Posted by ed_uk2010 on March 20, 2014, at 5:33:10
In reply to Cardiac Risks With Antibiotics, Clarithromycin, Le, posted by Phillipa on March 12, 2014, at 20:45:48
Far too much azithromycin (Zithromax) is being used in some countries, especially the US. It may be convenient but it promotes resistance, it is no more effective than amoxicillin and it is clearly less safe. As for levofloxacin (Levaquin), is also promotes resistance, is less safe and is associated with C. diff infection. Levofloxacin should be reserved for moderate to severe pneumonia where resistant organisms are likely or proven. There is no way GPs should be dishing it out for trivial infections. Azithromycin should be reserved mainly for use in STIs. Amoxicillin is a first-line antibiotic for moderate respiratory tract infections in primary care, but only where a bacterial cause is likely.
With respect to rxing levofloxacin and azithromycin in alleged penicillin allergy... Most people (possibly over 90% of pts) who think they are allergic to penicillins are not. Some people have severe immediate allergic reactions, but these are not common. A history of vague side effects, diarrhoea or late-onset rash rarely represents an allergy. Skin testing can be performed to assess allergy status because having to avoid penicillins can lead to more dangerous and less effective antibiotics being used instead, which is associated with longer hospital stays and possibly increased mortality.
poster:ed_uk2010
thread:1062377
URL: http://www.dr-bob.org/babble/20140307/msgs/1062812.html