azithromycin (Azimac)

Rethinking systemic adjuncts in periodontitis: a single centre acquisition cost comparison of antimicrobial and non-antimicrobial therapies.

Almanie Lina L, Neves Vitor C M VCM

Aims To compare National Health Service (NHS) acquisition costs of systemic antimicrobial regimens with emerging non-antimicrobial adjuncts in periodontal therapy and to model potential national financial implications.Methods A secondary acquisition cost comparison analysis was undertaken using three-year prescription data (2021-2024) from a service evaluation at Charles Clifford Dental Hospital. Antibiotic prescriptions were cross-referenced with clinical records to identify those issued for periodontitis. Direct acquisition costs were calculated using Sheffield Teaching Hospitals NHS Foundation Trust pricing.Results Of 643 antibiotic prescriptions, 445 (69.2%) were issued for periodontitis. Azithromycin accounted for 93.5% of periodontal prescriptions, whereas guideline-recommended amoxicillin plus metronidazole (A+M) represented 1.6%. Compared with A+M (£2.81 per course), azithromycin reduced acquisition costs by 55.16%. Non-antimicrobial adjuncts demonstrated substantially greater reductions depending on treatment duration, with metformin 500 mg achieving up to 91.46% reduction.Conclusions Non-antimicrobial systemic adjuncts demonstrate considerable direct cost advantages over traditional antimicrobial regimens. These findings highlight potential economic and antimicrobial stewardship benefits and support the need for formal cost-effectiveness analyses to inform future prescribing guidance.

Azithromycin is First-line Therapy for Atypical Coverage of Severe Community-Acquired Pneumonia.

Watson Haley D HD, Kooda Kirstin K

Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in low- and middle-income countries: a systematic review and meta‑analysis.

Awere-Duodu Aaron A, Kungu Frederick F, Atiase Yacoba Y, Donkor Eric S ES

Diabetic foot ulcers (DFUs) are often polymicrobial infections, necessitating antibiotic therapy. However, the high prevalence of antibiotic misuse and the growing issue of antibiotic resistance in low- and middle-income countries (LMICs) exacerbate the challenges in managing these ulcers, contributing to the risk of lower-limb amputations. This systematic review reported the bacterial profile and antibiotic resistance patterns associated with DFUs in LMICs. A systematic review and meta-analysis. A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science to retrieve relevant articles, which were screened according to predefined selection criteria. Publication bias was assessed with a funnel plot and Egger's regression test. A meta-analysis was conducted in RStudio version 4.5.2, using the random-effects model. Meta-regression and sensitivity analysis were conducted to assess the sources of heterogeneity and robustness of the included studies, respectively. The most frequently isolated bacteria were Staphylococcus aureus (22.64%), Escherichia coli (12.37%), Pseudomonas aeruginosa (8.49%), Klebsiella pneumoniae (5.19%), P. mirabilis (4.61%), and Coagulase-negative Staphylococci (4.86%). The prevalence of key antibiotic-resistant bacteria was as follows: Methicillin-resistant S. aureus (38.65%), Extended-spectrum beta-lactamase (ESBL)-producing E. coli (50.74%), and ESBL-producing K. pneumoniae (41.54%). S. aureus demonstrated the highest resistance to penicillin (96.87% (93.30; 99.32)), azithromycin (76.42% (64.54; 86.65)), and cefoxitin (68.19% (46.83; 86.67)). E. coli showed the highest resistance to ampicillin (86.60% (77.14; 94.18)) and cotrimoxazole (69.27% (57.35; 80.18)). Pathogenic bacteria isolated from DFUs in LMICs exhibit high rates of antibiotic and multidrug resistance. Alternative therapies, such as phage therapy, should be explored as potential treatments for DFUs to mitigate the impact of antibiotic resistance and decrease the rate of diabetes-related amputations. Open Science Framework (OSF) registry, available at https://doi.org/10.17605/OSF.IO/DPX9F.

Azithromycin-induced hepatocellular liver injury in a healthy young male: A case report.

Alharbi Ghaleb G, Al-Rasheedi Mabrouk M, Goresh Hind Khalid HK, Alharbi Faisal Abdullah FA et al.

Drug-induced liver injury (DILI) is an important and frequently under-recognized cause of acute hepatitis. Antibiotics represent one of the most commonly implicated drug classes. Azithromycin, a widely used macrolide antibiotic, is generally well tolerated; however, rare cases of idiosyncratic hepatotoxicity have been reported in the literature. This report describes a case of azithromycin-induced acute hepatocellular liver injury in a previously healthy 20-year-old male who developed jaundice, elevated aminotransferases, and hyperbilirubinemia within three days of initiating a standard three-day course of oral azithromycin 500 mg once daily (cumulative dose 1500 mg) prescribed for an upper respiratory tract infection. Biochemical analysis demonstrated a hepatocellular pattern of injury, confirmed by an R-value of 10.6 (ALT/ULN ÷ ALP/ULN), which exceeds the threshold of 5 required for this classification according to international guidelines. Viral hepatitis and autoimmune etiologies were excluded, and the patient specifically denied the use of dietary supplements, vitamins, bodybuilding or protein powders, and herbal remedies. Causality was assessed using the Roussel Uclaf Causality Assessment Method (RUCAM); on recalculation using the 2016 updated criteria, the score is 6, consistent with a probable causal relationship. The patient recovered fully with supportive care following prompt drug discontinuation, with normalization of liver function tests within eight weeks. This case highlights the importance of accurate biochemical classification of DILI, rigorous causality assessment, and heightened clinical vigilance when prescribing azithromycin even under standard guideline-recommended dosing regimens in young patients without pre-existing liver disease.