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Azithromycin is not useful as monotherapy for uncomplicated malaria. In combinations with other antimalarials, it may need to be used at high doses, potentially affecting tolerability.

To help prevent the malaria parasite from developing resistance to antimalarial medicines, the WHO recommends the use of combination therapy, where malaria infections are treated with more than one drug simultaneously. As azithromycin is an antibiotic that also has an effect on the malaria parasite, we assessed its efficacy and tolerability as an antimalarial when used alone or as part of combination therapy with other antimalarials. Our review of studies conducted over the past 14 years suggests that azithromycin is a relatively weak antimalarial whose efficacy depends on the drug dose and the partner drug in the combination therapy. The data suggest that, among adults, the higher doses needed to achieve an acceptable level of treatment success with malaria may be less well tolerated. Unless the ongoing product and dose optimisation process results in a universally efficacious product or identifies a specific niche application that is complementary to the current scala of more efficacious antimalarial combinations, azithromycin's future as an antimalarial does not look promising.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Azithromycin versus penicillin G benzathine for early syphilis

Syphilis is a complex disease that can involve virtually any organ in the body. The World Health Organization estimates that at least 12 million people are infected with syphilis worldwide. Some early research suggested that azithromycin was superior to benzathine penicillin G in the treatment of early syphilis, and that azithromycin can overcome the disadvantages of penicillin G benzathine. This review of three trials failed to identify a difference between azithromycin and benzathine penicillin G for early syphilis in the odds of cure rate, with the result being too imprecise to confidently rule out the superiority of either treatment option. Although gastrointestinal adverse effects were more common in the participants on azithromycin, than in those given benzathine penicillin G, the difference with benzathine penicillin did not reach statistical significance. More research is required in this area.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Azithromycin for acute lower respiratory tract infections

We conducted this review to compare azithromycin with amoxycillin or amoxyclav in treating acute lower respiratory tract infections (LRTI).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Treatment with macrolide antibiotics for people with cystic fibrosis and chronic chest infection

People with cystic fibrosis suffer from chest infections, often caused by the bacteria Pseudomonas aeruginosa. This bacteria is resistant to nearly all antibiotics that can be taken by mouth. Macrolide antibiotics, e.g. azithromycin, have no direct killing effect on Pseudomonas aeruginosa, but they may reduce the activity of these bacteria. We have included ten randomised controlled trials with a total of 959 participants in this review. Eight of these trials compared azithromycin (a macrolide antibiotic) to placebo and two compared different doses of azithromycin. Four trials in children and adults (549 participants) showed significant improvements in lung function after treatment with azithromycin compared to placebo at six months; although data from later time points are not so clear. Patients treated with azithromycin were about twice as likely to be free of pulmonary exacerbation; needed fewer oral antibiotics and had fewer instances of Staphylococcus aureus in cultures from their lungs and airways. Adverse events were not common and not obviously associated with azithromycin, although there was an increase in resistance to macrolides. Most studies used a three times a week dosing schedule. Taking a high weekly dose was linked to an increase in mild gastrointestinal adverse events. Further multicentre studies are needed to look at the long‐term effects of this antibiotic treatment, especially for infants diagnosed through newborn screening.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antibiotics reduce the prevalence of ocular infection with trachoma

Trachoma is common in people living in poor communities and is the most common infectious cause of vision loss. Repeated bouts of conjunctivitis (inflammation of the membranes of the eyes) caused by Chlamydia infection eventually lead to scarring and inward turning of the eyelid. The lashes rub on the cornea causing opacification and blindness. Antibiotics can be used to treat the Chlamydia infection and may be given as an ointment or by mouth. This review included 14 trials in 3587 people with ocular trachoma and eight community‐based trials (67 communities). Antibiotic treatment reduce conjunctivitis caused by trachoma ('active trachoma') and ocular infection in individuals. Community‐based trials provided evidence that azithromycin treatment reduces the prevalence of active trachoma and ocular Chlamydia infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Short course antibiotics for healthy children with uncomplicated acute otitis media

Acute otitis media (AOM), or middle ear infection, is a common childhood illness, with more than half of all children having at least one infection by the time they are seven. Although otitis media often resolves without treatment, it is frequently treated with antibiotics. The length of treatment varies widely. This review of 49 trials found that treating children with a short course (less than seven days) of antibiotics, compared to treatment with a long course (seven days or greater) of antibiotics, increases the likelihood of treatment failure in the short term. No differences are seen one month later. The amount of gastrointestinal adverse events decreased with a shorter course of antibiotics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antibiotics for whooping cough (pertussis)

Whooping cough is a highly contagious disease caused by pertussis bacteria and may lead to death, particularly in infants less than 12 months of age. Although it can be prevented by routine vaccination, it still affects many people. Thirteen trials involving 2197 participants were included in this review. We found that several antibiotic treatments were equally effective in eliminating the bacteria infecting patients, but they did not alter the clinical outcome. There was insufficient evidence to decide whether there is benefit for treating healthy contacts. Side effects were reported with antibiotics and they varied from one antibiotic to another. The result of the review should be interpreted with caution since this review is based on a limited number of trials and some of these trials involved small numbers of participants.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

The effect of short duration versus standard duration antibiotic therapy for streptococcal throat infection in children

Streptococcal (strep) throat infection is very common. A 10‐day course of penicillin is prescribed mainly to protect against the complication of acute rheumatic fever, which can occur approximately 20 days after streptococcal throat and cause damage to the heart valves. Cases of acute rheumatic fever have dropped dramatically in high‐income countries. Newer antibiotics taken for a shorter duration, may have a comparable effect to penicillin taken for 10 days.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drug treatment for small abdominal aortic aneurysms

An aneurysm is an abnormal localised widening (dilatation) of an artery. The most common place for such a dilatation is the abdominal aorta. This is the main artery linking the heart to the lower limbs and the organs of the abdomen, and a dilatation here is termed an abdominal aortic aneurysm (AAA). About 4% of men over 55 years of age have an AAA, but it is less common in women. Aneurysms over 55 mm in diameter carry a high risk of rupture, and rupture carries a high risk of death. To reduce the risks, screening programmes using ultrasound scanning have been introduced for selected groups in a number of countries. Patients with aneurysms over 55 mm are then evaluated for elective aneurysm repair. For aneurysms at or below the 55 mm cut‐off, the current treatment is 'watchful waiting', where the aneurysm is repeatedly scanned over time to see if it is enlarging. This review aimed to identify medical treatments which could slow or even reverse aneurysm growth, and thus delay or avoid the need for elective surgery.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antibiotics to treat respiratory infections caused by the bacteria Mycoplasma pneumoniae in children

This review sought to answer the question of whether antibiotics are effective in the treatment of LRTIs caused by the bacteria Mycoplasma pneumoniae (M. pneumoniae) in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Genital ulcer disease treatment for reducing sexual acquisition of HIV

The presence of a genital ulcer would provide an entry point for the HIV virus if an HIV‐negative individual with an ulcer has unprotected sexual intercourse with an HIV‐infected person. Treatment of the condition causing the genital ulcer would allow the ulcer to heal and therefore reduce the chances of HIV acquisition. This review assessed whether giving treatment for diseases that present with ulcers in the genital region would reduce sexual acquisition of HIV. Three studies were identified involving 173 HIV‐negative patients with genital ulcers. These studies did not provide sufficient evidence that treatment of genital ulcer diseases reduces sexual acquisition of HIV infection. However, genital ulcer diseases are public health problems in their own right and patients with these conditions should be treated appropriately; whether the treatment reduces the risk of HIV infection or not.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Interventions for the prevention of mycobacterium avium complex in adults and children with HIV

Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and can shorten the survival of these patients. We sought to examine effectiveness of all drugs for preventing MAC infection in adults and children with HIV infection. This review included eight trials conducted in the USA and Europe, published between 1993 and 2003.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Interventions for treating genital chlamydia trachomatis infection in pregnancy

Chlamydia is a sexually transmitted infection which, if a mother has it during pregnancy and labour, can cause eye or lung infections in the newborn baby. The risk of transmission during birth varies, but is about 20% to 50% for eye infections and about 10% to 20% for infection of the lungs. Mothers may also be at increased risk of infection of the uterus. The review looked at various antibiotics being used during pregnancy to reduce these problems and to assess any adverse effects. Tetracyclines taken in pregnancy are known to be associated with teeth and bone abnormalities in babies, and some women find erythromycin unpleasant to take because of feeling sick and vomiting. The review found eleven trials, involving 1449 women, on erythromycin, amoxycillin, azithromycin and clindamycin, and the overall trial quality was good. However, all the trials assessed 'microbiological cure' (that is they looked for an eradication of the infection) and none assessed whether the eye or lung problems for the baby were reduced. Also, none of the trials were large enough to assess potential adverse outcomes adequately. The review found amoxycillin was an effective alternative to erythromycin but lack of long‐term assessment of outcomes caused concern about its routine use in practice. If erythromycin is used, some women may stop taking it because of adverse effects. Azithromycin and clindamycin are potential alternatives. More research is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antibiotics for treating scrub typhus

Scrub typhus is transmitted by chiggers (mites), is a bacterial infection and causes fever and a typical sore on the skin, and is common in the western Pacific region and many parts of Asia, particularly in agricultural workers and travellers in areas where the disease is common, particularly people camping, rafting, or trekking . This review summarize the information from seven small trials about the effects of antibiotics on scrub typhus. Most of the antibiotics tested worked: this includes: doxycycline, tetracycline, telithromycin and azithromycin. Rifampicin seem to be more effective than doxycycline in areas where scrub typhus appears to respond poorly to standard anti‐rickettsial drugs.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antibiotics for bronchiolitis in children under two years of age

We reviewed the evidence on the effect of antibiotics on clinical outcomes in children with bronchiolitis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions to treat chronic infection of the prostate gland (chronic bacterial prostatitis)

Chronic bacterial prostatitis (CBP) involves infection and inflammation of the prostate gland in men of all ages. It can cause problems urinating, including discomfort and pain, increased frequency and urge, or problems emptying the bladder. Bacteria infecting the prostate are the cause of CBP. These bacteria may be sexually transmitted. To cure CBP, antibiotics must be administered for extended periods of time (four weeks or longer), but a permanent cure is not always guaranteed. Other drugs may be combined with antibiotics to improve CBP symptoms. This review found that fluoroquinolones like ciprofloxacin, levofloxacin, lomefloxacin, ofloxacin or prulifloxacin have equivalent effects and equivalent success rates in CBP patients. If atypical bacteria like chlamydia are suspected to cause CBP, macrolide antibiotics such as azithromycin may achieve better results compared to the fluoroquinolone ciprofloxacin. It must be taken into account that some of the studies that have been performed are of poor quality or have been performed on small numbers of participants. More studies are needed, focusing on new agents or on optimized doses of currently prescribed antibiotics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Antibiotics for prevention with IUDs

An intrauterine device (IUD) is a small device placed in the womb for long‐term birth control. Many people worry about the woman getting pelvic inflammatory disease (PID) with an IUD. This infection can lead to problems in getting pregnant. If PID occurs, it is often within the first few weeks. Antibiotics are sometimes used before inserting an IUD to prevent an infection. This review looked at how well these preventive drugs reduced problems. Such problems include PID, extra health care visits, and stopping IUD use in three months.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Fluoroquinolones for treating enteric fever

Researchers in The Cochrane Collaboration conducted a review of the effect of fluoroquinolone antibiotics in people enteric fever. After searching for relevant studies, they identified 26 studies involving 3033 patients. Their findings are summarized below.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Interventions for trachomatous trichiasis

Trachoma is the commonest infectious cause of blindness in the world. It is caused by a bacterium called Chlamydia trachomatis. This infection causes inflammation and scarring of the surface of the eye, which results in the eyelid turning in (entropion) so that the eyelashes touch the eyeball. This is known as trachomatous trichiasis. The lashes can scratch the corneal surface, leading directly or indirectly (from secondary infections) to corneal opacity. Surgery to correct the eyelid deformity is the main treatment for the late stages of the disease. Most cases of trachomatous trichiasis occur in sub‐Saharan Africa. They are generally treated by nurses with limited surgical training. Unfortunately the results of the surgery can be quite variable, with frequent post‐operative trichiasis reported. Therefore, we wanted to find out what types of surgery and other interventions give the best results in treating this condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antibiotics for treating cholera

Cochrane Collaboration researchers conducted a review of the effects of antibiotics for treating people with cholera. After searching for relevant trials, they included 39 randomized controlled trials enrolling 4623 people with cholera.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

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