1 Macrolide 1 antibacterial activity antibacterial activity - PowerPoint PPT Presentation

1 Macrolide 1 antibacterial activity antibacterial activity Macrolide 2 in bacteria 2 without resistance without resistance in bacteria mechanisms to to macrolide antibiotics macrolide antibiotics mechanisms 1 azithromycin, 1 , erythromycin azithromycin, clarithromycin clarithromycin, erythromycin, , roxithromycin roxithromycin, , telithromycin telithromycin 2 bacteria for 2 bacteria for which macrolide antibiotics are used which macrolide antibiotics are used Macrolide activity expressed as MIC (broth or agar dilution) or IC (Etest) values (mg/L). Data from the Swedish Reference Group of Antibiotics (SRGA, SRGA-M; see MIC-table in www.srga.org), and a synthesis of data from a large number of articles. The last slide shows reproducibility of disc diffusion over time. G Kahlmeter Clinical microbiology Central hospital 351 85 Växjö Sweden

Streptococcus pyogenes n =199 clinical isolates (B.Olsson-Liljequist, Sweden) 200 150 100 50 0 0,004 0,016 0,064 0,25 1 4 16 64 > 256 0,008 0,032 0,125 0,5 2 8 32 128 Erythromycin Benzylpenicillin Tetracycline Telithromycin Clindamycin Ciprofloxacin

Streptococcus pneumoniae n =199 clinical isolates (B.Olsson-Liljequist, Sweden) 200 150 100 50 0 0,004 0,016 0,064 0,25 1 4 16 64 >256 0,008 0,032 0,125 0,5 2 8 32 128 Erythromycin Bensylpenicillin Tetracycline Telithromycin Clindamycin Ciprofloxacine

Erythromycin - MIC distributions of isolates that lack resistance mechanisms Mg/L .004 .008 .016 .032 .064 .125 .25 .5 1 2 4 8 16 32 >64 ! ! ! ! S.aureus ! ! ! Coag-neg staph ! ! ! S.saprophyticus ! ! ! Streptococcus_A ! ! ! Streptococcus_B ! ! ! Pneumococci ! ! ! ! Strept misc ! ! ! ! ! Enterococcus ! ! ! Listeria ! ! ! Corynebacteria Bacillus spp ! ! ! ! ! ! ! ! H.influenzae AST ! ! ! M.catarrhalis ! ! ! ! B.pertussis ! ! ! P.multocida ! ! ! ! L. pneumophila ! ! ! Camp. jejuni ! ! ! ! N.gonorrhoeae ! ! ! ! N.meningitidis ! ! ! ! M.pneumoniae ! ! ! Borr. burgdorferi SRGA and SRGA- M, 1998-04-13, 2001-11-11 G Kahlmeter & B.Olsson-Liljequist

Roxithromycin – MIC-distributions of isolates that lack resistance mechanisms. Mg/L .004 .008 .016 .032 .064 .125 .25 .5 1 2 4 8 16 32 >64 ! ! ! S.aureus ! ! ! Coag-neg staph ! ! ! S.saprophyticus ! ! ! Streptococcus_A ! ! ! Streptococcus B ! ! ! Pneumococci ! ! ! Strept misc ! ! ! ! ! Enterococcus ! ! Listeria ! ! ! Corynebacteria ! ! ! Bacillus spp ! ! ! H.influenzae ! ! ! M.catarrhalis ! ! ! ! B. pertussis ! ! ! ! Bor. burgdorferi ! ! ! H.pylori SRGA and SRGA- M, 1998-04-13, 2001-11-11 G Kahlmeter & B.Olsson-Liljequist

Clarithromycin - MIC-distributions of isolates that lack resistance mechanisms. Mg/L .004 .008 .016 .032 .064 .125 .25 .5 1 2 4 8 16 32 >64 ! ! ! S.aureus ! ! ! Coag-neg staph ! ! ! S.saprophyt ! ! ! Streptococcus_A ! ! ! Streptococcus_B ! ! ! Pneumococci ! ! ! Strept misc ! ! ! Enterococcus ! ! Listeria ! ! ! Corynebacteria ! ! ! Bacillus sp ! ! ! ! H.influenzae ! ! ! M.catarrhalis ! ! ! ! ! ! M. pneumoniae ! ! ! Bor. burgdorferi ! ! ! ! Helicobacter SRGA and SRGA- M, 1998-04-13, 2001-11-11, G Kahlmeter G Kahlmeter & B.Olsson-Liljequist

Azitromycin - MIC-distributions of strains that lack resistance mechanisms. Mg/L .004 .008 .016 .032 .064 .125 .25 .5 1 2 4 8 16 32 >64 ! ! ! S.aureus ! ! ! Coag-neg staph ! ! ! S.saprophyticus ! ! ! Streptococcus_A ! ! ! Streptococcus_B ! ! ! ! Pneumococci ! ! ! Strept misc ! ! ! ! ! Enterococcus ! ! ! ! H.influenzae ! ! ! M.catarrhalis ! ! Bor. burgdorferi ! ! H.pylori SRGA and SRGA- M, 1998-04-13, 2001-11-11 G Kahlmeter & B.Olsson-Liljequist

Telithromycin - MIC-distributions of isolates that lack resistance mechanisms Mg/L .004 .008 .016 .032 .064 .125 .25 .5 1 2 4 8 16 32 >64 ! ! ! S.aureus ! ! ! Coag-neg staph ! ! ! S.saprophyt ! ! ! Streptococcus_A ! ! ! Streptococcus_B ! ! ! Pneumococci ! ! ! Strept misc ! ! ! ! E.faecalis ! ! ! E. faecium ! ! ! Listeria ! ! ! H.influenzae ! ! ! ! M.catarrhalis ! ! ! N.meningitidis ! ! ! ! ! ! Helicobacter ! ! ! ! Clostridium spp SRGA and SRGA- M, 2001-05-05 G Kahlmeter & B.Olsson-Liljequist

Streptococcus pyogenes Erythromycin 15 µg on ISA with horse blood 400 - 1100 isolates per year % 25 1991 20 1992 1993 1994 15 1995 1996 10 1997 1998 5 1999 0 6 19 23 30 40 Zone diameter (mm) G Kahlmeter ECCMID2000:29 2000-05-22