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Nontuberculous mycobacteria
Published in Anthony J. Hickey, Heidi M. Mansour, Inhalation Aerosols, 2019
M. Ghadiri, P.M. Young, D. Traini
Many of the antibiotics for NTM infection have undesirable side effects (56). However, mild side effects can be tolerated by patients for short time periods, but it is difficult to tolerate daily nausea and vomiting for prolonged treatment periods (12–24 months). For example, amikacin is an effective drug against most NTM species, but daily or intermittent use of systemic amikacin can have undesirable adverse effects, such as ototoxicity and nephrotoxicity (76). Gastrointestinal side effects with oral antibiotics are also common. Due to severe gastrointestinal disturbances, the use of macrolides may require dose adjustment. Renal function testing is also needed, especially for aminoglycosides. Rifampin, macrolides, imipenem, or tigecycline can cause drug-induced hepatotoxicity; therefore, liver function needs to be monitored regularly (88).
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
The properties of macrolides are very similar to each other and in general they have low toxicity and a similar spectrum of antimicrobial activity with cross-resistance occurring between individual members of the group. The macrolides are bacteriostatic or bactericidal, depending on the concentration and the type of micro-organism, and they are thought to interfere with bacterial protein synthesis.
Azithromycin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Macrolides are bacteriostatic antibiotics, characterized by a moderately broad spectrum of activity, which includes most Gram-positive but only selected Gram-negative organisms, as well as several bacteria responsible for intracellular infection, such as Mycobacteria spp., Chlamydia spp., or Legionella spp. Their activity is markedly reduced in acidic environments. Table 62.1 lists the susceptibilities observed for wild strains of the most relevant target organisms.
Advances in pharmacotherapy for bronchiectasis in adults
Published in Expert Opinion on Pharmacotherapy, 2023
Xiao-Xian Zhang, Zhao-Ming Chen, Zhen-Feng He, Wei-Jie Guan
There has been some robust evidence for maintaining low-dose macrolides in selected patients to reduce exacerbation risk despite certain pitfalls. In several clinical trials of inhaled antibiotics, the reduction in bacterial loads was not parallel to the reduction in exacerbation risks and symptom relief [33]. This might reflect the complexity between bacterial load and exacerbations and respiratory symptoms. In addition, the heterogeneity in the definition of exacerbations and inclusion criteria across different clinical trials might have contributed to the inconsistency of the principal findings. For instance, the ORBIT and RESPIRE trials required two or more exacerbations in the past year, while AIR-BX study did not mandate these inclusion criteria [30–34]. Another limitation was the selection of saline solution as placebo, which also confers mucoactive properties and has been recommended as a therapy by the European Respiratory Society guidelines to improve symptoms [26]. Therefore, saline nebulization might have obscured some of the true therapeutic effects in favor of an inhaled antibiotics. Additional areas for future investigation may include the merits of oral macrolides versus inhaled antibiotics, and continuous versus cyclic treatments.
Repurposing drugs for the management of COVID-19
Published in Expert Opinion on Therapeutic Patents, 2021
Jacopo Cusinato, Ylenia Cau, Anna Maria Calvani, Mattia Mori
Azithromycin (Figure 2) is an antibiotic of the macrolide family, widely used in the treatment of infections to the upper and lower respiratory tract, odontostomatological, skin, and soft tissue infections, non-gonococcal urethritis, and soft ulcers[101]. Antibacterial properties of macrolides derives from their interaction with the bacterial ribosome and the consequent inhibition of protein synthesis. Macrolides proved beneficial in patients with inflammatory lung disease. In vitro and in vivo studies have shown that macrolides mitigate inflammation and modulate the immune system also thanks to their ability to downregulate cell surface adhesion molecules, reduce the production of pro-inflammatory cytokines, stimulate phagocytosis by alveolar macrophages, and inhibit the activation and mobilization of neutrophils, although with a yet unclear mechanism[102].
Antimicrobial resistance among children in Africa: need for paediatric clinical trials
Published in Expert Review of Anti-infective Therapy, 2020
Pui-Ying Iroh Tam, Angela Dramowski, Appiah-Korang Labi, Hilda A. Mujuru, Babatunde O. Ogunbosi
Between 2010–2014 and 2015–2019, the number of registered studies increased 32.9%, interventional clinical trials increased 50.1%, and pediatric interventional clinical trials increased 47.7% (Figure 1(a)). By comparison, pediatric interventional antimicrobial clinical trials increased 25.6% over this same period (Figure 1(b)). The most common infectious conditions evaluated were trachoma, malnutrition, diarrhea and pneumonia. The most common antibacterial classes involved were macrolides (azithromycin, 19/46 (41%)), and penicillins (amoxicillin, 11/46 (24%)). Although in Africa the number of pediatric interventional antibacterial clinical trials roughly doubled during this timeframe, the 46 trials that were conducted over a 10-year period equates to 0.8% of all interventional antimicrobial clinical trials registered.