How effective is azithromycin in treating pneumonia

Respiratory Infections: When to Use Macrolides

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National and international guidelines are intended to help optimize the use of antibiotics against respiratory infections. For this purpose, standard procedures have been derived from therapeutic experience that are still far too little implemented, emphasized Prof. Hartmut Lode (Berlin) in Munich.
Exacerbation of chronic bronchitis: A resurgence of bronchitis should be treated according to the severity and antibiotic therapy should be adapted to the spectrum of pathogens. In severity I and II with FEV1 values ​​of more than 50 percent of the target values ​​in the stable situation, pneumococci, Haemophilus influenzae and Moraxella catarrhalis are the predominant pathogens. In these cases, the macrolide antibiotic azithromycin (Zithromax®) has proven itself. In controlled clinical studies, the substance has proven to be just as effective as beta-lactam antibiotics and fluoroquinolones, but is particularly patient-friendly and compliance-promoting for only three days when taken once a day, explained Lode.
In severity III of the exacerbation, in addition to the pathogens mentioned, the involvement of gram-negative bacteria such as Klebsiella, Proteus species or Enterobacteriaceae must also be expected. The patients are usually treated as inpatients and suffer from serious underlying diseases. Your lung function is significantly restricted: FEV1 is no more than 35 percent of the target value. Stage III requires beta-lactam antibiotics such as second-generation cephalosporins, broad-spectrum penicillins in combination with a beta-lactamase inhibitor, and usually also the administration of a fluoroquinolone. In stage IV, Pseudomonas aeruginosa is also often detected. Therefore, a parenteral cephalosporin plus an aminoglycoside or ciprofolaxin must then be administered.
Community acquired pneumonia: The use of azithromycin is recommended for patients under 60 years of age and without underlying diseases or risk factors (stays abroad, antibiotic pretreatment or kindergarten children in the family). The macrolides also include Mycoplasma pneumoniae and Chlamydia pneumoniae. A combination of beta-lactam antibiotics plus a macrolide such as azithromycin is appropriate for patients older than 60 years with underlying diseases and risk factors. Legionella can also be expected to be detected by azithromycin. Alternatively, a modern fluoroquinolone can be given in high doses, for example 750 mg levofloxacin daily. Azithromycin is recommended in the usual 3-day therapy for mild to moderate pneumonia. If resistant pneumococci are suspected and risk factors are present, the combination of a beta-lactam antibiotic with azithromycin is indicated.
The 3-day therapy with 500 mg azithromycin a day has proven to be just as effective for infections of the respiratory tract as a longer-lasting therapy with other antibiotics, such as doxycycline, underlined Prof. Ralf Stahlmann (Berlin). Prof. Stefan Ziel (Frankfurt / Main) emphasized the advantages of macrolides and especially azithromycin in pediatrics, where this macrolide has proven itself for years. Compared to erythromycin, the modern macrolides have a much broader antibacterial spectrum of activity and are significantly better tolerated. Compared with clarithromycin and roxithromycin, azithromycin has a significantly higher activity against gram-negative pathogens.
For the treatment of acute otitis media, in addition to the 3-day treatment, the single dose of azithromycin at a dose of 30 mg / kg body weight has been approved since June 2003. The high dose results in high concentrations of the antibiotic in leukocytes and in the middle ear. The 3-day therapy is also approved for the treatment of tonsillopharyngitis and community-acquired pneumonia in childhood, so that the pediatrician is well equipped with azithromycin. Siegfried Hoc

Press forum 10 years of Zithromax® "Respiratory Infections and Antibiotics: Effectiveness - Tolerance - Compliance" by Mack and Pfizer in Munich
Respiratory Infections: When to Use Macrolides

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