Resolution Of Community-acquired Pneumonia Research Articles

Macrolides for better resolution of community-acquired pneumonia: A global meta-analysis of clinical outcomes with focus on microbial aetiology

This meta-analysis examined the impact of macrolides on resolution of CAP and interpretation of clinical benefit according to microbiology; emphasis is given to data under-reported countries (URCs). This meta-analysis included 63 publications published between 1994 and 2022. Publications were analyzed for resolution of CAP (6,465 patients) and 30-day mortality (58,759 patients). A separate meta-analysis was done for the prevalence of respiratory pathogens in URCs. Mortality after 30 days was reduced by the addition of macrolides (OR 0.65, 95% CI 0.51-0.82). The odds ratio (OR) of CAP resolution when macrolides were added to the treatment regimen was 1.23 (95% confidence interval [CI] 1.00-1.52). The most prevalent pathogen was Streptococcus pneumoniae (12.68%; 95% CI 9.36-16.95%). Analysis of the epidemiology from the URCs included 12 publications. The most prevalent pathogens were S. pneumoniae (24.91%) and Klebsiella pneumoniae (12.90%). The addition of macrolides to the treatment regimen led to relative 35% decrease of 30-day mortality and to 23% relative increase resolution of CAP. PROSPERO; number CRD42022325280.

Survival benefit associated with clarithromycin in severe community-acquired pneumonia: A matched comparator study

Although analysis of retrospective studies has documented survival benefit from the addition of a macrolide to the treatment regimen for community-acquired pneumonia (CAP), no data are available to determine if there is differential efficacy between members of the macrolide family. In order to investigate this, an analysis was undertaken of data from 1174 patients with CAP who met the new Sepsis-3 definitions and were enrolled prospectively in the data registry of the Hellenic Sepsis Study Group. Four well-matched treatment groups were identified with 130 patients per group: clarithromycin and β-lactam; azithromycin and β-lactam; respiratory fluoroquinolone and β-lactam monotherapy. The primary endpoint was comparison of the effects of clarithromycin with β-lactam monotherapy on 28-day mortality. The secondary endpoint was resolution of CAP. Mortality rates for the clarithromycin, azithromycin, respiratory fluoroquinolone and β-lactam groups were 20.8%, 33.8% (P=0.026 vs clarithromycin), 32.3% (P=0.049 vs clarithromycin) and 36.2% (P=0.009 vs clarithromycin), respectively. After stepwise Cox regression analysis among all groups, clarithromycin was the only treatment modality associated with a favourable outcome (hazard ratio 0.61; P=0.021). CAP resolved in 73.1%, 65.9% (P=0.226 vs clarithromycin), 58.5% (P=0.009 vs clarithromycin) and 61.5% (P=0.046 vs clarithromycin) of patients, respectively. It is concluded that the addition of clarithromycin to the treatment regimen of patients with severe CAP leads to better survival rates.