Antibacterial Spectrum

The macrolides are effective against a number of organisms, including Mycoplasma spp., H. influenzae, Streptococcus spp. (including S. pyogenes and S. pneumoniae), staphylococci, gonococci, Legionella pneumophila, and other Legionella spp. There has been increasing resistance of S. pneumoniae to macrolides worldwide. This is true especially if the strain is resistant to penicillin. This resistance includes not only erythromycin but also clar-ithromycin and azithromycin. Approximately 10 to 15% of S. pneumoniae in the United States show complete resistance to macrolides. Staphylococci resistant to erythro-mycin are resistant to all macrolides. The hemolytic streptococci also exhibit varying degrees of cross-resistance to the macrolides and to lincomycin and clindamycin, although the macrolides are chemically unrelated to the last two agents. There are only minor variations in the antibacterial spectrum of the newer macrolides. Clarithromycin is very active against H. influenzae, Legionella, and Mycobacterium avium-intracellulare, whereas azithromycin is superior against Branhamella, Neisseria, and H. influenzae but less active against my-cobacterial species. Clarithromycin and azithromycin have significant activity against Mycobacterium avium complex (MAC), and it is one of the drugs of choice in treating disseminated MAC. Both azithromycin and clar-ithromycin can be used prophylactically in HIV and AIDS patients to help prevent disseminated MAC.

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