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Antimicrobial Agents and Chemotherapy, February 1998, p. 377-382, Vol. 42, No. 2
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Comparison of Pharmacodynamics of Azithromycin and Erythromycin In Vitro and In Vivo

Jan G. den Hollander,1,* Jenny D. Knudsen,2 Johan W. Mouton,1 Kurt Fuursted,2 Niels Frimodt-Møller,2 Henri A. Verbrugh,1 and Frank Espersen2

Department of Medical Microbiology and Infectious Diseases, University Hospital, Rotterdam, The Netherlands,1 and Division of Microbiology, Statens Serum Institut, Copenhagen, Denmark2

Received 17 March 1997/Returned for modification 18 September 1997/Accepted 22 November 1997

In this study, we determined the efficacy of various dosing regimens for erythromycin and azithromycin against four pneumococci with different susceptibilities to penicillin in an in vitro pharmacokinetic model and in a mouse peritonitis model. The MIC was 0.03 µg/ml, and the 50% effective doses (determined after one dose) of both drugs were comparable for the four pneumococcal strains and were in the range of 1.83 to 6.22 mg/kg. Dosing experiments with mice, using regimens for azithromycin of one to eight doses/6 h, showed the one-dose regimen to give the best result; of the pharmacodynamic parameters tested (the maximum drug concentration in serum [Cmax], the times that the drug concentration in serum remained above the MIC and above the concentration required for maximum killing, and the area under the concentration time curve), Cmax was the best predictor of outcome. The bacterial counts in mouse blood or peritoneal fluid during the first 24 h after challenge were not correlated to survival of the mice. The serum concentration profiles obtained with mice for the different dosing regimens were simulated in the in vitro pharmacokinetic model. Here as well, the one-dose regimen of azithromycin showed the best result. However, the killing curves in vivo in mouse blood and peritoneal fluid and in the vitro pharmacokinetic model were not similar. The in vitro killing curves showed a decrease of 2 log10 within 2 and 3 h for azithromycin and erythromycin, respectively, whereas the in vivo killing curves showed a bacteriostatic effect for both drugs. It is concluded that the results in terms of predictive pharmacodynamic parameters are comparable for the in vitro and in vivo models and that high initial concentrations of azithromycin favor a good outcome.

* Corresponding author. Present address: Department of Internal Medicine, Zuiderziekenhuis, Groene Hilledijk 315, 3075 EA Rotterdam, The Netherlands. Phone: 31-10-2903000, ext. 109. Fax: 31-10-2903361. E-mail: denHollander{at}BACL.AZR.NL.

Antimicrobial Agents and Chemotherapy, February 1998, p. 377-382, Vol. 42, No. 2
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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