Do macrolides penetrate into CNS ?

One of the german specialists did some journal research on azithromycin (I can list the studies if someone is interested). It seems that azithromycin does accumulate very good in brain tissue but not in spinal fluid.

Does someone know if this is also true for Roxythromycin? I think that MS patients do have quite serious damage to the blood brain barrier and this might result in higher levels than in other people. I'm asking myself if I can get sufficient brain tissue levels of Roxythromycin even if I don't have MS but other CNSi problems (e.g. brain fog, light sensitivity, ...). I don't think that my blood brain barrier is damaged in the same way as in a MS patient. Thanks for input.

So what you mean, I take it, is that people with MSi get higher levels of roxithromycin in their brain than the rest of their CNSi due to their damage of the blood brain barrier?

I haven't the least idea how badly damaged my blood brain barrier was but what I do know is that Boadicea, who doesn't have MS has been taking both roxithromycin and azithromycin at various times and has shown extremely good improvement rates, just like me who did have MS............................Sarah

Completed Stratton/Wheldon regime for aggressive secondary progressive MSi in June 2007, after four years, three of which intermittent.   Still improving bit by bit and no relapses since finishing treatment.

"So what you mean, I take it, is that people with MSi<i< get higher levels of roxithromycin in their brain than the rest of their CNSi<i< due to their damage of the blood brain barrier?"

What I mean is, if your blood brain barrier is damaged, more of a medication could make it into the brain than in a healthy control person. This might lead to the result that a medication works for you (MS patient) but not for another Cpn patient who has neurological symptoms but intact blood brain barrier.

This is why I also would prefer minocycline over doxycycline, because it penetrates much better in CNS and spinal fluid.

If an antibiotic gets into the brain tissue, that is probably quite enough for curing a brain infection.  The cerebrospinal fluid is constantly renewed: new fluid is made and old fluid reabsorbed.  About three or four times as much fluid is made per day as exists at any one time.  As for the blood-brain barrieri, that prevents things from getting into the brain, so it can't be an explanation for things getting into the brain but not into the CSF; that would have to have a different cause.

"As for the blood-brain barrieri<i<, that prevents things from getting into the brain, so it can't be an explanation for things getting into the brain but not into the CSF"

I don't know much about anatomy, but the doc says that azithromycin accumulates strongly in brain tissue but cannot be detected in csf. Here the study (I haven't read it in original):

Jaruratanasirikul S, Hortiwakul R, Tantisarasart T, Phuenpathom N, Tussanasunthornwong S. Distribution of azithromycin into brain tissue, cerebrospinal fluid, and aqueous humor of the eye. Antimicrob Agents
Chemother 1996; 40(3):825-6.

I'm not questioning that study, I'm just saying that it doesn't have anything to do with the blood-brain barrieri, because the blood-brain barrier is, well, between the blood and the brain.  The barrier between the brain and the CSF is a different question.  CSF is not blood; it is a clear liquid surrounding the brain and cushioning it.  In some circumstances it might be important for an antibiotic to get into the CSF, but it isn't with Cpni, since Cpn only grows intracellularly.  Also, as mentioned, the CSF is constantly being refreshed, and of course the brain is the important part anyway.

Norman, I think I agree with you. But my initial question was if other macrolides than azithromycin do also penetrate in brain tissue or if this is specific for this substance. I'm asking because I got problems with azi and would like to try roxythromycin instead.

I hope I got you right Norman and made my point clear. It's a bit complicated discussing such things in a language other than your own.

'my initial question was if other macrolides than azithromycin do also penetrate in brain tissue or if this is specific for this substance.'

Ah, now, although I am not Norman, I get your query.  I have never taken azithromycin, just roxithromycin with doxycycline,1 but my biggest recovery was even before I started on metronidazolei, so roxithromycin must be able to penetrate brain tissue, since the brain was where most of my damage occured.....................Sarah

Completed Stratton/Wheldon regime for aggressive secondary progressive MSi in June 2007, after four years, three of which intermittent.   Still improving bit by bit and no relapses since finishing treatment.

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