The ecological impact of clarithromycin on the gastrointestinal microbiota has been investigated in several studies on healthy volunteers (71-74). In the aerobic microbiota the numbers of E. coli have been observed to decrease significantly while there has been a concomitant overgrowth of other aerobic Gram-negative species. The degree of the disturbances in numbers of enterobacteria has varied depending on the dosing regimen. In the study where the lowest dose was applied, there was a suppression also of the number of streptococci (74). In the anaerobic microbiota decreased numbers have been detected mainly of bifidobacteria, lactobacilli, clostridia and Bacteroides species.


The influence of dirithromycin on the normal human intestinal microbiota has been evaluated in healthy persons (75). The major route of elimination of the agent is fecal, and high fecal concentrations were demonstrated with apparent disturbances in both the aerobic and anaerobic microbiota. The numbers of E. coli decreased, streptococci and staphylococci increased and there was overgrowth of dirithromycin-resistant enterobacteria. Anaerobic Gram-positive cocci, bifidobacteria, eubacteria and Bacteroides decreased while clostridia and lactobacilli increased during the treatment period.


Marked disturbances have been observed in the intestinal microbiota during oral administration of erythromycin in healthy adults (74,76) and in infants (7). The aerobic Gram-positive cocci were reduced in numbers and there were marked reductions in the

Table 5 Impact of Macrolides, Azalide, Ketolide, Lincosamide, and Streptogramin on the Intestinal Microbiota

Impact on Emergence of resistance Overgrowth of

Days of Anaero- Concen-
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