CLINICAL STUDY ON AZITHROMYCIN IN 10% FINE GRANULES AND 100mg CAPSULES IN THE FIELD OF PEDIATRICS

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  • 小児科領域におけるAzithromycin 10% 細粒剤及び 100mg カプセル剤の基礎的・臨床的検討

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Abstract

Azithromycin (AZM), a new oral macrolide antibiotic, in 10% fine granules or 100 mg capsules was given to pediatric patients to treat various infections. The following results were obtained in our studies of AZM for its antibacterial activities against clinical isolates, its pharmacokinetics, its efficacy, and its safety.<BR>1. MICs of AZM, erythromycin (EM) and clarithromycin (CAM) were determined against a total of 57 strains all at 106 cfu/ml. Among Gram-positive cocci, MICs of AZM ranged from 0.78 to> 100 μg/ml against Staphylococcus aureus (20 strains), from 0.05 to 0.1 μg/ml against Streptococcus pyogenes (11 strains), and from 0.0125 to 3.13μg/ml against Streptococcus pneumoniae (10 strains). These MICs were similar to those of the other macrolides. Among Gram-negative bacilli, MICs of AZM were 0.05μg/ml against Moraxella subgenus Branhamella catarrhalis (1 strain), from 0.78 to 3.13μg/ml against Haemophilus influenzae (9 strains), 0.78μg/ml against Haemophilus parainfluenzae(1 strain) and 6.25 μg/ml against Salmonella sp.(1 strain). These values were similar to or lower than those of the other macrolides. Against Mycoplasma pneumoniae, MICs of AZM were ≥0.0008 μg/ml in three strains. One strain of M. pneumoniae showed tolerance to AZM at MIC 25 μg/ml. The other agents exhibited higher MIC than AZM against this organism.<BR>2. Plasma samples were collected from five patients receiving fine granules and four patients receiving capsules for drug level determination. The patients received AZM at 10.0-16.3 mg/kg body weight once daily for 3 days. Drug concentrations in plasma at two hours after Day 3 dosing were in a range between 0.02 and 0.19μg/ml for fine granules and were in a range between 0.11 and 0.42 μg/ml for capsules.<BR>3. Urine samples were collected from four patients receiving fine granules and four patients receiving capsules. Drug levels were determined to be 3μ/ml at post-treatment 48 hours for fine granules and post-treatment 72 hours for capsules. Urinary excretion rates of AZM in three patients on capsules lied in a range between 4.69 and 10.17%.<BR>4. Effectiveness of AZM in fine granules was evaluated in 128 patients having a total of 19 different infections. AZM was rated “excellent” in 51 patients, “good” in 63, “fair” in 8, “poor” in 6, resulting in an efficacy rate of 89.1%. Effectiveness of AZM in capsular form was evaluated in 23 patients with five different infections. AZM was found “excellent” in 13 patients and “good” in 10, resulting in an efficacy rate of 100%.<BR>5. AZM in fine granules eradicated 45 strains of 54 in 8 different bacteria. AZM in capsules eradicated 9 strains of 10 strains in 6 different bacteria.<BR>6. As for adverse reactions, one patient complained of eruption, one vomiting, one loose stool, five diarrhea, when administered with fine granular form of AZM. One patient on AZM capsules experienced urticaria and vomiting.<BR>7. As for abnormal laboratory changes, three patients were found with decreased WBC, seven with increased eosinophil, two with increased GOT and GPT, one with increased GPT. They were all on fine granular form of AZM. As far as abnormalities found in patients administered with AZM in capsular form, two showed decreased WBC, one decreased WBC along with increased eosinophil, and three increased eosinophil.

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