A comparison of azithromycin and penicillin V for the treatment of streptococcal pharyngitis

Article Abstract:

Streptococcal pharyngitis (sore throat due to infection by streptococci) due to infection by group A beta-hemolytic streptococci (GABHS) can be treated with penicillin. However, many patients are allergic to this drug, and the infection sometimes remains even after treatment is over. To evaluate the effectiveness of azithromycin, a newly developed azalide antibiotic, a study was carried out of 242 patients with GABHS at 29 medical centers. The patients were randomly assigned to receive either azithromycin (151) or penicillin V (90): those in the azithromycin group took the drug once daily for five days, and those in the penicillin group took their drug every six hours for 10 days. They returned for follow-up clinic visits and additional throat cultures were taken on days 6, 11, 18, and 30 after drug therapy began. Results showed that all patients with one exception in each group were clinically cured or improved. Approximately 87 percent (131 patients) of the azithromycin group and 78 percent (70 patients) of the penicillin group were cured. GABHS was eradicated in 91 percent and 96 percent of the azithromycin and penicillin treated patients, respectively. When the infection recurred, clinical signs, such as sore throat and fever, were present in 3 of 13 azithromycin patients, and in 7 of 10 penicillin patients. Most side effects (diarrhea, nausea, and abdominal pain) were mild or moderate, but the azithromycin group had a higher frequency of these effects. Overall, azithromycin and penicillin V were comparable both clinically and bacteriologically. Larger studies should be carried out to investigate the effectiveness of both drugs against GABHS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Streptococcal infections

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Azithromycin in the treatment of uncomplicated genital chlamydial infections

Article Abstract:

Infection with Chlamydia trachomatis, a sexually transmitted organism, can lead to ectopic pregnancy (pregnancy located in a site other than the uterus) or infertility, and causes inflammation of the urethra in both sexes, and inflammation of the cervix in women. Although drugs such as tetracycline, doxycycline, erythromycin, and other agents are effective against Chlamydia trachomatis, they must be taken at least twice daily for seven days. Patients, particularly those without symptoms, often fail to take a full course of medication, and infections may persist. The effectiveness of azithromycin, one of a newly developed group of antibiotics called azalides, against Chlamydia trachomatis was evaluated in this article. Because azithromycin enters tissues readily, and becomes highly concentrated there, shorter durations of treatment are likely to be effective than with other drugs having poorer tissue penetration. To determine the optimal dose, it will be necessary to learn how long the drug remains in genital epithelial cells, the site of chlamydial infections. Research evidence suggests that a single dose of azithromycin is effective against uncomplicated chlamydial infections. Studies supporting this viewpoint are described. In one study, a single dose of azithromycin was more effective than seven days of ciprofloxacin; no significant side effects were reported with either drug. Since noncompliance with drug therapy is an important problem in treating chlamydial infections, a single-dose drug such as azithromycin offers considerable hope for improved cure rates. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chlamydia infections

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Clinical microbiology of azithromycin

Article Abstract:

The activity of azithromycin, an azalide drug with several properties that make it preferable to erythromycin in many clinical situations, against specific microorganisms is reviewed. The minimum inhibitory concentrations of the drug needed to check the growth of both Gram-positive and Gram-negative bacteria (a classification system based on the organism's response to the Gram stain) are listed. It is active against Haemophilus influenzae, against which erythromycin is inactive. Azithromycin is also effective against certain intracellular pathogens such as Chlamydia trachomatis (which causes genital chlamydia infections) and Legionella species. Results from experiments with animal models of infection indicate that high tissue levels of the drug may be effective even when blood levels are below the levels thought to be necessary for effectiveness. Some of these results are summarized. Azithromycin acts by inhibiting bacterial protein synthesis at the 50S ribosomal level. Because its movement into tissues is rapid and its concentration in tissues is high, measurement of blood levels of the drug is not a useful indicator of overall concentration in the body. Much remains to be learned concerning the clinical effectiveness of azithromycin. (Consumer Summary produced by Reliance Medical Information, Inc.)

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