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Background Recently, differences in development of bacterial resistance were observed for macrolides with short and long elimination half life. Although one might speculate that this observation is to be explained by prolonged subinhibitory concentrations at the site of bacterial dwelling, the pharmacokinetic (PK) confirmation of this theory is missing. Thus we set out to compare PK of azithromycin and erythromycin in plasma, polymorphonuclear leukocytes (PML) and interstitial space fluid (ISF) of soft tissues.

Tissue pharmacokinetics of individual macrolides support observed differences in development of bacterial resistance