Infectious Disease Book

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Extended Spectrum MacrolideAka: Azithromycin, Zithromax, Clarithromycin, Biaxin, Telithromycin, Ketek

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  1. See also
    1. Erythromycin
  2. Pharmacokinetics: Half Life
    1. Clarithromycin: 5 hours
    2. Telithromycin: 10 hours
    3. Azithromycin: 68 hours
  3. Dosing: Azithromycin (Zithromax)
    1. Directions
      1. Take more than 1 hour before or 2 hours after food
      2. Adult
        1. Day 1: 500 mg PO qd
        2. Day 2 to 5: 250 mg PO qd
      3. Child
        1. Day 1: 10 mg/kg PO qd (maximum: 500 mg)
        2. Day 2 to 5: 5 mg/kg PO qd (maximum: 250 mg)
      4. Infant under age 6 months
        1. 10 mg/kg/day for 5 days
    2. New preparations
      1. ZMax 2 grams orally x1 dose (Available in 2005)
        1. For uncomplicated community acquired Pneumonia
        2. Vomiting >1 hour after dose - no additional med
        3. Use within 12 hours of reconstituting
      2. References
        1. (2005) Prescribers Letter 12(8):44
  4. Dosing: Clarithromycin (Biaxin)
    1. May take with or without food
    2. Adult: 250 to 500 mg PO bid
    3. Child: 7.5 mg/kg PO bid
  5. Dosing: Telithromycin
    1. Adult: 800 mg PO daily
    2. Course
      1. Acute Exacerbation of Chronic Bronchitis: 5 days
      2. Acute Sinusitis: 5 days
      3. Community acquired Pneumonia: 7 days
  6. Adverse effects
    1. Less Nausea and Vomiting than with Erythromycin
    2. Clarithromycin perverts sense of taste in 20%
  7. Major indications for newer broad spectrum Macrolides
    1. Erythromycin not tolerated
    2. Single dose Chlamydia trachomatis treatment
    3. Respiratory infections
      1. Otitis Media (Azithromycin)
      2. Community Acquired Pneumonia
        1. Consider Doxycycline as alternative
      3. Acute Sinusitis (Azithromycin)
        1. Not recommended due to growing resistance rates
      4. Non-tuberculous Mycobacterial infections
      5. Helicobacter infections
  8. Activity Spectrum
    1. Macrolide resistance is increasing
      1. Resistance to one Macrolide is resistance to all
    2. Spectrum includes organisms covered by Erythromycin
    3. Clarithromycin
      1. Streptococcus Pneumoniae (Pneumococcus)
      2. Staphylococcus aureus
      3. Toxoplasmosis gondii
      4. Mycobacterium leprae
      5. Mycobacterium Avium Complex
      6. Borrelia Burgdorferi
    4. Azithromycin
      1. Haemophilus Influenzae
      2. Moraxella catarrhalis
      3. Toxoplasmosis gondii
      4. Mycobacterium Avium Complex (Clarithromycin better)
      5. Borrelia Burgdorferi
    5. Telithromycin
      1. Similar to other extended spectrum Macrolides
      2. Appears to have greater activity for pneumococcus
      3. May be used in place of other broad spectrum agents
        1. Augmentin
        2. Extended spectrum Fluoroquinolones
      4. References
        1. Fogarty (2003) J Antimicrob Chemother 51:947

Azithromycin (C0052796)

Definition (MSH)A semi-synthetic macrolide antibiotic structurally related to ERYTHROMYCIN. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis.
Definition (CSP)semi-synthetic macrolide antibiotic; related to erythromycin.
Definition (NCI)An azalide, derived from erythromycin, and a member of a subclass of macrolide antibiotics with bacteriocidal and bacteriostatic activities. Azithromycin reversibly binds to the 50S ribosomal subunit of the 70S ribosome of sensitive microorganisms, thereby inhibiting the translocation step of protein synthesis, wherein a newly synthesized peptidyl tRNA molecule moves from the acceptor site on the ribosome to the peptidyl (donor) site, and consequently inhibiting RNA-dependent protein synthesis leading to cell growth inhibition and cell death.
ConceptsOrganic Chemical (T109) , Antibiotic (T195)
MSHD017963
EnglishAzithromycin, Azithromycin - chemical, AZITHROMYCIN PREPARATION, Azythromycin, N-methyl-11-aza-10-deoxy-10-dihydroerythromycin A, XZ-450
Spanishazitromicina
Parent ConceptsMacrolide Antibiotics (C0003240), Erythromycin (C0014806), [AM200] ERYTHROMYCINS/MACROLIDES (C0973479), Duplicate concept (C1274013), Macrolides (Non-erythromycins, Non-ketolides) (C1579342)
SourcesCSP, LNC, MSH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Clarithromycin (C0055856)

Definition (MSH)A semisynthetic macrolide antibiotic derived from ERYTHROMYCIN that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation.
Definition (CSP)semi-synthetic macrolide antibiotic; derivative of erythromycin.
Definition (NCI)An antibiotic drug used to treat infection. It belongs to the family of drugs called macrolides.
Definition (PDQ)A semisynthetic 14-membered ring macrolide antibiotic. Clarithromycin binds to the 50S ribosomal subunit and inhibits RNA-dependent protein synthesis in susceptible organisms. Clarithromycin has been shown to eradicate gastric MALT (mucosa-associated lymphoid tissue) lymphomas, presumably due to the eradication of tumorigenic Helicobacter pylori infection. This agent also acts as a biological response modulator, possibly inhibiting angiogenesis and tumor growth through alterations in growth factor expression. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42308&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=42308&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C1054" NCI Thesaurus)
Definition (NCI)A semisynthetic 14-membered ring macrolide antibiotic. Clarithromycin binds to the 50S ribosomal subunit and inhibits RNA-dependent protein synthesis in susceptible organisms. Clarithromycin has been shown to eradicate gastric MALT (mucosa-associated lymphoid tissue) lymphomas, presumably due to the eradication of tumorigenic Helicobacter pylori infection. This agent also acts as a biological response modulator, possibly inhibiting angiogenesis and tumor growth through alterations in growth factor expression. (NCI04)
ConceptsOrganic Chemical (T109) , Antibiotic (T195)
MSHD017291
English6-O-Methylerythromycin, CLARITH, Clarithromycin, CLARITHROMYCIN PREPARATION
Spanish6-O-metileritromicina, claritromicina
Parent ConceptsMacrolide Antibiotics (C0003240), Erythromycin (C0014806), [AM200] ERYTHROMYCINS/MACROLIDES (C0973479), [GA303] H.PYLORI AGENTS (C0973551), Macrolides (Non-erythromycins, Non-ketolides) (C1579342)
SourcesCSP, LNC, MSH, MTHSPL, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Zithromax (C0678143)

ConceptsOrganic Chemical (T109) , Antibiotic (T195)
MSHD017963
EnglishAzadose, Azithromycin Pfizer Brand, Azitrocin, Bayer Brand of Azithromycin Dihydrate, Mack Brand of Azithromycin Dihydrate, Pfizer Brand of Azithromycin, Pfizer Brand of Azithromycin Dihydrate, Ultreon, Zithromax, Zitromax
SourcesCSP, MSH, MTH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


Biaxin (C0701281)

ConceptsOrganic Chemical (T109) , Antibiotic (T195)
MSHD017291
EnglishBiaxin
SourcesMSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)


telithromycin (C0907410)

ConceptsOrganic Chemical (T109) , Antibiotic (T195)
MSHC106791
Englishtelithromycin
Spanishtelitromicina
Parent ConceptsMacrolide Antibiotics (C0003240), Ketolides (C1449860)
SourcesLNC, MSH, MTHSPL, NCI, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Ketek (C1452484)

ConceptsOrganic Chemical (T109) , Antibiotic (T195)
MSHC106791
EnglishAventis brand of telithromycin, Ketek
SourcesMSH, MTH, NCI, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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