Dental therapeutic indications for the newer - Long-acting macrolide antibiotics

Background. When treating oral infections, clinicians have used the macroli de antibiotic erythromycin as an alternative antibiotic for patients who ha ve documented allergic reactions to penicillins. In this article, the autho r reports on his assessment of the pharmacology of erythromycin and the new er macrolide antibiotics, as well as of their indications for the preventio n of bacterial endocarditis and their,possible use for oral-dental infectio ns. Types of Studies Reviewed. The author reviewed the current clinical pharmac ology Literature with specific emphasis on reports indicating these antibio tics' efficacy in treating oral-dental infections. Results. Azithromycin, clarithromycin and dirithromycin are erythromycin an alogues that are currently marketed in the United States. All three have th e therapeutic advantages over erythromycin of longer durations of action, e nhanced acid stabilities and improved tissue distributions. A lower inciden ce of gastrointestinal distress and abdominal cramping is reported for all three of these newer agents than for erythromycin. Azithromycin and dirithr omycin do not appear to compete for the same hepatic drug-metabolizing enzy mes as erythromycin and therefore are not associated with the same drug int eractions. Conclusions and Clinical Implications. The newer macrolide antibiotics offe r the advantage of fewer adverse gastrointestinal effects than erythromycin and dosing regimens of only once or twice a day. Yet, the extremely high p rice of the newer macrolides compared with that of erythromycin limits thei r routine use.