Zithromax: The Story Behind The Scenery (Part 2)

[Guest guest]

While a period of time of ten to fifteen years may be soon enough for my

daughter, we all know that there are thousands of patients out there,

who won't make it so long. For those pwcf it is a MUST, that we do

everything to spread the word about AZM.

The first time that someone draw the link from the good results of the

EM treatment in DPB to cystic fibrosis was in 1995. And it was mentioned

even at that early stage, that the efficacy of macrolide antibiotics had

nothing to do with their antibacterial properties.

It lasted until 1998, when Jaffe et al. published their first paper

about AZM and CF. And while it is a shame that the abstract of this

paper isn't available at Pubmed, Gould has spread it all over the

world and every CARING CF-doc should have read it by now. And even those

US docs, who generally believe in nothing from abroad, should have

started thinking after they have read the comment of Dr. Altshuler from

U of Cal, San Diego to this paper. And he very clearly pointed out, that

the observed results in his opinion did not stem from the antibacterial

properties of AZM.

Three months later another related abstract was published from Shryock

et al., where it was explained again, that macrolide antibiotics work in

an unknown way, different from their antibacterial properties.

One year later, at the NACFC in Seattle, the abstract book was full of

interesting reports about AZM. None of them mentioned, that resistance

was a subject to think about. Dr. Saiman from Columbia University

expressed it quite clearly, that the synergistic effect of macrolide

antibiotics paired with conventional antimicrobial agents is what you

have to look at.

The latest published paper about AZM and CF shows, that AZM inhibits the

binding of the bacteria to the lung cells too.

Numerous studies about AZM and CF are running at the moment all over the

world.

Point is, it is still unknown, how macrolides work. They seem to have

three effects, namely that they act anti-inflammatory, that they inhibit

the building of biofilms and that they inhibit the binding of the

pseudomonas bacteria to the cells of the lung.

There may be reasons, why a doc does not prescribe Zithromax, for

instance allergies or contra-indications with other drugs. Or simply the

fact that long-term treatment with AZM is not FDA approved. But telling

a patient that AZM will have no effect, because the patient is resistant

to it is nonsense. And we have to find a way to help those pwcf, who are

running out of time and are willing to take the risk of a non-approved

treatment.

I appreciate any comments on this, especially any hints how we can

spread the word of AZM and CF to all pwcf in a way, that the patients

can make their decision based on as much information about this as

possible.

Torsten, dad of Fiona 4wcf

1: Am J Med 1995 Dec 29;99(6A):26S-30S

Biofilm disease: its clinical manifestation and therapeutic

possibilities of

macrolides.

Kobayashi H.

Department of Internal Medicine, Kyorin University School of Medicine,

Tokyo, Japan.

In the investigation of the disease manifestation of DPB from the

viewpoint of biofilm disease, the important factors are an excess

antigen-antibody reaction in which alginate acts as the antigen and the

resulting formation of immune complex. The effects of 14- and

15-membered macrolides are

inhibition of immunoreaction induced by alginate and their inhibitory

effect on alginate production serving as an antigen at the GMD level.

Further, the specificity of macrolides on these actions was also

evidenced from the standpoint of structural activity. In my opinion,

based on the similarity in pathogenic process between patients with

infected cystic fibrosis and patients with Pseudomonas biofilm disease,

long-term administration of 14- or 15-membered ring macrolides can be

tried in patients with infected cystic fibrosis.

*******************************************************

Lancet. 1998 Feb 7;351(9100):420.

Jaffe A, Francis J, Rosenthal M, Bush A.

Long-term azithromycin may improve lung function in children with cystic

fibrosis.

No abstract available.

PMID: 9482305 [PubMed - indexed for MEDLINE]

***************************************************

Journal of Antimicrobial Chemotherapy. 41(5):505-512, 1998 May

Shryock TR. Mortensen JE. Baumholtz M.

trs@...

The effects of macrolides on the expression of bacterial virulence

mechanisms [Review]

***************************************

ABSTRACTS FROM THE NACFC IN SEATTLE

348. long term macrolide antibiotics improve pulmonary function in CF

Pirzada etal., Sheffield, UK

Two groups with each 18 CF patients, daily 250 mg AZM for a mean of ca,

9 months, no side effects.

Control group: decline in pulm. function ca. 3.7% (both FEV1 and FVC),

AZM group increase in pulm. function: FEV1 2.17% and FVC 5.7%.

Additional effects: weight gain, controls: +0.88 kg, AZM group: +3.71 kg

352. effect of AZM treatment on sputum rheology in CF patients

Tai etal. Edmonton, Canada, Hamburg, Germany

10 CF patients, chronical infected with PA, three months low dose oral

AZM, 250 mg twice weekly, also regular treatment with i.v. antibiotics

every three months

Difference between sputum samples before AZM and during AZM: factor 2.10

in viscoelasticity, significant effect, predicting improved mucociliary

clearance with AZM therapy

421. Effect of Chronic Azithromycin on Lung Function in Cystic Fibrosis

MI Anstead et al., University of Kentucky, Lexington

541. synergistic activity of macrolide antibiotics paired with

conventional

antimicrobial agents against multiply antibiotic resistant PA isolated

from

CF-patients

Saiman etal. Pfizer, NY, USA

***************************************

Infection. 2001 Jan-Feb;29(1):7-11

Baumann U, Fischer JJ, Gudowius P, Lingner M, Herrmann S, Tummler B, von

der Hardt H.

Buccal adherence of Pseudomonas aeruginosa in patients with cystic

fibrosis under long-term therapy with azithromycin.

.