dirithromycin is a macrolide antibiotic.
• Erythromycin, clarithromycin, and azithromycin are other commonly used macrolides.

Purpose of the Study:

• To review the clinical microbiology and therapeutic use of dirithromycin.
• To compare dirithromycin with erythromycin, clarithromycin, and azithromycin.

Main Methods:

• Literature search of MEDLINE and journal reviews (1966-1996).
• Evaluation of pharmacokinetic, adverse effect, and drug interaction data from open and controlled studies.
• Assessment of clinical efficacy in respiratory and skin infections via controlled trials.

Main Results:

• Dirithromycin has a similar spectrum of activity to other macrolides, with some exceptions (e.g., higher in vitro activity against Campylobacter jejuni).
• Pharmacokinetics allow once-daily dosing with prolonged tissue concentrations; no dose adjustment needed for elderly or mild renal/hepatic impairment.
• Clinical efficacy and bacteriologic eradication rates are comparable to erythromycin for susceptible pathogens.
• Adverse effects are similar to other macrolides, primarily gastrointestinal.
• No clinically significant drug interactions reported with theophylline, oral contraceptives, cyclosporine, or terfenadine.

Conclusions:

• Dirithromycin possesses favorable pharmacokinetic properties, including once-daily dosing and sustained tissue concentrations.
• Its spectrum of activity, efficacy, and safety profile appear similar to erythromycin.
• Dirithromycin may not offer distinct advantages over clarithromycin or azithromycin.
• Further research may define a specific role for dirithromycin in clinical practice.