The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis

Paul, Mical; Nielsen, Anders Dencker; Gafter‐Gvili, Anat; Tacconelli, E.; Andreassen, Steen; Almanasreh, N.; Goldberg, Elad; Cauda, Roberto; Frank, Uwe; Leibovici, Leonard

doi:10.1183/09031936.00031007

Cited by 41 publications

(30 citation statements)

References 32 publications

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“…However, there are no randomized controlled trials comparing a single ␤-lactam with the same drug supplemented with a macrolide, and these recommendations are largely supported by observational studies of selected populations which have shown lower mortality rates for patients treated with ␤-lactam-macrolide combination therapy than those for patients treated with ␤-lactam monotherapy (21,35,74,180,301). However, other studies failed to show a benefit of macrolide-containing combinations (58,223). The synergy between ␤-lactams and macrolides against S. pneumoniae is not documented in vitro (172) or in vivo (115), although macrolides inhibit the production of the pneumococcal toxin, pneumolysin (8).…”

Section: Influenza and Sepsismentioning

confidence: 95%

Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications

2010

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SUMMARY Macrolides have diverse biological activities and an ability to modulate inflammation and immunity in eukaryotes without affecting homeostatic immunity. These properties have led to their long-term use in treating neutrophil-dominated inflammation in diffuse panbronchiolitis, bronchiectasis, rhinosinusitis, and cystic fibrosis. These immunomodulatory activities appear to be polymodal, but evidence suggests that many of these effects are due to inhibition of extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation and nuclear factor kappa B (NF-κB) activation. Macrolides accumulate within cells, suggesting that they may associate with receptors or carriers responsible for the regulation of cell cycle and immunity. A concern is that long-term use of macrolides increases the emergence of antimicrobial resistance. Nonantimicrobial macrolides are now in development as potential immunomodulatory therapies.

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Section: Influenza and Sepsismentioning

confidence: 95%

Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications

2010

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“…A study from three centers in Germany, Israel, and Italy compared mortality in CAP patients who received either a β -lactam (n=169) or a β -lactam plus a macrolide (n=282). 26 The mortality was 22% vs 7% (P=0.0001), respectively, but when the authors adjusted for confounding factors using propensity score matching to account for differences in each group, they were only able to compare 27 patients in each group, erasing any statistical difference. The differences they accounted for, and for which they excluded patients from analysis, were septic shock, mental status changes, and having an infiltrate on chest radiograph.…”

Section: Literature Reviewmentioning

confidence: 99%

A review of macrolide based regiments for community-acquired pneumonia.

Arnold¹,

Beavin²

2017

JRI

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“…(87) Although most guidelines recommend empirical antibiotic coverage of atypical pathogens, there is controversy regarding the level of scientific evidence on which this practice is based. A recently published observational study involving hospitalized patients (n = 201) revealed that previous outpatient treatment with a beta-lactam antibiotic correlated with an increased possibility (approximately three times greater) of an atypical pathogen being present, whereas the possibility of pneumococci being present was reduced to one third.…”

Section: Recommendationsmentioning

confidence: 99%

“…(83,90) However, the validity of such observational studies is questionable. (87) Further prospective studies of such patients, comparing beta-lactam mono therapy with beta-lactam-macrolide combination therapy and electing the mortality rate as the primary outcome measure, are needed.…”

Section: Predictors Of Specific Pathogensmentioning

confidence: 99%

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

et al. 2009

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Community-acquired pneumonia continues to be the acute infectious disease that has the greatest medical and social impact regarding morbidity and treatment costs. Children and the elderly are more susceptible to severe complications, thereby justifying the fact that the prevention measures adopted have focused on these age brackets. Despite the advances in the knowledge of etiology and physiopathology, as well as the improvement in preliminary clinical and therapeutic methods, various questions merit further investigation. This is due to the clinical, social, demographical and structural diversity, which cannot be fully predicted. Consequently, guidelines are published in order to compile the most recent knowledge in a systematic way and to promote the rational use of that knowledge in medical practice. Therefore, guidelines are not a rigid set of rules that must be followed, but first and foremost a tool to be used in a critical way, bearing in mind the variability of biological and human responses within their individual and social contexts. This document represents the conclusion of a detailed discussion among the members of the Scientific Board and Respiratory Infection Committee of the Brazilian Thoracic Association. The objective of the work group was to present relevant topics in order to update the previous guidelines. We attempted to avoid the repetition of consensual concepts. The principal objective of creating this document was to present a compilation of the recent advances published in the literature and, consequently, to contribute to improving the quality of the medical care provided to immunocompetent adult patients with community-acquired pneumonia.Keywords: Pneumonia; Diagnosis; Epidemiology; Practice guideline; Primary prevention. ResumoA pneumonia adquirida na comunidade mantém-se como a doença infecciosa aguda de maior impacto médico-social quanto à morbidade e a custos relacionados ao tratamento. Os grupos etários mais suscetíveis de complicações graves situam-se entre os extremos de idade, fato que tem justificado a adoção de medidas de prevenção dirigidas a esses estratos populacionais. Apesar do avanço no conhecimento no campo da etiologia e da fisiopatologia, assim como no aperfeiçoamento dos métodos propedêuticos e terapêuticos, inúmeros pontos merecem ainda investigação adicional. Isto se deve à diversidade clínica, social, demográfica e estrutural, que são tópicos que não podem ser previstos em sua totalidade. Dessa forma, a publicação de diretrizes visa agrupar de maneira sistematizada o conhecimento atualizado e propor sua aplicação racional na prática médica. Não se trata, portanto, de uma regra rígida a ser seguida, mas, antes, de uma ferramenta para ser utilizada de forma crítica, tendo em vista a variabilidade da resposta biológica e do ser humano, no seu contexto individual e social. Esta diretriz constitui o resultado de uma discussão ampla entre os membros do Conselho Científico e da Comissão de Infecções Respiratórias da Sociedade Brasileira de Pneumologia e Tisiol...

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The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis

Cited by 41 publications

References 32 publications

Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications

Mechanisms of Action and Clinical Application of Macrolides as Immunomodulatory Medications

A review of macrolide based regiments for community-acquired pneumonia.

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009

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