์์ง์ค๋ก๋ง์ด์
**์์ง์ค๋ก๋ง์ด์ (Azithromycin)**์ ์์๋ผ์ด๋(azalide) ํ์ ๋ถ๋ฅ์ ์ํ๋ ๊ด๋ฒ์ ๋ฐํฉ์ฑ ๋งํฌ๋ก๋ผ์ด๋๊ณ ํญ์์ ์ ๋๋ค. ์๋ฆฌ์ค๋ก๋ง์ด์ ๊ณผ ๊ฐ์ ๊ตฌํ ๋งํฌ๋ก๋ผ์ด๋๊ณ ์ฝ๋ฌผ์ ๋นํด ํฌ์ฌ ๋น๋๋ฅผ ์ค์ผ ์ ์๋ ๋งค์ฐ ์ ๋ฆฌํ ์ฝ๋ํ์ ํน์ฑ ๋๋ฌธ์ ์์ํ์์ ๋๋ฆฌ ์ฌ์ฉ๋ฉ๋๋ค. **์ฃผ์ ์์์ ํน์ง:** * **ํ์ํ ์กฐ์ง ์นจํฌ๋ ฅ:** ์์ง์ค๋ก๋ง์ด์ ์ ์์ธํฌ(๋์์ธํฌ ๋ฐ ๋คํํต ๋ฐฑํ๊ตฌ)์ ์ฌ์ ์์ธํฌ์ ๋ฅ๋์ ์ผ๋ก ํก์๋ ํ ๊ฐ์ผ ๋ถ์๋ก ์ด๋ํฉ๋๋ค. ์ด๋ก ์ธํด ์กฐ์ง ๋ด ๋๋๊ฐ ํ์ฒญ ๋๋๋ณด๋ค ์ต๋ 100๋ฐฐ๊น์ง ๋์์ง ์ ์์ต๋๋ค. * **๊ธด ๋ฐ๊ฐ๊ธฐ:** ์ด ์ฝ๋ฌผ์ ๋งค์ฐ ๊ธด ์กฐ์ง ๋ฐ๊ฐ๊ธฐ(๊ฐ์ ๊ฒฝ์ฐ ์ต๋ 90์๊ฐ)๋ฅผ ๋ํ๋ด์ด, ์ด๊ธฐ ๋ถํ ์ฉ๋ ํฌ์ฌ ํ ํ์ค ํฌ์ฌ(์: 3~5์ผ ๊ฐ๊ฒฉ)๊ฐ ๊ฐ๋ฅํฉ๋๋ค. * **ํญ๊ท ์คํํธ๋ผ:** ๋ค์ํ ๊ทธ๋ ์์ฑ๊ท (์: ์ฐ์์๊ตฌ๊ท , ํฌ๋์๊ตฌ๊ท ), ์ผ๋ถ ๊ทธ๋ ์์ฑ๊ท (ํค๋ชจํ๋ฃจ์ค, ๋ณด๋ฅด๋ฐํ ๋ผ) ๋ฐ ๋น์ ํ ๋ณ์์ฒด(๋ง์ด์ฝํ๋ผ์ค๋ง ๋ด๋ชจ๋์ , ๋ณด๋ ๋ฆฌ์ ๋ถ๋ฅด๊ทธ๋๋ฅดํ๋ฆฌ, ํก์ํ๋ผ์ค๋ง ์ข , ๋ฐ๋ฅดํ ๋ฌ๋ผ ์ข ํฌํจ)์ ํจ๊ณผ์ ์ ๋๋ค. * **ํน์ ์ฉ๋:** ๊ฐ์ ๋ณด๋ฅด๋ฐํ ๋ผ ํ๋ ด, ๊ณ ์์ด ์๋ถ ํธํก๊ธฐ ๊ฐ์ผ, ๊ณ ์์ด ๋ฐ๋ฅดํ ๋ฌ๋ผ์ฆ, ๊ฐ์ ๋ฐ๋ฒ ์์ ๊น์๋ ๊ฐ์ผ(์ํ ๋ฐ์ฟ ์จ๊ณผ ๋ณ์ฉ), ๋ง์์ง์ ๋ก๋์ฝ์ฟ ์ค ์ํด ๊ฐ์ผ์ ์์ฃผ ์ฌ์ฉ๋ฉ๋๋ค. > **์์ ํ:** ๊ด๋ฒ์ํ ์ ์ฉ์ฑ์๋ ๋ถ๊ตฌํ๊ณ , ์์ง์ค๋ก๋ง์ด์ ์ ๊ณ ์์ด์ ๊ณ ์์ด ํด๋ผ๋ฏธ๋์(Chlamydophila felis)๋ ๊ณ ์์ด ํ๊ตฌ ๋ง์ด์ฝํ๋ผ์ค๋ง(Mycoplasma haemofelis)๋ฅผ ์ ๊ฑฐํ๋ ๋ฐ๋ ํจ๊ณผ๊ฐ ์๋ ๊ฒ์ผ๋ก ๋ํ๋ฌ์ต๋๋ค.
์์ฉ ๊ธฐ์ : Azithromycin exerts its antibacterial effects by binding to the **50S ribosomal subunit** of susceptible microorganisms. * **Mechanism:** By binding to the 50S subunit, it blocks **transpeptidation** and **translocation** processes โ inhibits RNA-dependent protein synthesis. * **Action Type:** It is generally considered **bacteriostatic**, but can be bactericidal at high concentrations or against highly susceptible organisms. * **Targeted Delivery:** The drug is actively transported to the site of infection by host phagocytic cells. During active phagocytosis, azithromycin is released locally, providing high concentrations directly at the site of bacterial invasion.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Susceptible infections ยท 5-10 mg/kg PO once daily for 3-5 days ยท PO ยท q24h ยท 3-5 days
- Susceptible infections (pulse dosing) ยท 5 mg/kg PO once daily for 2 days, then every 3-5 days for a total of 5 doses ยท PO ยท q24h then q3-5d ยท 5 doses total
- 'Derm' infections ยท 5-10 mg/kg PO once daily for 5-7 days. For animals that are difficult to pill, a dose given every 5 days (after the initial 5-7 day course of therapy) may be effective if continued treatment is necessary. ยท PO ยท q24h then q5d ยท 5-7 days initially
- Canine pyoderma ยท 10 mg/kg PO once daily for 5-10 days ยท PO ยท q24h ยท 5-10 days
- Babesia gibsoni (Asian genotype) infections ยท Atovaquone 13.3 mg/kg PO q8h with a fatty meal and Azithromycin 10 mg/kg PO once daily. Give both drugs for 10 days. ยท PO ยท q24h ยท 10 days ยท Reserve immunosuppressive therapy for cases that are not rapidly responding (3-5 days) to anti-protozoal therapy.
- Idiopathic lymphoplasmacytic (chronic) rhinitis ยท Doxycycline 3-5 mg/kg PO q12h, or azithromycin 5 mg/kg PO q24h in combination with piroxicam 0.3 mg/kg PO q24h. ยท PO ยท q24h ยท Long term ยท Used for immunomodulatory effects.
- Susceptible infections ยท 5-10 mg/kg ยท PO ยท q24h ยท May increase dosing interval to q48h after 3-5 days of treatment ยท Doses are empirical and subject to change
- Chlamydiosis (experimentally infected cockatiels) ยท Azithromycin 40 mg/kg PO once every other day (q48h) for 21 days ยท PO ยท q48h ยท 21 days ยท Birds were dosed via metallic feeding tube into crop using the commercially available human oral suspension.
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to azithromycin or any other macrolide antibiotics
์ด์๋ฐ์
- Vomiting (especially at high doses)
- Diarrhea
- GI cramping
- Potential hepatotoxicity
- Local tissue reactions (IV site)
- Muscle damage (IM injection)
- Diarrhea in foals
์ฝ๋ฌผ ์ํธ์์ฉ
- Antacids (magnesium- and aluminum-containing) ยท May reduce the rate of absorption of azithromycin; separate dosages by 2 hours
- Cisapride ยท Other macrolides are contraindicated with cisapride due to potential for fatal arrhythmias; use with extreme caution or avoid
- Cyclosporine ยท Azithromycin may potentially increase cyclosporine blood levels; monitor carefully
- Digoxin ยท Other macrolides can increase digoxin levels; monitor carefully ยท major
- Pimozide ยท Contraindicated; acute deaths have occurred in humans
- Methylprednisolone ยท May increase serum levels of methylprednisolone ยท moderate
- Theophylline ยท May increase serum levels of theophylline ยท major
- Terfenadine ยท May increase serum levels of terfenadine ยท major
๋ชจ๋ํฐ๋ง
- Clinical efficacy (resolution of infection signs)
- Adverse effects (especially GI distress or signs of hepatic impairment)
๊ณผ์ฉ๋
Acute oral overdoses are unlikely to cause significant morbidity other than gastrointestinal distress, including **vomiting, diarrhea, and GI cramping**. Treatment should be supportive and symptomatic.
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