Macrolides, Ketolides, and Glycylcyclines: Azithromycin, Clarithromycin, Telithromycin, Tigecycline a,b, b JerryM.Zuckerman, MD *, Fozia Qamar, MD , a,b Bartholomew R.Bono, MD KEYWORDS Macrolides Ketolides Glycylcyclines Antimicrobials Review Erythromycin, the first macrolide antibiotic discovered, has been used since the early 1950s for the treatment of upper respiratory tract and skin and soft tissue infections caused by susceptible organisms, especially in patients who are allergic to penicillin. Several drawbacks, however, have limited the use of erythromycin, including frequent gastrointestinal intolerance and a short serum half-life. Advanced macrolide antimi- crobials synthesized by altering the erythromycin base have resulted in compounds with broader activity, more favorable pharmacokinetics and pharmacodynamics, and better tolerability. In 1991 and 1992, the US Food and Drug Administration (FDA) approved two of these agents, clarithromycin (Biaxin) and azithromycin (Zithro- max), for clinical use. Since their introduction, these advanced macrolides have been used extensively for the treatment of respiratory tract infections, sexually transmitted diseases, and infections caused by Helicobacter pylori and Mycobacterium avium complex (MAC). Ketolides, a new class of macrolides, share many of the characteristics of the advanced macrolides. Their in vitro spectrum of activity also includes gram-positive organisms (Streptococcus pneumoniae, Streptococcus pyogenes) that are macrolide a Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107, USA b Division of Infectious Diseases, Department of Medicine, Albert Einstein Medical Center, Klein Building, Suite 331, 5501 Old York Road, Philadelphia, PA 19141, USA * Corresponding author. Division of Infectious Diseases, Department of Medicine, Albert Einstein Medical Center, Klein Building, Suite 331, 5501 Old York Road, Philadelphia, PA 19141. E-mail address:
[email protected] (J.M.