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

Author(s): Eisenblatter M, Klaus C, Pletz MW, Orawa H, Hahn H, Wagner J, Lode H

Affiliation(s): Institute for Microbiology and Hygiene, Charite-University Medicine Berlin, Campus Benjamin Franklin, Free University and Humboldt University Berlin, Berlin, Germany. martin.eisenblaetter@charite.de

Publication date & source: 2008-11, Eur J Clin Microbiol Infect Dis., 27(11):1087-92. Epub 2008 May 30.

Publication type: Randomized Controlled Trial; Research Support, Non-U.S. Gov't

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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