A prospective, double-blind, multicenter study comparing clarithromycin extended-release with trovafloxacin in patients with community-acquired pneumonia

Sokol, William N.; Sullivan, James G.; Acampora, Matthew D.; Busman, Todd; Notario, Gerard

doi:10.1016/s0149-2918(02)85136-0

Cited by 32 publications

(11 citation statements)

References 8 publications

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“…Four trials reported bacterial superinfections (RR 1.87, 95% CI 0.63 – 5.52), with no events in two of the trials. Resistance development was reported in two trials: one reported no resistance in either group [19] and the other reported the development of one multiresistant Pseudomonas sp. per arm [25].…”

Section: Resultsmentioning

confidence: 99%

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Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials

Skalsky

Yahav

Lador

et al. 2013

Clinical Microbiology and Infection

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The relative efficacy, safety and ecological implications of macrolides vs. quinolones in the treatment of community-acquired pneumonia (CAP) are debatable. We performed a systematic review and meta-analysis of randomized controlled trials comparing any macrolide vs. any quinolone for the treatment of CAP among adult inpatients or outpatients, as monotherapy or both in combination with a beta-lactam. We did not limit inclusion by pneumonia severity, publication status, language or date of publication. The primary outcomes assessed were 30-day all-cause mortality and treatment failure. Two authors independently extracted the data. Fixed effect meta-analysis of risk ratios (RRs) with 95% confidence intervals was performed. Sixteen trials (4989 patients) fulfilling inclusion criteria were identified, mostly assessing outpatients with mild to moderate CAP. All-cause mortality was not significantly different for macrolides vs. quinolones, RR 1.03 (0.63-1.68, seven trials), with a low event rate (2%). Treatment failure was significantly lower with quinolones, RR 0.78 (0.67-0.91, 16 trials). The definition of failure used in the primary studies was not clearly representative of patients' benefit. Microbiological failure was lower with quinolones, RR 0.63 (0.49-0.81, 13 trials). All adverse events, adverse events requiring discontinuation and any premature antibiotic discontinuation were significantly more frequent with macrolides, mainly on account of gastrointestinal adverse events. Resistance development was not assessed in the trials. Randomized controlled trials show an advantage of quinolones in the treatment of CAP with regard to clinical cure without need for antibiotic modification at end of treatment and gastrointestinal adverse events. The clinical significance of this advantage is unclear.

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Section: Resultsmentioning

confidence: 99%

“…1). Eight trials included mostly ( ‡70%) outpatients [12][13][14][15][16][17][18][19], four did not report the management setting but were most probably conducted in the community [20][21][22][23] and four included mainly hospitalized patients [24][25][26][27]. Most studies restricted inclusion to mild-moderate CAP.…”

Section: Resultsmentioning

confidence: 99%

Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials

Skalsky

Yahav

Lador

et al. 2013

Clinical Microbiology and Infection

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“…Two contacts indicated that additional data were unavailable, two confirmed that their studies included only outpatients and were thus eligible, and one provided data enabling calculation of outcomes among outpatients, thus permitting inclusion in the present analysis. Therefore, 13 studies were included (table 1) [9][10][11][12][13][14][15][16][17][18][19][20][21]. The two reviewers were in initial agreement on 340 (82%) out of 416 entries regarding study methods and results, and 115 (88%) out of 130 entries regarding study quality rating.…”

Section: Resultsmentioning

confidence: 99%

“…For the primary objective and meta-analysis (atypical versus no atypical coverage), there were six eligible studies, three regarding macrolides versus b-lactams [15][16][17] and three of fluoroquinolones versus b-lactams [11,13,14], with a total of 1,193 patients. For the secondary objective and metaanalyses, there were seven eligible studies, five regarding macrolides versus fluoroquinolones [9,12,[18][19][20] and two of cephalosporins versus b-lactams/b-lactamase inhibitors [10,21], with a total of 2,209 patients.…”

Section: Resultsmentioning

confidence: 99%

Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis

Maimon¹,

Nopmaneejumruslers²,

Marras³

2008

European Respiratory Journal

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“…Clinical cure rates were nearly identical in patients that could be clinically evaluated at the test-of-cure visit (Gotfried et al, 2002). A similar study compared clarithromycin extended-release to trovafloxacin (Sokol, Sullivan, Acampora, Busman, & Notario, 2002). There were no significant differences between the groups in regards to clinical and bacteriologic cure rates, pathogen eradication rate, and radiographic success rate.…”

Section: Comparative Studiesmentioning

confidence: 85%

Appropriate Outpatient Macrolide Use in Community‐Acquired Pneumonia

Gotfried

2004

Journal of the American Academy of Nurse Practitioners

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In an effort to improve outcomes, several guidelines have been published recommending appropriate antimicrobial agents to treat CAP in different patient populations. All guidelines base treatment recommendations on the hospitalization status of the patient, and all agree that coverage of atypical pathogens as part of an initial empirical regimen is important. Comorbidity and modifying factors that may increase the risk of infection with resistant organisms also are taken into account. Controversy exists regarding the use of newer macrolides versus newer fluoroquinolones as initial empirical therapy. The applicability of the reported increasing resistance of common pneumonia pathogens to outcomes in regimens containing newer macrolides is a subject of debate. Defining appropriate antimicrobial use in different patient groups should help achieve better outcomes and allay the development of resistance.

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A prospective, double-blind, multicenter study comparing clarithromycin extended-release with trovafloxacin in patients with community-acquired pneumonia

Cited by 32 publications

References 8 publications

Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials

Macrolides vs. quinolones for community-acquired pneumonia: meta-analysis of randomized controlled trials

Antibacterial class is not obviously important in outpatient pneumonia: a meta-analysis

Appropriate Outpatient Macrolide Use in Community‐Acquired Pneumonia

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