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Author: Admin | 2025-04-28
Necessary for the initial treatment of severe Legionnaires’ disease and the addition of oral rifampin is recommended during the first 3–5 days of macrolide or doxycycline therapy in severely ill and/or immunocompromised patients; after a response is obtained, rifampin can be discontinued and therapy changed to an oral regimen. Some clinicians suggest that azithromycin may be the preferred macrolide for the treatment of severe Legionnaires’ disease and may also be preferred for empiric therapy in patients with severe community-acquired pneumonia (CAP) that may be caused by Legionella. (See Community-acquired Pneumonia under Uses: Respiratory Tract Infections.)Mycobacterium avium Complex (MAC) InfectionsAlthough erythromycin is not used in the treatment of mycobacterial infections, other macrolides (azithromycin, clarithromycin) are used in the treatment and prevention of Mycobacterium avium complex (MAC) infections. Nongonococcal UrethritisOral erythromycin or oral azithromycin is used for the treatment of nongonococcal urethritis. While C. trachomatis is a frequent cause of nongonococcal urethritis, these infections can be caused by Ureaplasma urealyticum or Mycoplasma genitalium; Trichomonas vaginalis and HSV also are possible causes of nongonococcal urethritis. The CDC currently considers a single oral dose of azithromycin or a 7-day regimen of oral doxycycline the regimens of choice for the treatment of nongonococcal urethritis. Alternative regimens recommended by the CDC are a 7-day regimen of oral erythromycin base or ethylsuccinate or a 7-day regimen of oral ofloxacin or levofloxacin. Patients with persistent or recurrent urethritis who were not compliant with the treatment regimen or were reexposed to untreated sexual partner(s) should be retreated with the initial regimen. If the patient has recurrent and persistent urethritis, was compliant with the regimen, and reexposure can be excluded, the CDC recommends an additional 7-day regimen of oral erythromycin given in conjunction with a single 2-g dose of oral metronidazole.PertussisErythromycin is considered the drug of choice for the treatment of Bordetella pertussis infection (pertussis, whooping cough) and for prevention in contacts of patients with pertussis. According to CDC data, there were an average of 2900 cases of pertussis each year in the US from 1980–1990; however, the incidence of pertussis has been gradually increasing during the last decade. In
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