Telithromycin 800 mg once daily is a convenient, optimal-spectrum, first-line treatment for CAP in adults, at least as effective and well tolerated as high-dose amoxicillin.

This retrospective analysis was performed to determine the clinical and bacteriologic efficacy of the ketolide antibacterial telithromycin in patients with community-acquired pneumonia (CAP) with pneumococcal bacteremia. Patients 13 years old with radiologically confirmed CAP and a positive blood culture for Streptococcus pneumoniae at screening were analyzed from eight multicenter Phase III/IV clinical trials. In four open-label, non-comparative studies, patients received telithromycin 800 mg once daily for 7-10 days. In four randomized, controlled, double-blind, comparative studies, patients received telithromycin 800 mg once daily for 5-10 days or a comparator antimicrobial (amoxicillin 1000 mg three times daily, clarithromycin 500 mg twice daily, or trovafloxacin 200 mg once daily) for 7-10 days. In total, 118 patients (telithromycin, 94/1061 [8.9%]; comparator, 24/244 [9.8%]) had documented pneumococcal bacteremia. Those who were treated with telithromycin achieved a clinical cure rate of 90.2% (74/82, per-protocol population); S. pneumoniae was eradicated in 77/82 (93.9%) bacteremic patients who received telithromycin and 15/19 (78.9%) comparator-treated patients. Clinical cure was also observed among telithromycin-treated bacteremic patients who were infected with penicillin- or erythromycin-resistant strains of S. pneumoniae (5/7 and 8/10, respectively). In conclusion, telithromycin achieves high clinical and bacteriologic cure rates in CAP patients with pneumococcal bacteremia.

No abstract

As S. pneumoniae is the leading bacterial cause of community-acquired RTIs, and antibacterial resistance is increasing among this species, these findings support the use of telithromycin as first-line therapy in this setting.

The efficacy of telithromycin 800 mg once daily for 5 to 10 days (1 study comprised 5-or 7-day telithromycin) was evaluated in 8 phase III/IV studies in patients with mild to moderate community-acquired pneumonia caused by atypical/intracellular pathogens. Atypical/intracellular pathogens were identified by serology and/or polymerase chain reaction analysis of sputum. Clinical outcome was assessed at test of cure (days 17 to 24) in the per-protocol population. In total, 2289 patients received telithromycin, and 702 received comparators. Of these, 1925 (including 4.5% identified with atypical pathogens) and 540 (including 8.1% identified with atypical pathogens), respectively, were included in the analysis. The clinical success rate for telithromycin was 91.2% (1755/1925) overall and 94.4% (34/36), 97.3% (36/37), and 100% (13/13) for Chlamydophila (Chlamydia) pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila, respectively (vs. 90.7% [490/540], 94.7% [18/19], 90.9% [20/22], and 2/3, respectively, for pooled comparators). Telithromycin is clinically efficacious in patients with mild to moderate community-acquired pneumonia caused by atypical/intracellular pathogens. (Infect Dis Clin Pract 2005;13:10-16)