Efficacy of erythromycin compared to clarithromycin and azithromycin in adults or adolescents with community-acquired pneumonia: A Systematic Review and meta-analysis of randomized controlled trials

Ashy, Noha; Alharbi, Layan; Alkhamisi, Rawan; Alradadi, Rima; Eljaaly, Khalid

doi:10.1016/j.jiac.2022.04.020

“…A comprehensive search was performed to obtain all relevant RCTs in our study and we paid more attention to pulmonary function indexes. Previous meta-analyses have reported overall response rate, total safety, improvement time of clinical symptoms and levels of inflammatory factors [ 31 – 33 ], while our study involved FEV1, the ratio of FEV1/FVC and PEF, which are the gold standards for the diagnosis of impaired pulmonary function [ 22 ]. To avoid misdiagnosis, pathogen identification was added as one of the inclusion criteria, which has never been highlighted before.…”

Section: Discussionmentioning

confidence: 99%

Azithromycin sequential therapy plus inhaled terbutaline for Mycoplasma Pneumoniae pneumonia in children: a systematic review and meta-analysis

Sheng,

Liang,

Zhao

et al. 2024

BMC Infect Dis

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Background An improper host immune response to Mycoplasma pneumoniae generates excessive inflammation, which leads to the impairment of pulmonary ventilation function (PVF). Azithromycin plus inhaled terbutaline has been used in the treatment of Mycoplasma pneumoniae pneumonia (MPP) in children with impaired pulmonary function, but previous randomized controlled trials (RCTs) showed inconsistent efficacy and safety. This study is aimed to firstly provide a systematic review of the combined therapy. Methods This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO CRD42023452139). A PRISMA-compliant systematic review and meta-analysis was performed. Six English and four Chinese databases were comprehensively searched up to June, 2023. RCTs of azithromycin sequential therapy plus inhaled terbutaline were selected. The revised Cochrane risk of bias tool for randomized trials (RoB2) was used to evaluate the methodological quality of all studies, and meta-analysis was performed using Stata 15.0 with planned subgroup and sensitivity analyses. Publication bias was evaluated by a funnel plot and the Harbord’ test. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Results A total of 1,938 pediatric patients from 20 RCTs were eventually included. The results of meta-analysis showed that combined therapy was able to significantly increase total effectiveness rate (RR = 1.20, 95%CI 1.15 to 1.25), forced expiratory volume in one second (SMD = 1.14, 95%CIs, 0.98 to 1.29), the ratio of forced expiratory volume in one second/forced vital capacity (SMD = 2.16, 95%CIs, 1.46 to 2.86), peak expiratory flow (SMD = 1.17, 95%CIs, 0.91 to 1.43). The combined therapy was associated with a 23% increased risk of adverse reactions compared to azithromycin therapy alone, but no significant differences were found. Harbord regression showed no publication bias (P = 0.148). The overall quality of the evidence ranged from moderate to very low. Conclusions This first systematic review and meta-analysis suggested that azithromycin sequential therapy plus inhaled terbutaline was safe and beneficial for children with MPP. In addition, the combined therapy represented significant improvement of PVF. Due to lack of high-quality evidence, our results should be confirmed by adequately powered RCTs in the future.

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“…It is important to recognize that interclass macrolide differences have been noted in some studies. While one systematic review and meta-analysis found no comparator studies between erythromycin and azithromycin, studies comparing erythromycin with clarithromycin showed erythromycin to be less effective [104]. Furthermore, a systematic review of azithromycin versus clarithromycin in combination with a BL, showed a higher success rate for azithromycin-based combinations, but a shorter hospital length of stay with clarithromycin-based combinations [105].…”

Section: Are the Benefits Of Combination Antibiotic Therapy Specifica...mentioning

confidence: 99%

The Global Burden of Community-Acquired Pneumonia, Encompassing Invasive Pneumococcal Disease and the Prevalence of Its Associated Cardiovascular Events, With a Focus on Pneumolysin and Macrolide Antibiotics in Pathogenesis and Therapy

Feldman¹

2023

Preprint

3

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Despite innovative advances in anti-infective therapies and vaccine development technologies, community-acquired pneumonia (CAP) remains the most persistent cause of infection-related mortality globally. Confronting the ongoing threat posed by Streptococcus pneumoniae (the pneumococcus), the most common bacterial cause of CAP, particularly to the non-immune elderly, remains challenging due to the propensity of the elderly to develop invasive pneumococcal disease (IPD), together with the predilection of the pathogen for the heart. The resultant development of often fatal cardiovascular events (CVEs), particularly during the first seven days of acute infection, is now recognized as a relatively common complication of IPD. The current review represents an update on the prevalence and types of CVEs associated with acute bacterial CAP, particularly IPD. In addition, it is focused on recent insights into the involvement of the pneumococcal pore-forming toxin, pneumolysin (Ply), in subverting host immune defenses, particularly the protective functions of the alveolar macrophage during early-stage disease. This, in turn, enables extra-pulmonary dissemination of the pathogen, leading to cardiac invasion, cardiotoxicity and myocardial dysfunction. The review concludes with an overview of the current status of macrolide antibiotics in the treatment of bacterial CAP in general, as well as severe pneumococcal CAP, including a consideration of the mechanisms by which these agents inhibit the production of Ply by macrolide-resistant strains of the pathogen.

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“…It is important to recognize that inter-class macrolide differences have been noted in some studies. While one systematic review and meta-analysis found no comparator studies between erythromycin and azithromycin, studies comparing erythromycin with clarithromycin showed erythromycin to be less effective [ 104 ]. Furthermore, a systematic review of azithromycin versus clarithromycin in combination with a BL, showed a higher success rate for azithromycin-based combinations, but a shorter hospital length of stay with clarithromycin-based combinations [ 105 ].…”

Section: Are the Benefits Of Combination Antibiotic Therapy Specifica...mentioning

confidence: 99%

The Global Burden of Community-Acquired Pneumonia in Adults, Encompassing Invasive Pneumococcal Disease and the Prevalence of Its Associated Cardiovascular Events, with a Focus on Pneumolysin and Macrolide Antibiotics in Pathogenesis and Therapy

Feldman

¹

2023

IJMS

10

0

View full text Add to dashboard Cite

Despite innovative advances in anti-infective therapies and vaccine development technologies, community-acquired pneumonia (CAP) remains the most persistent cause of infection-related mortality globally. Confronting the ongoing threat posed by Streptococcus pneumoniae (the pneumococcus), the most common bacterial cause of CAP, particularly to the non-immune elderly, remains challenging due to the propensity of the elderly to develop invasive pneumococcal disease (IPD), together with the predilection of the pathogen for the heart. The resultant development of often fatal cardiovascular events (CVEs), particularly during the first seven days of acute infection, is now recognized as a relatively common complication of IPD. The current review represents an update on the prevalence and types of CVEs associated with acute bacterial CAP, particularly IPD. In addition, it is focused on recent insights into the involvement of the pneumococcal pore-forming toxin, pneumolysin (Ply), in subverting host immune defenses, particularly the protective functions of the alveolar macrophage during early-stage disease. This, in turn, enables extra-pulmonary dissemination of the pathogen, leading to cardiac invasion, cardiotoxicity and myocardial dysfunction. The review concludes with an overview of the current status of macrolide antibiotics in the treatment of bacterial CAP in general, as well as severe pneumococcal CAP, including a consideration of the mechanisms by which these agents inhibit the production of Ply by macrolide-resistant strains of the pathogen.

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Efficacy of erythromycin compared to clarithromycin and azithromycin in adults or adolescents with community-acquired pneumonia: A Systematic Review and meta-analysis of randomized controlled trials

Cited by 6 publications

References 24 publications

Azithromycin sequential therapy plus inhaled terbutaline for Mycoplasma Pneumoniae pneumonia in children: a systematic review and meta-analysis

Azithromycin sequential therapy plus inhaled terbutaline for Mycoplasma Pneumoniae pneumonia in children: a systematic review and meta-analysis

The Global Burden of Community-Acquired Pneumonia, Encompassing Invasive Pneumococcal Disease and the Prevalence of Its Associated Cardiovascular Events, With a Focus on Pneumolysin and Macrolide Antibiotics in Pathogenesis and Therapy

The Global Burden of Community-Acquired Pneumonia in Adults, Encompassing Invasive Pneumococcal Disease and the Prevalence of Its Associated Cardiovascular Events, with a Focus on Pneumolysin and Macrolide Antibiotics in Pathogenesis and Therapy

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