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Pneumoniae using broth microdilution. To prove that azithromycin ( Zithromax ) exerts its antifungal effect by inhibiting protein synthesis, we studied [35S]-methionine incorporation

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into protein in one Aspergillus

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isolate. The MIC of amphotericin B was 1 microg/ml antibiotics for sinus infection and pregnancy concentrations (MICs) of penicillin, azithromycin ( Zithromax

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), clarithromycin, and clindamycin were determined for 307 isolates of S. Multidrug-resistant strains of Streptococcus pneumoniae are increasingly com worldwide, but the clinical significance of their resistance to the macrolide

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antibiotics is controversial.

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Based on serum concentrations, clarithromycin achieved its pharmacodynamic target in 76.9% of isolates, compared with 59.9% for azithromycin ( Zithromax ). Pneumoniae and to evaluate the pharmacodynamics of azithromycin ( Zithromax ) and clarithromycin based on serum and epithelial lining fluid (ELF) concentrations. Neither amphotericin B at 0.125 microg/ml (fourfold below its MIC) nor azithromycin ( Zithromax ) at 16 microg/ml (>

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azythromycin

or 16-fold below its MIC) had any effect on protein synthesis when tested alone. Based on ELF concentrations, clarithromycin achieved its pharmacodynamic

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target in 86.7% of penicillin-resistant

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isolates, compared with 28.3% for azithromycin ( Zithromax ). Overall, 19.5%, 25.4%, 25.1%, and 7.2% of the 307 pneumococcal isolates were resistant to penicillin, azithromycin ( Zithromax ), clarithromycin, and clindamycin, respectively. However, 71.7% of penicillin-resistant strains were also resistant to azithromycin ( Zithromax ) and clarithromycin. The purpose of this study was to determine the in vitro activity of penicillin, azithromycin ( Zithromax ), clarithromycin, and clindamycin against clinical isolates of S. Pneumoniae isolates than did

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azithromycin ( Zithromax ). Upon combination, however, a 68% inhibition in protein synthesis was evident by the inhibition of [35S]-methionine incorporation. On the basis of serum and ELF concentrations, clarithromycin achieved pharmacodynamic targets against a greater proportion of S. Using serum and ELF concentrations after standard dosing, we calculated the proportion of isolates against which it would be possible to obtain a ratio of azithromycin ( Zithromax ) area under the curve to MIC > or 25 and clarithromycin concentrations that exceeded the MIC for > or 40% of the dosing interval. Applying pharmacokinetic and pharmacodynamic principles can assist in the selection of appropriate antimicrobial therapy. Synergism, defined as a >

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or twofold reduction in the MIC of both drugs upon combination, was demonstrated between amphotericin B and azithromycin ( Zithromax ) for all 25 isolates. All isolates were resistant to azithromycin ( Zithromax ).

Based on ELF concentrations, clarithromycin achieved its pharmacodynamic target in 93.5% of isolates, compared with 74.6% for azithromycin ( Zithromax ).