The use of macrolides in treatment of upper respiratory tract infections |
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Authors: | Aleksandra K Wierzbowski Daryl J Hoban Tamiko Hisanaga Mel DeCorby George G Zhanel |
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Institution: | (1) Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, MS673-Microbiology, Health Sciences Centre, 820 Sherbrook Street, R3A 1R9 Winnipeg, Manitoba, Canada |
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Abstract: | Antimicrobial resistance is a growing problem among upper respiratory tract pathogens. Resistance to β-lactam drugs among
Streptococcus pneumoniae, Haemophilus influenzae, and Streptococcus pyogenes is increasing. As safe and well-tolerated antibiotics, macrolides play a key role in the treatment of community-acquired
upper respiratory tract infections (RTIs). Their broad spectrum of activity against gram-positive cocci, such as S. pneumoniae and S. pyogenes, atypical pathogens, H. influenzae (azithromycin and clarithromycin), and Moraxella catarrhalis, has led to the widespread use of macrolides for empiric treatment
of upper RTIs and as alternatives for patients allergic to β-lactams. Macrolide resistance is increasing among pneumococci
and recently among S. pyogenes, and is associated with increasing use of the newer macrolides, such as azithromycin. Ribosomal target modification mediated
by erm(A) erm(TR)] and erm(B) genes and active efflux due to mef(A) and mef(E) are the principal mechanisms of resistance in S. pneumoniae and S. pyogenes. Recently, ribosomal protein and RNA mutations have been found responsible for acquired resistance to macrolides in S. pneumoniae, S. pyogenes, and H. influenzae. Although macrolides are only weakly active against macrolide-resistant streptococci species producing an efflux pump (mef) and are inactive against pathogens with ribosomal target modification (erm), treatment failures are uncommon. Therefore, macrolide therapy, for now, remains a good alternative for treatment of upper
RTIs; however, continuous monitoring of the local resistance patterns is essential. |
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