Comparative randomized trial of azithromycin versus erythromycin and amoxicillin for treatment of community‐acquired pneumonia in children

Abstract

Our objective was to compare the clinical efficacy of azithromycin vs. erythromycin and amoxicillin in the treatment of presumed bacterial community-acquired pneumonia in ambulatory children, and to evaluate the etiologies of these illnesses. One hundred and ten children, aged 1 month to 14 years, were enrolled between January 1996-January 1999. Children were distributed into two groups according to clinical and radiological patterns: classic or atypical pneumonia. Patients with classic pneumonia were randomly assigned to receive oral amoxicillin 75 mg/kg/day for 7 days, or azithromycin 10 mg/kg/day for 3 days; patients with atypical pneumonia received azithromycin 10 mg/kg/day for 3 days, or erythromycin 50 mg/kg/day for 14 days. Chest X-ray, clinical, and laboratory parameters were obtained on enrollment. Clinic visits were performed on days 3, 7, and 14, and chest X-ray follow-up on days 7 and 14. Microbiological diagnosis of classic pathogens was based on blood and bronchial secretion cultures. The diagnosis of atypical pathogens C. pneumoniae, C. trachomatis, and M. pneumoniae was based on PCR and serologic tests.Forty-seven children met the criteria for classic pneumonia (23 children received azithromycin, and 24 received amoxicillin), and 59 children had atypical pneumonia (33 children were treated with azithromycin, and 26 with erythromycin). Demographic characteristics at enrollment were similar between children with classic pneumonia treated with azithromycin and erythromycin and children treated with azithromycin and erythromycin for atypical pneumonia. However, on day 7, children with classic pneumonia who received azithromycin normalized their chest X-ray more often than those who received amoxicillin (81.0% vs. 60.9%, respectively, P = 0.009). The same was true for children with atypical pneumonia; their chest X-rays had normalized by day 14 (100% in those with azithromycin vs. 81% in those with erythromycin, P = 0.059). Also, children with atypical pneumonia treated with azithromycin had earlier cessation of cough than children treated with erythromycin (3.6 +/- 1.9 vs. 5.5 +/- 3.6 days respectively, P = 0.02). There were only three children with side effects (mild diarrhea, all in the erythromycin group). Etiological agents were identified in 41% of children. In conclusion, azithromycin is an effective therapeutic option for the treatment of community-acquired classic and atypical pneumonia in children.

Blood, Tissue, and Intracellular Concentrations of Azithromycin during and after End of Therapy

“…On the other hand, no reports of significant numbers of clinical failures associated with azithromycin treatment are available in literature. A number of studies tested safety and efficacy of high-dose azithromycin for the treatment of several pediatric indications, including most notably respiratory tract infections and acute otitis media (45)(46)(47). Unfortunately, we are not aware of comparable studies investigating the use of highdose azithromycin to treat skin and soft tissue infections.…”

Treatment of Mycoplasma Pneumonia: A Systematic Review

“…2 Of the 4943 total citations reviewed, 16 met criteria for inclusion in the qualitative synthesis. 5,12,13,16,17,[20][21][22][23][24][25][26][27][28][29][30] One RCT 20 used different outcome metrics at 2 different times and, for the purposes of this review, was considered 2 separate RCTs. Therefore, 17 studies were included.…”

“…30 Ten RCTs 12 10 One study did not report the total number of pediatric patients. 17 Studies used various combinations of methods for M. pneumoniae detection; 5 used culture of nasopharyngeal specimens, 17,23,24,27,28 15 used serology, 5,12,13,16,17,[20][21][22][23][24][25][26][28][29][30] and 6 used polymerase chain reaction assays of upper airway specimens. 12,20,23,25,26,28 No trials were placebo controlled, and a number of studies received pharmaceutical company funding.…”

“…17 Studies used various combinations of methods for M. pneumoniae detection; 5 used culture of nasopharyngeal specimens, 17,23,24,27,28 15 used serology, 5,12,13,16,17,[20][21][22][23][24][25][26][28][29][30] and 6 used polymerase chain reaction assays of upper airway specimens. 12,20,23,25,26,28 No trials were placebo controlled, and a number of studies received pharmaceutical company funding. 12,13,16,20,24,25 When we evaluated for overall quality among all studies included, detection bias, which included items such as validity and reliability of study outcomes, was the most frequently identified bias category (12/17 studies, 71%) ( Table 3).…”

Decrease in antibiotic use among children in the 1990s: not all antibiotics, not all children

“…6,8,10,26 In FY 2001, visitbased rates for BS macrolide prescriptions were highest among children with lower respiratory tract infections, for which there is evidence from randomized controlled trials of clinical superiority of BS macrolides over other antibiotics. 27 However, 6% to 8% of physician visits for otitis media, pharyngitis or sinusitis, and bronchitis or asthma that year resulted in a BS macrolide prescription. The association of asthma exacerbations with Chlamydia pneumoniae infections may warrant use of macrolides, but not BS macrolides.…”