Although erythromycin is a well-established antibiotic, there are relatively few primary indications for its use. These indications include the treatment of Mycoplasma pneumoniae infections, eradication of Corynebacterium diphtheriae from pharyngeal carriers, the early preparox-ysmal stage of pertussis, chlamydial infections, and more recently, the treatment of Legionnaires' disease, Campylobacter enteritis, and chlamydial conjunctivitis, and the prevention of secondary pneumonia in neonates.
Erythromycin is effective in the treatment and prevention of S. pyogenes and other streptococcal infections, but not those caused by the more resistant fecal streptococci. Staphylococci are generally susceptible to erythromycin, so this antibiotic is a suitable alternative drug for the penicillin-hypersensitive individual. It is a second-line drug for the treatment of gonorrhea and syphilis. Although erythromycin is popular for the treatment of middle ear and sinus infections, including H. influenzae, possible erythromycin-resistant S. pneumoniae is a concern.
The new macrolides have similar indications for use as erythromycin but with some additional areas of potential value. Clarithromycin has activity against Toxo-plasma gondii and Mycobacterium avium-intracellulare, and it has expanded coverage against untypable H. in-fluenzae strains that predominate in exacerbations of chronic bronchitis. Azithromycin has less coverage against these organisms, and because of its lower peak serum concentrations and prolonged protein binding, it partitions less well across bronchial membranes. The prolonged half-life and protein binding and the use of an abbreviated one-time dose of azithromycin appear to be extremely beneficial in the treatment of sexually transmitted diseases.
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