Section Review Anti-infectives: Recent developments in 14- and 15-membered macrolides

Macrolides, such as clarithromycin and azithromycin, have gained wide acceptance for the treatment of both upper and lower respiratory tract infections as well as cutaneous infections. As a result of their efficacy against pathogens such as Legionella, Chlamydia and Campylobacter spp., many new macrolides have been synthesised to overcome some of the drawbacks of older agents such as erythromycin. These newer agents possess better activity against Haemophilus influenzae, induce less gastrointestinal irritation, require fewer doses, and possess increased activities against anaerobes, Legionella, Branhamella spp., Chlamydia, and Pasteurella multocida, whilst retaining potent activity against streptococci. This review will summarise the human pharmacokinetic profiles, antibacterial activities, clinical efficacy studies on traditional and new indications, and the resistance mechanisms (as well as recent developments in research on the identification of non-bacterial uses) of 14- and 15-membered macrolides.