Article

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

ABSTRACT

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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    • "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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    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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    Preview · Article · Jun 2006 · Réanimation
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