Mortality in patients with community‐onset pneumonia at low risk of drug‐resistant pathogens: Impact of β‐lactam plus macrolide combination therapy

Abstract

In patients with community-onset pneumonia at low DRP risk, BLM treatment reduced 30-day mortality compared with BL. Independent risk factors for mortality are potential confounding factors when assessing antibiotic effects in randomized clinical trials.

Contemporary Concise Review 2018: Respiratory infections and tuberculosis

“…There are limited published data evaluating the effects of antibiotic in CAP according to the DRP risk. In a post hoc analysis of a prospective multicentre cohort of patients with CAP, Okumura et al have shown that β‐lactam and macrolide in combination reduced the 30‐day mortality (adjusted odds ratio: 0.28, 95% CI: 0.09–0.87) compared with β‐lactam alone. In addition, among patients at low risk for CAP‐DRP, independent host factors associated with mortality included high arterial carbon dioxide (PaCO 2 ) level, non‐ambulatory status, leucopenia, low haematocrit, older age, tachypnoea, low serum albumin level and low body temperature.…”

Empiric antibiotics for community‐acquired pneumonia: A macrolide and a beta‐lactam please!

“…In this issue of Respirology , Okumura et al . add to the already extensive body of literature suggesting that optimal empiric therapy for CAP is a macrolide and a beta‐lactam.…”

“…In summary, those that continue to believe that the data are flawed and do not wish to give a macrolide are unlikely to be swayed by the study by Okumura et al . While it is possible that tetracyclines have similar anti‐inflammatory and anti‐toxin functions to macrolides, the lack of any significant studies to show a comparative clinical benefit signifies that they cannot be recommended as empiric therapy in the place of a macrolide.…”

“…In this issue of Respirology, Okumura et al 1 add to the already extensive body of literature suggesting that optimal empiric therapy for CAP is a macrolide and a beta-lactam. Although the data presented is a post-hoc analysis of a prospective observational study, the mortality benefits Okumura et al identified from adding a macrolide to beta-lactam monotherapy in patients not at risk of drug-resistant pathogens (like Pseudomonas or methicillin-resistant Staphylococcus aureus) was striking-13.8% versus 1.8% (P < 0.001).…”

“…It is worth noting that macrolides shut down pnemolysin toxin production even in macrolideresistant pneumococci within 20 min of exposure. 10 In summary, those that continue to believe that the data are flawed and do not wish to give a macrolide are unlikely to be swayed by the study by Okumura et al 1 While it is possible that tetracyclines have similar anti-inflammatory and anti-toxin functions to macrolides, the lack of any significant studies to show a comparative clinical benefit signifies that they cannot be recommended as empiric therapy in the place of a macrolide. As for me, I find the data overwhelmingly in favour of using combination therapy and if I ever get CAP, I would like a macrolide followed a short time later by a third generation cephalosporin please, preferably getting both within 2 h of presenting.…”