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From December 1984 to June 1986, a prospective clinical trial was carried out in 48 patients with acute community-acquired pneumonia, comparing 2 possible therapeutic schemes: one, using only one antibiotic (roxithromycin: RXT) presumptively active on most of the germs usually involved. In a second group, the identification of the germs involved was attempted on the basis of clinical, epidemiological and radiological data, followed by treatment with the antibiotic/s (ATB) known to be more active against the suspected organisms. The dosage of RXT was 300 mg/day, orally during an average of 9 days. The mean duration of treatment in ATB group was 12 days. In both groups, the following microorganisms were identified: RXT group: St. pneumoniae (13 cases), H. influenzae (1), B. catarrhalis (1); mixed infections: St. pneumoniae + H. influenzae (2); Mycoplasma pneumoniae (3) and 4 patients with unidentified germ; in ATB group: St. aureus (3), St. pneumoniae (5), H. influenzae (2), B. catarrhalis (1); mixed infections: St. aureus + Enterobacter + E. coli (1); Mycoplasma pneumoniae (2) and 10 patients with unidentified germ. The therapeutic results were satisfactory (curation rate: 92%) and similar for both groups of treatment, concluding that both schemes are comparable. Therefore, the choice for one or the other scheme should be based on other reasons, such as easy administration and cost of the treatment.
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Macrolides, a class of antimicrobials isolated from Streptomycetes more than 50 years ago, are used extensively to treat sinopulmonary infections in humans. In addition, a growing body of experimental and clinical evidence indicates that long-term (years), low (sub-antimicrobial)-dose 14- and 15-membered ring macrolide antibiotics, such as erythromycin, clarithromycin, roxithromycin and azithromycin, express immunomodulatory and tissue reparative effects that are distinct from their anti-infective properties. These salutary effects are operative in various lung disorders, including diffuse panbronchiolitis, cystic fibrosis, persistent chronic rhinosinusitis, nasal polyposis, bronchiectasis, asthma and cryptogenic organizing pneumonia.The purpose of this overview is to outline the immunomodulatory effects of macrolide antibiotics in patients with asthma.
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The effect of three macrolides (azithromycin, roxithromycin and erythromycin) on the interaction in vitro of human polymorphonuclear leukocytes (PMNs) with Staphylococcus aureus was examined. The exposure of S. aureus to 0.25 MIC of roxithromycin and erythromycin but not of azithromycin significantly increased the uptake of opsonized bacteria by human PMNs. The preincubation of PMNs with 1, 10 and 25 mg/l of the three antimicrobial agents did not affect either the uptake of S. aureus or the superoxide radical production by human PMNs. At these same concentrations the three agents showed slight but not significant intracellular activity in PMNs against S. aureus. It is concluded that treatment of S. aureus with subinhibitory concentrations of roxithromycin and erythromycin enhanced phagocytosis by PMNs, but the three macrolides tested did not directly affect the functions of human PMNs against S. aureus.
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This is an observational study of the introduction of the SAFE strategy employing a collaborative approach and its impact on trachoma in the area.
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The in vitro activities of two ketolides, HMR 3004 and HMR 3647 (telithromycin), and the comparator agents erythromycin A, azithromycin, clarithromycin, roxithromycin, levofloxacin, ofloxacin and penicillin G were determined by an agar dilution method against 410 isolates of Corynebacterium diphtheriae. Test isolates originated from diverse geographical locations, including the former USSR, where epidemic diphtheria has re-emerged during the 1990s. All isolates tested were susceptible to penicillin G, ofloxacin and levofloxacin. The two ketolides and four macrolides were highly active against 405 of the 410 isolates. HMR 3004 was the most active of the drugs, followed by HMR 3647, clarithromycin, erythromycin A, roxithromycin and azithromycin. Five isolates showed reduced susceptibility to all macrolides and ketolides tested; three were non-toxigenic isolates from Australia and the remaining two were from cases of diphtheria in Vietnam. Inducible (MLS(B)) resistance was detected in the isolates from Vietnam, but not in the isolates originating from Australia. Significant antimicrobial resistance remains rare amongst C. diphtheriae; nevertheless, new ketolide antimicrobials may have a role to play in the treatment and control of this re-emergent pathogen.
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The MICs of erythromycin and three new macrolide antibiotics were determined for 36 quinolone-susceptible and 106 quinolone-resistant Campylobacter jejuni. The MIC90 values of azithromycin, clarithromycin, roxithromycin and erythromycin were 0.5, 4, 16 and 4 mg/l respectively. No difference was found between macrolide activity against the quinolone-susceptible and the quinolone-resistant strains. Clarithromycin and especially azithromycin might eventually replace erythromycin for the treatment of Campylobacter jejuni infections in view of their pharmacological properties.
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This was a pilot study of the use of a clinical pharmacist as a therapeutics adviser (academic detailer) to modify antibiotic prescribing by general practitioners.
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The activities of HMR 3004 and HMR 3647 and comparator agents, especially macrolides, were determined by the agar dilution method against 262 aerobic and 120 anaerobic strains isolated from skin and soft tissue infections associated with human and animal bite wounds. HMR 3004 and HMR 3647 were active against almost all aerobic and fastidious facultative isolates (MIC at which 90% of the isolates are inhibited [MIC90], < or = 0.5 and 1 microg/ml, respectively) and against all anaerobes [Bacteroides tectum, Porphyromonas macacae (salivosa), Prevotella heparinolytica, Porphyromonas sp., Prevotella sp., and peptostreptococci] at < or = 0.25 and < or = 0.5 microg/ml, respectively, except Fusobacterium nucleatum (HMR 3004, MIC90 = 16 microg/ml; HMR 3647, MIC90 = 8 microg/ml) and other Fusobacterium species (MIC90, 1 and 2 microg/ml, respectively). In general, HMR 3004 and HMR 3647 were more active than any of the macrolides tested. Azithromycin was more active than clarithromycin against all Pasteurella species, including Pasteurella multocida subsp. multocida, Eikenella corrodens, and Fusobacterium species, while clarithromycin was more active than azithromycin against Corynebacterium species, Weeksella zoohelcum, B. tectum, and P. heparinolytica.
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A review of consumption and excretion rates of 17 pharmaceuticals, two musk fragrances and two hormones by the Spanish population in 2003 was performed. For that purpose, three different models were used: (i) extrapolation of the per capita use in Europe to the number of inhabitants of Spain for musk fragrances; (ii) annual prescription items multiplied by the average daily dose for pharmaceuticals and; (iii) excretion rates of different groups of population for hormones. This information enabled the prediction of the expected concentrations (PEC) entering sewage treatment plants (STPs), which were subsequently compared with the measured environmental concentrations (MEC) in raw sewage. Annual drugs consumption in Spain ranges from few kilograms (Oxazepam and 17alpha-ethinylestradiol) to several hundred of tons (Ibuprofen). The quantities of musks used accounts for 110-450 kg d(-1) and the total amount of hormones excreted daily reaches almost 1 kg d(-1). 12 out of 21 selected substances were predicted to be present in raw sewage influent at concentrations greater than 100 ng l(-1) and these predicted concentrations fitted with the measured values for half of them (Carbamazepine, Diazepam, Ibuprofen, Naproxen, Diclofenac, Sulfamethoxazole, Roxithromycin, Erythromycin and 17alpha-ethinylestradiol).