Pallasch T J
Pharmacology Section, University of Southern California School of Dentistry, Los Angeles, USA.
Dent Today. 1997 Nov;16(11):72, 74-5, 78-9.
The macrolides remain excellent antibiotics for many infections particularly those involving intracellular and/or respiratory pathogens. Erythromycin is still an effective drug for many acute orofacial infections. The newer macrolides, azithromycin and clarithromycin, should also prove efficacious although there is very little current data on their use in orofacial infections. They have the advantages over erythromycin of less GI toxicity, higher tissue concentrations, greater gram-negative spectrum, and once or twice daily dosing for better patient compliance. Macrolide concentration in inflammatory cells and transport to the site of infection is a distinct advantage over other antibiotics. Both erythromycin and clarithromycin are associated with significant drug interactions but azithromycin is devoid of such potential toxicity. Azithromycin is less effective against gram-negative cocci than erythromycin and clarithromycin and attains very high tissue concentrations for a very long time, but whether either of these characteristics is clinically significant for orofacial infections is presently unknown.
大环内酯类药物仍然是治疗许多感染的优秀抗生素，特别是那些涉及细胞内和/或呼吸道病原体的感染。红霉素对许多急性口腔面部感染仍然是一种有效的药物。较新的大环内酯类药物阿奇霉素和克拉霉素也应证明是有效的，尽管目前关于它们在口腔面部感染中的应用数据非常少。它们比红霉素具有以下优势：胃肠道毒性较小、组织浓度较高、革兰氏阴性菌谱更广，并且每日给药一次或两次，患者依从性更好。与其他抗生素相比，炎症细胞中的大环内酯类药物浓度以及向感染部位的转运是一个明显的优势。红霉素和克拉霉素都与显著的药物相互作用有关，但阿奇霉素没有这种潜在毒性。阿奇霉素对革兰氏阴性球菌的疗效不如红霉素和克拉霉素，并且在很长一段时间内都能达到非常高的组织浓度，但这些特性对口腔面部感染是否具有临床意义目前尚不清楚。
