Macrolides in Genital Infections Syphilis Erythromycin: - - PowerPoint PPT Presentation

Macrolides in Genital Infections

Syphilis

Erythromycin: ineffective in neurosyphilis no longer recommended for treatment Azithromycin: limited data, more required 500 mg daily x 10 role to be determined? Other agents: animal data only no indications at present

Macrolides in Genital Infections

Chancroid

Erythromycin: 500 mg 6 hourly for 7 days effective, but ? compliance Azithromycin: 500 mg orally x 1 effective, both for culture positive and negative ulcers

Donovanosis (Granuloma inguinale)

Erythromycin: 500 mg 6 hourly for 2 to 3 weeks established therapy Azithromycin: 500 mg orally x 7 days, or 1 gram weekly for 4 weeks effective, both for histological and clinical cases

Macrolides in Genital Infections

Gonorrhoea

Erythromycin: active in vivo. not effective in single dose unless combined with rifampicin Azithromycin: 1 g x 1 is 85 - >95% effective 2 g x1 >99% effective, but SE problem? ?cost Spiramycin: single doses of 2.5 g,

• r 4 - 12g x 2 days

80 - 85% effective in single dose

Macrolides in Genital Infections

Activity of various macrolides against C. trachomatis

Antimicrobial MIC (mg/l Clarithromycin 0.007 Josamycin 0.03 Roxithromycin 0.03 Midecamycin acetate 0.06 Erythromycin 0.06 Azithromycin 0.125 Spiramycin 0.5

Macrolides in Genital Infections

Antimicrobial

• M. hominis
• U. urealyticum

MIC (mg/l) MIC (mg/l) Midecamycin acetate 0.008 - 0.12 0.03 - 0.25 Clarithromycin 8 - 64 0.025 - 1.0 Josamycin not available 0.02 - 0.5 Roxithromycin 8 - >64 0.06 - 1.0 Azithromycin 2 - 16 0.12 - 1.0 Erythromycin >32 0.12 - 2.0 Activity of various macrolides against M. hominis &U. urealyticum

Macrolides in Genital Infections

Chlamydial and non-specific genital infection

Erythromycin: 500 mg 6- 12 hourly for 7 - 14 days effective, but ?compliance? Spiramycin: 1g 12 hourly for 14 days Roxithromycin 300 - 450 mg daily for 7 - 14 days Josamycin 500 mg 12 hourly for 12 days (? Pregnancy) 500 mg 8 hourly for 8 days Clarithromycin 250 mg 12 hourly for 7 No indication to use any of above except erythromycin (cheap)

Macrolides in Genital Infections

Chlamydial and non-specific genital infection

Azithromycin

• single oral dose of 1 g
• microbiological cure rates approach 100%
• clinical cure rates for chlamydia positive or negative

non-gonococcal in fection range between 80% and 95%

• clinical cure rates same as conventional doxycycline
• pharmacoeconomics may favour first line use
• role in PID requires further study

Macrolides in Genital Infections

Compliance Comeback Counselling Condom Cost Contact tracing