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Cethromycin
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
Ketolides as a class were designed to overcome macrolide resistance in Streptococcus pneumoniae strains, and are generally intrinsically more active against these strains than the parent compounds. Cethromycin has shown excellent activity against both macrolide-susceptible and macrolide-resistant S. pneumoniae strains (see Table 65.1). Minimum inhibitory concentration (MIC) values for ketolides are only moderately increased in S. pneumoniae strains harboring low level (macrolide efflux) or high level (ribosomal methylase) resistance to macrolides. However, ketolides have been shown to be induders of erm(B) expression (Park and Min, 2015). Cethromycin displays greater activity than telithromycin and macrolides toward Streptococcus pyogenes, a common pathogen in upper airway infections such as tonsillitis and pharyngitis. Cethromycin activity toward Staphylococcus aureus (macrolide-susceptible and -inducible ribosomal methylation strains) is comparable to that of telithromycin. Strains with constitutive resistance to erythromycin are resistant to both ketolides.
In vitro activity of the ketolide cethromycin in multidrug-resistant clinical Neisseria gonorrhoeae isolates and international reference strains
Published in Journal of Chemotherapy, 2019
Susanne Jacobsson, Emilie Alirol, Magnus Unemo
In conclusion, the ketolide cethromycin demonstrated high in vitro activity against the majority of the N. gonorrhoeae isolates tested, including XDR and MDR strains. However, the identified cross-resistance with azithromycin indicates that cethromycin may not be considered for empirical first-line monotherapy of gonorrhoea. Nevertheless, cethromycin could be valuable in combination antimicrobial therapy (e.g. together with ceftriaxone or some new promising antimicrobial such as zoliflodacin) and for second-line therapy e.g. for cases with ceftriaxone resistance or allergy. This could be particularly effective in combination with a molecular test targeting the 23S rRNA A2059G gene mutation causing resistance to cethromycin. Additional studies further evaluating cethromycin including in vitro selection, mechanisms and biological fitness of cethromycin resistance, pharmacokinetic/pharmacodynamic studies to inform optimal dosing as well as RCTs evaluating clinical efficacy in patients with urogenital and extragenital gonorrhoea would be valuable. Clinical activity against other STIs such as infections due to Chlamydia trachomatis and Mycoplasma genitalium should also be explored.