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| |  ECCMID: Once Daily Azithromycin Equal To Twice Daily Clarithromycin In Respiratory Tract Infections By Pamela A. Hunter Special to DG News
ISTANBUL, TURKEY -- April 4, 2001 -- Macrolides are often used to treat lower respiratory tract infections (LRTI) since they have good activity against a broad spectrum of the organisms commonly causing such infections. They offer advantages relative to beta-lactam antibiotics as they are active against atypical pathogens (Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophilia). The presence of these pathogens is suggested by various characteristics, including an enzyme-linked immunosorbent assay, which can detect antibodies, symptoms and age of the patient. Azithromycin is a modified macrolide (an azalide) with the added advantage that it only has to be dosed once daily, given advantages in patient compliance and ease of administration. A study reported at the 11th European Congress of Clinical Microbiology and Infectious Diseases in Istanbul was presented by Dr. A. Arguedas, from Costa Rica. The study compared a short-term (three-day) daily dosing regimen with azithromycin with a standard ten-day twice daily dosing regimen with clarithromycin for the treatment of outpatients with LRTI suspected of being caused by atypical pathogens. The study involved patients from South America and Germany, aged between eight to 65 years. The dose of azithromycin was one 500 mg tablet for adults and 10 mg/kg oral suspension for children weighing less than 45 kg, taken once daily for three days and the clarithromycin dose was a 250 tablet for adults or 7.5 mg/kg oral suspension for children under 12 years of age taken twice daily for 10 days. One-hundred and thirty-four patients received azithromycin, 43 of whom were aged under 18, and 128 received clarithromycin, 47 of whom were aged under 18. The study was open label and randomised. Patients were assessed at entry to the trial, at the end of therapy (between day 10 and 22) and again at the end of the trial (between days 39 and 57). Any adverse events were noted. The clinical responses were statistically similar in the two treatment groups with a clinical cure or improvement seen in 98 percent of patients treated with azithromycin and 97 percent of patients treated with clarithromycin at the end of treatment. By the end of the study, the clinical response in the two groups still did not differ statistically, with a 97 percent response to azithromycin and a 93 percent response to clarithromycin. Slightly more adverse events were seen in the clarithromycin group (9.4 percent) compared with the azithromycin group (4.5 percent). The majority of the adverse events were gastrointestinal. The authors conclude that short term (three-day) dosing once daily with azithromycin was equivalent in efficacy to a ten-day course of clarithromycin, given twice daily for the treatment of LRTI. In addition to the advantages of a shorter period of dosing and the convenience of once daily dosing, azithromycin was also better tolerated.
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