Azithromycin in the clinic of infectious diseases

Authors

DOI:

https://doi.org/10.15574/SP.2023.129.106

Keywords:

children, infectious diseases, antibiotics, macrolides, azithromycin

Abstract

Infectious diseases are extremely common among children, characterized by a severe course and are the leading cause of death among young children.

Purpose - to increase the awareness of medical workers regarding the current trends in the therapy of infectious diseases and highlight the feasibility of using azithromycin, based on the latest international recommendations.

This review presents the main characteristics of the most common infectious diseases, as well as modern approaches to their treatment. Antibiotic therapy is an integral part of the treatment of most infections. Azithromycin is an antibacterial drug from the group of macrolides, characterized by a wide range of applications in pediatric practice. We considered the mechanisms of its bacteriostatic, antimicrobial, immunomodulatory activity and presented the results of numerous studies on the effectiveness of azithromycin use in infectious diseases.

Conclusions. Azithromycin is an effective and proven antibacterial agent for various pathological conditions, such as diseases of the lower respiratory tract (pneumonia, acute bronchitis, bronchiolitis), acute intestinal infections and Lyme borreliosis. Studies of this drug show good tolerability, low rate of adverse reactions and high safety profile, which allows it to be prescribed to young children, and bacteriostatic, antimicrobial, immunomodulatory and bactericidal activity contribute to a wide range of applications in pediatric practice.

No conflict of interests was declared by the authors.

References

ABCD study team. (2020). A double-blind placebo-controlled trial of azithromycin to reduce mortality and improve growth in high-risk young children with non-bloody diarrhoea in low resource settings: the Antibiotics for Children with Diarrhoea (ABCD) trial protocol. Trials. 21 (1): 71. https://doi.org/10.1186/s13063-019-3829-y; PMid:31931848 PMCid:PMC6956478

Ahmed T, Chisti MJ, Rahman MW, Alam T, Ahmed D et al. (2021). Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings: A Randomized Clinical Trial. JAMA Netw Open. 4 (12): e2136726. https://doi.org/10.1001/jamanetworkopen.2021.36726; PMid:34913980 PMCid:PMC8678692

Altunaiji S, Kukuruzovic R, Curtis N, Massie J. (2007). Antibiotics for whooping cough (pertussis) Cochrane Database Syst Rev. 3: CD004404. https://doi.org/10.1002/14651858.CD004404.pub3; PMid:17636756

Ates L, Hanssen-Hübner C, Norris DE, Richter D, Kraiczy P, Hunfeld KP. (2010). Comparison of in vitro activities of tigecycline, doxycycline, and tetracycline against the spirochete Borrelia burgdorferi. Ticks Tick Borne Dis. 1: 30-34. https://doi.org/10.1016/j.ttbdis.2009.11.004; PMid:21771509

Borkner L, Misiak A, Wilk MM, Mills KHG. (2018). Azithromycin Clears Bordetella pertussis Infection in Mice but Also Modulates Innate and Adaptive Immune Responses and T Cell Memory. Front Immunol. 9: 1764. https://doi.org/10.3389/fimmu.2018.01764; PMid:30105030 PMCid:PMC6077268

Bruzzese E, Giannattasio A, Guarino A. (2018). Antibiotic treatment of acute gastroenteritis in children. F1000Res. 7: 193. https://doi.org/10.12688/f1000research.12328.1; PMid:29511533 PMCid:PMC5814741

Cameron D, Johnson L, Maloney E. (2014). Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Review of Anti-Infective Therapy. 12; 9: 1103-1135. https://doi.org/10.1586/14787210.2014.940900; PMid:25077519 PMCid:PMC4196523

Carloan P. (2019). Pediatric Bronchitis: Practice Essentials, Pathophysiology, Etiology. URL: https://emedicine.medscape.com/ article/1001332overview.

Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD). (2022). Lyme Disease. URL: https://www.cdc.gov/lyme/index.html.

Che SY, He H, Deng Y, Liu EM. (2019). Clinical effect of azithromycin adjuvant therapy in children with bronchiolitis: a systematic review and Meta analysis. Zhongguo Dang Dai Er Ke Za Zhi. 21 (8): 812-819. doi: 10.7499/j.issn.1008-8830.2019.08.014.

Das R, Kabir MF, Ashorn P, Simon J, Chisti MJ, Ahmed T. (2022). Maternal Underweight and Its Association with Composite Index of Anthropometric Failure among Children under Two Years of Age with Diarrhea in Bangladesh. Nutrients. 14 (9): 1935. https://doi.org/10.3390/nu14091935; PMid:35565901 PMCid:PMC9105738

De Bruyn G, Hahn S, Borwick A. (2000). Antibiotic treatment for travellers' diarrhoea. Cochrane Database Syst Rev. 3: CD002242. https://doi.org/10.1002/14651858.CD002242; PMCid:PMC6532602

Entringer S. (2020). Drugs.com «Azithromycin». URL: https://www.drugs.com/azithromycin.html.

Farzam K, Nessel TA, Quick J. (2022). Erythromycin. StatPearls. StatPearls Publishing; Treasure Island. URL: https://europepmc.org/article/NBK/nbk532249.

Fry NK, Campbell H, Amirthalingam G. (2021). JMM Profile: Bordetella pertussis and whooping cough (pertussis): still a significant cause of infant morbidity and mortality, but vaccine-preventable. J Med Microbiol. 70 (10): 001442. https://doi.org/10.1099/jmm.0.001442

Giguere S, Jacks S, Roberts GD, Hernandez J, Long MT, Ellis C. (2004). Retrospective Comparison of Azithromycin, Clarithromycin, and Erythro mycin for the Treatment of Foals with Rhodococcus equi Pneumonia. J Vet Intern Med. John Wiley & Sons. 18: 568-573. https://doi.org/10.1111/j.1939-1676.2004.tb02587.x; PMid:15320600

Guarino A, Aguilar J, Berkley J, Broekaert I, Vazquez-Frias R, Holtz L et al. (2020). Acute Gastroenteritis in Children of the World: What Needs to Be Done? J Pediatr Gastroenterol Nutr. 70 (5): 694-701. https://doi.org/10.1097/MPG.0000000000002669; PMid:32079974 PMCid:PMC7613312

Guarino A, Ashkenazi S, Gendrel D, Vecchio AL, Shamir R, Szajewska H. (2014). ESPGHAN/ESPID Evidence-based Guidelines for the Management of Acute Gastroenteritis in Children in Europe. Journal of pediatric gastroenterology and nutrition. 39; 1: 132-152. https://doi.org/10.1097/MPG.0000000000000375; PMid:24739189

Guarino A, Lo Vecchio A, Dias JA, Berkley JA, Boey C, Bruzzese D et al. (2018). Universal Recommendations for the Management of Acute Diarrhea in Nonmalnourished Children. Journal of Pediatric Gastroenterology and Nutrition. 67; 5: 586-593. https://doi.org/10.1097/MPG.0000000000002053; PMid:29901556 PMCid:PMC7116696

Handy LK, Bryan M, Gerber JS, Zaoutis T, Feemster KA. (2017). Variability in Antibiotic Prescribing for Community-Acquired Pneumonia. Pediatrics: 139. URL: https://pubmed.ncbi.nlm.nih.gov/28270546/. https://doi.org/10.1542/peds.2016-2331; PMid:28270546 PMCid:PMC5369668

Hart JD, Kalua K, Keenan JD, Lietman TM, Bailey RL. (2020). Effect of Mass Treatment with Azithromycin on Causes of Death in Children in Malawi: Secondary Analysis from the MORDOR Trial. Am J Trop Med Hyg. 103 (3): 1319-1328. https://doi.org/10.4269/ajtmh.19-0613; PMid:32342837 PMCid:PMC7470551

Hawk D, Tribble DR, Riddle MS. (2010). Clinical treatment of nondysentery travelers' diarrhea during deployment. Mil Med. 175 (3): 140-146. https://doi.org/10.7205/MILMED-D-09-00190; PMid:20358701

Heidary M, Samangani AE, Kargari A, Nejad AK, Yashmi I, Motahar M, Taki E, Khoshnood S. (2022). Mechanism of action, resistance, synergism, and clinical implications of azithromycin. J Clin Lab Anal. 36 (6): e24427. https://doi.org/10.1002/jcla.24427

Hunfeld KP, Brade V. (2006). Antimicrobial susceptibility of Borrelia burgdorferi sensu lato: what we know, what we don't know, and what we need to know. Wien Klin Wochenschr. 22: 659-668. https://doi.org/10.1007/s00508-006-0693-z; PMid:17160604

Johnson RC, Kodner C, Russell M, Girard D. (1990). In-vitro and in-vivo susceptibility of Borrelia burgdorferi to azithromycin. J Antimicrob Chemother. 25: 33-38. https://doi.org/10.1093/jac/25.suppl_A.33; PMid:2154436

Justice NA, Le JK. (2022). Bronchiolitis. StatPearls. Treasure Island (FL): StatPearls Publishing. UR: https://www.ncbi.nlm.nih.gov/books/NBK441959/.

Kinkade S, Long NA. (2016). Acute Bronchitis. Am Fam Physician. 94: 560-565. URL: https://www.aafp.org/afp/2016/1001/p560.html.

Kramarov SO, Yevtushenko VV. (2021). The role of azithromycin in the antibacterial therapy of acute respiratory infections in children. Modern Pediatrics. Ukraine. 7 (119): 63-71. https://doi.org/10.15574/SP.2021.119.63

Kronman MP, Zhou C, Mangione-Smith R. (2014). Bacterial Prevalence and Antimicrobial Prescribing Trends for Acute Respiratory Tract Infec tions. Pediatrics. 134: e956-965. https://doi.org/10.1542/peds.2014-0605; PMid:25225144

Lower Respiratory Infections Collaborators. (2018). Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016 .Lancet Infect. Dis. 18 (11): 1191-1210.

Luisi F, Roza CA, Silveira VD, Machado CC, Rosa KMD, Pitrez PM et al. (2020). Azithromycin administered for acute bronchiolitis may have a protective effect on subsequent wheezing. J Bras Pneumol. 46 (3): e20180376. https://doi.org/10.36416/1806-3756/e20180376; PMid:32130359 PMCid:PMC8650811

Ministry of Health of Ukraine. (2021). World Pneumonia Day. URL: https://moz.gov.ua/article/health/pnevmonija-osnovni-simptomi-ta-likuvannja.

Morley VJ, Firgens EPC, Vanderbilt RR, Zhou Y, Zook M, Read AF, MacGeorge EL. (2020). Factors associated with antibiotic prescribing for acute bronchitis at a university health center. BMC Infect Dis. 20 (1): 177. https://doi.org/10.1186/s12879-020-4825-2; PMid:32102652 PMCid:PMC7045376

National Institute for Health and Clinical Excellence (NICE). (2008). Respiratory tract infection (selflimiting): prescribing antibiotics. NICE Guidel: 1-20. URL: www.nice.org.uk/CG69.

Park JY, Park S, Lee SH, Lee MG, Park YB, Oh KC et al. (2016). Microorganisms Causing CommunityAcquired Acute Bronchitis: The Role of Bacterial Infection. Larcombe A, editor. PLoS One. Public Library of Science. 11: e0165553. URL: https://dx.plos.org/10.1371/journal.pone.0165553. https://doi.org/10.1371/journal.pone.0165553; PMid:27788254 PMCid:PMC5082923

Parnham MJ, Erakovic Haber V, Giamarellos-Bourboulis EJ, Perletti G, Verleden GM, Vos R. (2014). Azithromycin: mechanisms of action and their relevance for clinical applications. Pharmacol Ther. 143 (2): 225-245. https://doi.org/10.1016/j.pharmthera.2014.03.003; PMid:24631273

Patel PH, Hashmi MF. (2022). Macrolides. In: StatPearls. Treasure Island (FL): StatPearls Publishing. URL: https://www.ncbi.nlm.nih.gov/books/NBK551495/.

Platts-Mills JA, Houpt ER, Liu J, Zhang J, Guindo O, Sayinzoga-Makombe N et al. (2021). Etiology and Incidence of Moderate-to-Severe Diarrhea in Young Children in Niger. J Pediatric Infect Dis Soc. 10 (12): 1062-1070. https://doi.org/10.1093/jpids/piab080; PMid:34468743 PMCid:PMC8719619

Public Health Center of the Ministry of Health of Ukraine. (2020). Lyme disease. URL: https://phc.org.ua/kontrol-zakhvoryuvan/inshi-infekciyni-zakhvoryuvannya/osoblivo-nebezpechni-infekcii/khvoroba-layma.

Ralston SL, Lieberthal AS, Meissner HC et al. (2014). Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 134 (5): 1474-1502.

Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS et al. (2017). 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clinical Infectious Diseases. 65; 12: e45-e80. https://doi.org/10.1093/cid/cix669; PMid:29053792 PMCid:PMC5850553

The National Institute for Health and Care Excellence. (2018). NICE guideline. «Lyme disease» [NG95]. URL: https://www.nice.org.uk/guidance/ng95.

UNICEF. (2022). Childhood diseases. URL: https://www.unicef.org/health/childhood-diseases.

WHO. (2017). Diarrhoeal disease URL: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.

WHO. (2019). Pertussis. URL: https://www.who.int/health-topics/pertussis#tab=tab_1.

WHO. (2020). WHO reveals leading causes of death and disability worldwide: 2000-2019. URL: https://www.who.int/news/item/09-12-2020-who-reveals-leading-causes-of-death-and-disability-worldwide-2000-2019.

WHO. (2022). Pneumonia in children. URL: https://www.who.int/ru/news-room/fact-sheets/detail/pneumonia.

Yang J. (2020). Mechanism of azithromycin in airway diseases. J Int Med Res. SAGE Publications Ltd: 48. https://doi.org/10.1177/0300060520932104; PMid:32589092 PMCid:PMC7323306

Yeo YH, Shiu SI, Ho HJ, Zou B, Lin JT, Wu MS, Liou JM, Wu CY. (2018). Taiwan Gastrointestinal Disease and Helicobacter Consortium. First-line Helicobacter pylori eradication therapies in countries with high and low clarithromycin resistance: a systematic review and network meta-analysis. Gut. 67 (1): 20-27. https://doi.org/10.1136/gutjnl-2016-311868; PMid:27670375

Published

2023-02-27

Issue

Section

Practical doctor school