Resistência bacteriana aos Macrolídeos: um olhar sobre a Azitromicina

Abstract

It is increasingly important to focus on the battle against bacterial resistance to antibiotics. The indiscriminate use of these drugs weighs on an already unbalanced equilibrium between strains resistant to the available medications and the difficult and slow process of creating new antibiotics. To mitigate these effects, it is mandatory that current antibiotics are able to maintain the lowest resistance profile possible. The rationalization in the prescription has a predominant role in this goal, because the incorrect use can lead to selecting bacterial defense mechanisms. The current context, during the SARS-CoV-2 pandemic, in which several drugs were used in an attempt to reposition its function for the viral fight, became an additional complicating factor for the rational use of antimicrobials. When using Azithromycin for its immunomodulatory effect within a pathology that is essentially viral, the doors are opened for the increase of bacterial resistance to this medication and its drug class. There is plausibility to state that the indiscriminate use of this antibiotic, regardless of its intended function, increases the possibility of selecting resistant bacteria. Azithromycin is a semi-synthetic compound discovered in the 1950s, based on the structure of erythromycin, the original drug of the class, and shares with it its mechanisms of action and has its main focus on inhibiting bacterial protein synthesis by binding to the 23S subunit ribosomal. Its means of resistance are well described and are important to understand the reasons for bacterial selection and can influence the search for new, more effective drugs.