Azithromycin vs Cefuroxime Plus Erythromycin for Empirical Treatment of Community-Acquired Pneumonia in Hospitalized Patients: A Prospective, Randomized, Multicenter Trial

University of Louisville, Louisville, Kentucky, United States
Archives of Internal Medicine (Impact Factor: 17.33). 05/2000; 160(9):1294-300. DOI: 10.1001/archinte.160.9.1294
Source: PubMed


Azithromycin is a newer macrolide antibiotic with in vitro activity against both typical and atypical pathogens. The ATS guidelines suggest that either a cephalosporin or a beta-lactam /beta-lactamase inhibitor (+/-erythromycin) be the initial, empiric therapy for community-acquired pneumonia in hospitalized patients. 148 evaluable patients with community-acquired pneumonia were enrolled. Randomization was stratified by age and severity of illness. Each patient received extensive testing for atypical pathogens, including PCR, serology, culture, and urinary antigen. The experimental regimen was iv azithromycin (500mg qd) followed by oral azithromycin (500mg qd). The ATS regimen was iv ceturoxime (750 mg q8h) followed by oral cefiiroxime axetil (500mg q12h), plus erythromycin (500mg-1000mg iv or po qid, if atypical pathogens were suspected). Immunosuppressed patients were excluded. The overall clinical efficacy rates for azithromycin vs cefuroxime plus erythromycin were identical (91%). For bacteremic pneumococcal pneumonia, clinical efficacy rates for azithromycin vs the ATS regimen were 67% (2/3) and 75% (3/4), respectively. No differences were statistically significant. 3 patients died, but no deaths were attributed to antibiotic failure. In summary, azithromycin as monotherapy was as effective as the ATS regimen of ceruroxime plus erythromycin in the treatment of community-acquired pneumonia.

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Available from: Emanuel N Vergis
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    • "Two to fifteen percent of all hospitalizations for community-acquired pneumonias in Europe and North America are caused by Legionella and recent studies suggest that rates of legionellosis may be increasing [2]. The optimal antibiotic treatment of legionellosis has never been investigated in a randomized clinical trial, but most clinicians use either macrolides or fluoroquinolones [3,4] alone or combined with rifampicin [5]. "
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    ABSTRACT: Legionella is a common cause of bacterial pneumonia. Community-acquired [CAL] and hospital-acquired legionellosis [HAL] may have different presentations and outcome. We aimed to compare clinical characteristics and examine predictors of mortality for CAL and HAL. We identified hospitalized cases of legionellosis in 4 Danish counties from January 1995 to December 2005 using the Danish national surveillance system and databases at departments of clinical microbiology. Clinical and laboratory data were retrieved from medical records; vital status was obtained from the Danish Civil Registration System. We calculated 30- and 90-day case fatality rates and identified independent predictors of mortality using logistic regression analyses. We included 272 cases of CAL and 60 cases of HAL. Signs and symptoms of HAL were less pronounced than for CAL and time from in-hospital symptoms to legionellosis diagnosis was shorter for CAL than for HAL (5.5 days vs. 12 days p < 0.001). Thirty-day case fatality was 12.9% for CAL and 33.3% for HAL; similarly 90-day case fatalities in the two groups were 15.8% and 55.0%, respectively. In a logistic regression analysis (excluding symptoms and laboratory tests) age >65 years (OR = 2.6, 95% CI: 1.1-5.9) and Charlson comorbidty index > or =2 (OR = 2.7, 95% CI: 1.1-6.5) were associated with an increased risk of death in CAL. We identified no statistically significant predictors of 30-day mortality in HAL. Signs and symptoms were less pronounced in HAL compared to CAL. Conversely, 30-day case fatality was almost 3 times higher. Clinical awareness is important for the timely diagnosis and treatment especially of HAL. There is a need for further studies of prognostic factors in order to improve the therapeutic approach to legionellosis and potentially reduce mortality.
    Full-text · Article · May 2010 · BMC Infectious Diseases
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    • "La durée optimale du traitement antibiotique en cas de pneumonies communautaires sévères ayant nécessité l'hospitalisation en réanimation n'est pas connue. Les seuls travaux publiés qui ont essayé de répondre à cette question ont en fait porté sur des pneumonies peu sévères et en règle générale ont comparé deux molécules différentes, par exemple un macrolide de longue durée d'action ou une fluoroquinolone et une bêtalactamine [1] [2] [3] [4]. Il est cependant intéressant de noter que les recommandations récentes , qu'il s'agisse de celles faites par l'ATS (American Thoracic Society) ou par la Société européenne de pneumologie proposent de raccourcir la durée de traitement à sept à dix jours [5] [6]. "
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    ABSTRACT: A high number of controlled studies have shown that early and adequate antimicrobial treatment significantly improves the prognosis of severe infections in critically ill patients. In contrast, few well-designed trials have evaluated the optimal duration of antibiotic therapy. Consequently, current recommendations regarding this question are based primarily on clinical experience and expert opinions. In most cases, the number of organisms is significantly reduced within 24 hours provided that: antibiotics are appropriate, the patient is immunocompetent, the source of infection is controlled and there is no foreign material. In the majority of patients, a long duration (>8 days) is not justified and may contribute to increase the selection pressure for resistance. A recent prospective, randomised trial has shown that 8 days of adequate antibiotic therapy is an adequate duration for ventilator-associated pneumonia. Future trials will probably compare predefined different duration or discontinuation policies based on clinical response and evolution of biological markers.
    Preview · Article · Jun 2006 · Réanimation
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