Drugs online research references
Pharmacotherapy. 2000 Jun;20(6):657-61.
Comparison of the serum and intracellular pharmacokinetics of azithromycin in healthy and diabetic volunteers.
Ernst EJ, Klepser ME, Klepser TB, Nightingale CH, Hunsicker LG.
Division of Clinical and Administrative Pharmacy, University of Iowa, College of Pharmacy, Iowa City 52242, USA.
STUDY OBJECTIVE: To compare serum and intracellular pharmacokinetics of azithromycin in healthy volunteers and patients with diabetes. DESIGN: Open-label, parallel study. SETTING: Clinical research center. SUBJECTS: Twelve patients with diabetes and 12 healthy volunteers. INTERVENTIONS: Subjects were given a single 500-mg dose of azithromycin followed by 250 mg/day for 2 days. Blood samples were obtained just before and after the third dose for up to 24 hours for serum and 168 hours for intracellular measurement of azithromycin. MEASUREMENTS AND MAIN RESULTS: Pharmacokinetic parameters were calculated by noncompartmental methods and compared with a t test. The groups did not differ in maximum concentration, time to maximum concentration, or area under the concentration-time curve in serum or polymorphonuclear cells (PMNs). Differences in the PMN:serum ratio were observed at the 24-hour time point (healthy 1209 +/- 432, diabetic 859 +/- 286, p=0.051). CONCLUSION: In general, the pharmacokinetics of azithromycin are comparable in diabetics and healthy volunteers. Accumulation of drug in macrophages was slightly lower in patients.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10853621&dopt=Abstract
word match zithromax online literature
Antimicrob Agents Chemother. 2000 Jul;44(7):1990-4.
Mycobacterium avium grown in Acanthamoeba castellanii is protected from the effects of antimicrobials.
Miltner EC, Bermudez LE.
Kuzell Institute for Arthritis and Infectious Diseases, California Pacific Medical Center Research Institute, San Francisco, California, USA.
Mycobacterium avium is a common cause of systemic bacterial infection in patients with AIDS. Infection with M. avium has been linked to bacterial colonization of domestic water supplies and commonly occurs through the gastrointestinal tract. Acanthamoeba castellanii, a waterborne protozoan, may serve as an environmental host for M. avium. It has been shown that growth of M. avium in amoebae enhances invasion and intracellular replication of the bacteria in human macrophages and intestinal epithelial cell line HT-29 as well as in mice. We determined that growth of M. avium within A. castellanii influenced susceptibility to rifabutin, azithromycin, and clarithromycin. No significant activity against M. avium was seen with rifabutin, azithromycin, and clarithromycin when used to treat monolayers on both day 1 and day 4 after infection. When tested in a macrophage-like cell line (U937), all compounds showed significant anti-M. avium activity. Growth of M. avium in amoebae appears to reduce the effectiveness of the antimicrobials. These findings may have significant implications for prophylaxis of M. avium infection in AIDS.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10858369&dopt=Abstract
word match zithromax online literature
Int J Technol Assess Health Care. 1999 Summer;15(3):531-47.
The cost-effectiveness of prophylaxis for Mycobacterium avium complex in AIDS.
Scharfstein JA, Paltiel AD, Weinstein MC, Seage GR, Losina E, Craven DE, Freedberg KA.
Johns Hopkins School of Public Health, USA.
OBJECTIVE: To develop a simulation model to project costs, life expectancy, and cost-effectiveness in discounted dollars per quality-adjusted life-year (QALY) saved for clinical strategies to prevent Mycobacterium avium complex (MAC) in patients with AIDS. METHODS: We used natural history data from the Multicenter AIDS Cohort Study, efficacy and toxicity data from randomized clinical trials, and cost data from the AIDS Cost and Services Utilization Survey. The model permits timing of prophylaxis to be stratified by CD4 count (201-300, 101-200, 51-100, and < or = 50/mm3), and allows combinations of prophylaxis, crossover to second- and third-line agents for toxicity, and consideration of adherence, resistance, and quality of life. RESULTS: The model projects that the average HIV-infected patient with a beginning CD4 count between 201 and 300/mm3 has total lifetime costs of approximately $43,150 and a quality-adjusted life expectancy of 42.35 months. If azithromycin prophylaxis for M. avium complex is begun after the CD4 declines to 50/mm3, costs and quality-adjusted survival increase to approximately $44,040 and 42.78 months, respectively, for an incremental cost-effectiveness ratio of $25,000/QALY compared with no M. avium complex prophylaxis. Other prophylaxis options (i.e., rifabutin, clarithromycin, and combination therapies) either cost more but offer shorter survival, or have cost-effectiveness ratios above $260,000/QALY. Sensitivity analysis reveals that, for reasonable assumptions about quality of life, risk of infection, prophylaxis cost, adherence, and resistance, azithromycin remains the most cost-effective prophylaxis option. CONCLUSIONS: Azithromycin prophylaxis, begun after the CD4 count has declined to 50/mm3, is the most cost-effective M. avium complex prophylaxis strategy. Consistent with new United States Public Health Service guidelines, it should be the first-line prophylaxis option.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10874380&dopt=Abstract
word match zithromax online literature
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