zithromax and Candidiasis

Long-term administration of azithromycin (AZM) in children with cystic fibrosis (CF) has improved outcomes. However, the doses and schedule of administration are not very well studied in children with CF.. A randomized controlled trial was conducted to compare the effect of two doses of azithromycin (5mg/kg/day and 15mg/kg/day) on FEV(1) and pulmonary exacerbations in children with cystic fibrosis. Enrolled children were randomly allocated to receive daily azithromycin (5mg/kg/day or 15mg/kg/day) for 6months. Clinical assessment and FEV(1) measurement were performed monthly.. 56 children (28 in high dose group and 28 in low dose group) were enrolled. 47 (24 and 23 children in low and high dose groups) completed 12months of follow up. There was no difference in clinical scores, FEV(1), pulmonary exacerbation rates between two groups at baseline, 6months and at 12months. Per protocol analysis revealed that pulmonary exacerbation increased after discontinuing AZM and there was significantly more increase after 12months of enrolment in children getting high dose azithromycin. There was no improvement in FEV(1) in either group at the end of treatment period. Children tolerated daily low as well as high dose AZM well for 6months. There was no significant side effect of azithromycin.. In this randomized controlled trial, we did not find differences in the effect of 2 doses (5mg/kg/day or 15mg/kg/day) of AZM on change in percentage predicted FEV(1), clinical scores, Pseudomonas colonization rates, pulmonary exacerbations and need for antibiotics. There was increase in exacerbations after stopping azithromycin in both the groups. Our results also suggest that the decrease in the incidence of LRTI persists only till 6months after discontinuing azithromycin.

Topics: Anti-Bacterial Agents; Azithromycin; Body Weight; Candidiasis; Child; Child, Preschool; Cystic Fibrosis; Female; Forced Expiratory Volume; Humans; Interleukin-8; Male; Pneumonia, Bacterial; Pseudomonas aeruginosa; Pseudomonas Infections; Spirometry; Sputum; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pneumoniae; Treatment Outcome

Male Crl:CD1(ICR) BR mice were fed either chow containing Candida albicans or regular chow. The gastrointestinal tract of the C. albicans-fed mice was permanently colonized by the yeast. Groups of C. albicans-colonized mice were subsequently treated either with a macrolide (erythromycin, clarithromycin, roxithromycin or azithromycin) for 10 days or a normal saline solution (controls). Other controls included non-colonized mice receiving the same antibiotics or a saline solution. Our data are as follows: (i) C. albicans-colonized mice treated with each macrolide had highly significant increase in colony counts of C. albicans in their stools compared to C. albicans-colonized mice treated with saline only; (ii) discontinuation of macrolide treatment showed a trend towards lower colony counts, which was not statistically significant (colony counts were sustained even after discontinuation of antibiotic treatment); (iii) dissemination of C. albicans did not occur; (iv) mice fed regular chow treated with the study drugs or saline did not have any yeasts in their stools. In conclusion, oral erythromycin, clarithromycin, roxithromycin and azithromycin cause a modest increase of the C. albicans concentration of the gastrointestinal tract. This increase is not associated with a higher risk of disseminated candidiasis.

Topics: Animals; Anti-Bacterial Agents; Antifungal Agents; Azithromycin; Candida albicans; Candidiasis; Clarithromycin; Digestive System; Drug Therapy, Combination; Erythromycin; Mice; Mice, Inbred ICR; Roxithromycin; Tissue Distribution

Participants at the XI International Conference on AIDS in Vancouver appeared impressed by the improvements being made in the diagnosis, treatment, and prophylaxis of AIDS-related opportunistic infections. Improvements in the following areas are discussed: cytomegalovirus infection prophylaxis and maintenance with oral ganciclovir, prophylactic effects of azithromycin against Mycobacterium avium complex infection and its potential for preventing Pneumocystis carinii pneumonia, and the use of doxil versus bleomycin plus vincristine in treating Kaposi's sarcoma. Developments in the use of cyclodextrin (itraconazole) for treating oral candidiasis showed it may be a more suitable option than fluconazole given fluconazole's high price, drug interactions, and potential to cause resistance.

Topics: AIDS-Related Opportunistic Infections; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Azithromycin; Bleomycin; Candidiasis; Cytomegalovirus Infections; Doxorubicin; Drug Carriers; Ganciclovir; Humans; Liposomes; Mycobacterium avium-intracellulare Infection; Pneumonia, Pneumocystis; Sarcoma, Kaposi; Vincristine