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Influence of azithromycin and clarithromycin on macrolide susceptibility of viridans streptococci from the oral cavity of healthy volunteers

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Abstract

Oral viridans streptococci are a reservoir of resistance genes for pathogens. Through prolonged exposure, long-acting macrolides (e.g., azithromycin) may induce the resistance of the commensals to macrolides more frequently than macrolides with a shorter half-life (e.g., clarithromycin). In a prospective, randomized, evaluator-blinded trial in healthy volunteers receiving standard courses of either azithromycin (n = 20) or clarithromycin (n = 20), we compared the susceptibility of oral viridans streptococci to macrolides over a period of 12 weeks. There was a significant temporal increase in the numbers of resistant isolates in both groups (p < 0.0005 at week 1). The proportion of macrolide-resistant isolates over time was significantly higher following azithromycin treatment (p = 0.0005), but returned to baseline values until week 12 in both groups. Temporal differential effects of azithromycin and clarithromycin on the induction of resistance were observed and need to be investigated regarding their effect on co-colonizing pathogens.

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Acknowledgments

This work was supported financially by Pfizer Pharmaceuticals, Pfizer, New York, NY. The company was not involved in the analysis and presentation of the data, nor with the preparation of the manuscript. Parts of this work were presented at the 14th European Congress on Clinical Microbiology and Infectious Diseases (ECCMID), Prague, Czech Republic, April 2004, poster #P521.

We are grateful to Prof. Walter E. Haefeli, Department of Internal Medicine VI, Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Germany, for the determination of the antimicrobial concentrations in urine. We thank Jutta Imlau, Gabriele Schreiber, and Margot Rau for their expert technical assistance.

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Authors and Affiliations

  1. Institute for Microbiology and Hygiene, Charité—University Medicine Berlin, Campus Benjamin Franklin, Free University and Humboldt University Berlin, Hindenburgdamm 27, 12203, Berlin, Germany

    M. Eisenblätter, C. Klaus, H. Hahn & J. Wagner

  2. Department of Respiratory Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    M. W. R. Pletz

  3. Department of Biostatistics and Clinical Epidemiology, Charité—University Medicine Berlin, Campus Charité Mitte, Free University and Humboldt University Berlin, Luisenstr. 65, 10117, Berlin, Germany

    H. Orawa

  4. Department of Chest and Infectious Diseases, Helios Klinikum Emil von Behring, Zum Heckeshorn 33, 14109, Berlin, Germany

    H. Lode

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  1. M. Eisenblätter
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  2. C. Klaus
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  3. M. W. R. Pletz
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  4. H. Orawa
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  5. H. Hahn
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  6. J. Wagner
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  7. H. Lode
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Correspondence to M. Eisenblätter.

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Eisenblätter, M., Klaus, C., Pletz, M.W.R. et al. Influence of azithromycin and clarithromycin on macrolide susceptibility of viridans streptococci from the oral cavity of healthy volunteers. Eur J Clin Microbiol Infect Dis 27, 1087–1092 (2008). https://doi.org/10.1007/s10096-008-0547-x

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  • DOI: https://doi.org/10.1007/s10096-008-0547-x

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