Is Azithromycin the First‐Choice Macrolide for Treatment of Community‐Acquired Pneumonia?

Abstract

Combination treatment with a beta-lactam plus a macrolide may improve the outcome for elderly patients with community-acquired pneumonia (CAP). The prognoses and mortality rates for elderly patients with CAP who receive ceftriaxone combined with a 3-day course of azithromycin or a 10-day course of clarithromycin were compared in an open-label, prospective study. Of 896 assessable patients, 220 received clarithromycin and 383 received azithromycin. There were no significant differences between groups with regard to the severity score defined by the Pneumonia Patient Outcomes Research Team (PORT) study group; the incidence of bacteremia was also not significantly different. However, for patients treated with azithromycin, the length of hospital stay was shorter (mean+/-SD, 7.4+/-5 vs. 9.4+/-7 days; P<.01) and the mortality rate was lower (3.6% vs. 7.2%; P<.05), compared with those treated with clarithromycin. There might be a difference in the outcome for patients with CAP depending on the macrolide used. A shorter treatment course with azithromycin may result in better compliance with therapy.

Re-evaluation of the therapy of severe pneumonia caused by Streptococcus pneumoniae

“…A retrospective study (1997)(1998)(1999)(2000) from Spain examined 603 patients who were admitted with CAP and treated with combination therapy [62]. All of the patients received ceftriaxone.…”

The Role of Resistance and Impact on Appropriate Antimicrobial Use

“…14,15 The extended-spectrum macrolide antibiotic azithromycin is unique from other macrolide type antibiotics in that it tends to concentrate in the white blood cells, which gravitate toward the site of infection. The white blood cells lyse and release their contents, including azithromycin.…”

“…14 The authors suggested that a shorter treatment course with azithromycin may result in better compliance with therapy.…”

Systematic Review and Meta-analysis of the Efficacy of Short-Course Antibiotic Treatments for Community-Acquired Pneumonia in Adults

“…Concerning the microbiological causes of pneumonia, Streptococcus pneumoniae was the most prevalent pathogen in 9 studies (9,10,14,15,17,18,(26)(27)(28) and Mycoplasma pneumoniae was the most prevalent in 6 studies (13,20,(22)(23)(24)(25). Chlamydophila pneumoniae (12,29), Haemophilus influenzae (19), and Staphylococcus aureus (11) were the most common pathogens in the remaining studies. Of note is that 2 studies included exclusively patients with atypical pneumonia (23,24).…”

“…Mortality. Pooling of studies with treatments approved by the FDA (13,17,18,28,29) showed that mortality was lower in the short-course treatment group than in the long-course treatment group (2.4% versus 5.2%) (1,634 patients, RR ϭ 0.54 [95% CI, 0.32 to 0.89]). Mortality was also lower among patients who received treatment for Յ6 days than among those who received treatment for Ն7 days when we pooled studies with both FDA-approved and non-FDA-approved treatments (9 clinical trials) (1.9% versus 3.6%) ( Fig.…”