Intravenous azithromycin plus ceftriaxone followed by oral azithromycin for the treatment of inpatients with community-acquired pneumonia: an open-label, non-comparative multicenter trial

Abstract

Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estimated that 2,000,000 people are affected by CAP every year. Of those, 780,000 are admitted to hospital, and 30,000 have death as the outcome. This is an open-label, non-comparative study with the purpose of evaluating efficacy, safety, and tolerability levels of IV azithromycin (IVA) and IV ceftriaxone (IVC), followed by oral azithromycin (OA) for the treatment of inpatients with mild to severe CAP. Eighty-six patients (mean age 56.6 +/- 19.8) were administered IVA (500 mg/day) and IVC (1g/day) for 2 to 5 days, followed by AO (500 mg/day) to complete a total of 10 days. At the end of treatment (EOT) and after 30 days (End of Study--EOS) the medication was evaluated clinically, microbiologically and for tolerability levels. Out of the total 86-patient population, 62 (72.1%) completed the study. At the end of treatment, 95.2% (CI95: 88.9% - 100%) reported cure or clinical improvement; at the end of the study, that figure was 88.9% (CI95: 74.1% - 91.7%). Out of the 86 patients enrolled in the study, 15 were microbiologically evaluable for bacteriological response. Of those, 6 reported pathogen eradication at the end of therapy (40%), and 8 reported presumed eradication (53.3%). At end of study evaluation, 9 patients showed pathogen eradication (50%), and 7 showed presumed eradication (38.89%). Therefore, negative cultures were obtained from 93.3% of the patients at EOT, and from 88.9% at the end of the study. One patient (6.67% of patient population) reported presumed microbiological resistance. At study end, 2 patients (11.11%) still reported undetermined culture. Uncontrollable vomiting and worsening pneumonia condition were reported by 2.3% of patients. Discussion and Conclusion Treatment based on the administration of IV azithromycin associated to ceftriaxone and followed by oral azithromycin proved to be efficacious and well-tolerated in the treatment of Brazilian inpatients with CAP.

Medication Use for Childhood Pneumonia at a Children’s Hospital in Shanghai, China: Analysis of Pattern Mining Algorithms

“…For example, a combination of 2 antibiotics produced by FP-Growth (cefuroxime and azithromycin) was evaluated by Vergis et al [38], who found no increased risk of mortality associated with prescribing the 2 antibiotics continuously or simultaneously. Another example is by Rubio et al [39], which evaluated the sequential combination of cefotaxime and cefixime, finding that prescribing them within 2 to 3 days of each other may result in shorter hospital stays, a pattern that was also found by PrefixSpan. Results that have not been mentioned in the current literature (eg, pattern 3) warrant further investigation.…”

A clinical pathway for community-acquired pneumonia: an observational cohort study

“…The product labeling does not specify doses for either outpatients or inpatients. Most studies of azithromycin in combination with ceftriaxone for ward patients have used an initial 500 mg IV dose for at least two days followed by oral therapy, although guidelines recommend either IV or PO azithromycin when used in combination with beta-lactams [1,19-21]. Conventional macrolides are considered to be time-dependent antibiotics; however, azithromycin is thought to be unique.…”

Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: a systematic review

“…24 The intervention arm in each study has a combination of a macrolide and a beta-lactam, while the comparator group was either a fluoroquinolone (n ¼ 4) or another macrolide (n ¼ 2), except if the study comparator was a control group. The length of hospital stay was reported in five studies, [19][20][21][22][23][24] and the clinical success rate was reported in all of the included studies. 13,[19][20][21][22][23][24]…”