By Ed Susman
Special to DG News
CHICAGO, IL -- October 30, 2002 -- The antibiotic
azithromycin was just as effective in the treatment of pertussis as the standard
therapy - erythromycin - and was better tolerated and resulted in greater
compliance with the prescribed therapy.
The finding was reported here Tuesday at the 40th
annual meeting of the Infectious Diseases Society of America.
Joanne Langley, MD, associate professor of
pediatrics at Dalhousie University, in Halifax, Canada, noted that while
erythromycin is considered standard of care, doctors are aware that it is
associated with gastrointestinal discomfort among many patients.
"We undertook the study because the newer macrolide
antimicrobials such as azithromycin are better tolerated, but they have not been
adequately studied in pertussis," Dr. Langley said.
The study, which enrolled 477 children aged 6
months to 16 years through 10 centers in Canada and one in the United States,
who had untreated culture positive pertussis or respiratory illness suspected to
be pertussis. Suspected pertussis was defined as a paroxysmal cough of any
duration, a cough with an inspiratory whoop, a cough ending in apnea, vomiting
or gagging or a child with any cough and culture-proven pertussis.
Dr. Langley said the results showed that five days
of azithromycin and 10 days of erythromycin were equally effective for the
treatment of pertussis in children. "Azithromycin was better tolerated than
erythromycin," she said. "Compliance was better with azithromycin than with
erythromycin."
In the intent-to-treat analysis, azithromycin
eradicated culture-proven pertussis in 93.1 percent of the cases, while
erythromycin eradicated culture-proven pertussis in 94.6 percent of the cases.
In those patients who actually underwent the treatment protocol, both drugs were
100 percent effective in eradicating the pathogen, and none of these patients
suffered a recurrence in the four-to-six week follow-up period.
Dr. Langley reported that 50 to 65 percent of
erythromycin patients reported some antibiotic-associated adverse events,
primarily gastrointestinal complaints, while about 30 percent of azithromycin
patients reported adverse events.
The patients received 10 mg/kg - to a maximum of
500 mg - of azithromycin on the first day of the trial and then were given 4
mg/kg with a maximum daily dose of 250 mg on days 2 through 5, or erythromycin
at a dose 40 mg/kg, with a maximum of 1 gram, in three divided doses for 10
days.
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