Addition of a macrolide to a ß-lactam in bacteremic pneumococcal pneumonia

Abstract

In the study presented here, data collected prospectively from 340 adult patients hospitalised in five countries with bacteremic pneumococcal CAP and treated with a ss-lactam +/- a macrolide were analysed retrospectively to evaluate the efficacy of this antimicrobial combination. Univariate and multivariate analyses revealed no significant effect on case fatality rate when a macrolide/ss-lactam regimen was used as initial therapy. Results were not affected by severity of illness, or by excluding patients who died within 2 days of admission. Identified predictors of death in a multivariate regression model were age >65 years (OR=2.6), two or more lung lobes affected (OR=2.2), and severity of disease as estimated using the acute physiology score (APS)>8.

Comparison of β-Lactam and Macrolide Combination Therapy versus Fluoroquinolone Monotherapy in Hospitalized Veterans Affairs Patients with Community-Acquired Pneumonia

“…It is not clear if any specific combination of agents is most effective, but most studies have examined the efficacy of combining an extended-spectrum cephalosporin and a macrolide (4,11,16,31,33,42). Conversely, several studies have refuted the advantages of combination therapy over monotherapy for severe CAP (5,13,19). Data comparing the outcomes of the two most frequently recommended empirical antibiotic regimens for CAP (dual therapy with an extended-spectrum ␤-lactam and a macrolide or montherapy with an antipneumococcal quinolone) for patients with severe CAP are sparse.…”

The need for macrolides in hospitalised community-acquired pneumonia: propensity analysis

“…However, outcome comparisons were adjusted most commonly to risk factors for mortality, not identical to the risk factors for the treatment regimen. Studies that showed similar characteristics for patients receiving monotherapy and combination therapy, or adjusting for the differences observed between the groups, showed no differences in outcomes [26][27][28]. The authors believe that differences between study groups similar to those in the present cohort might have existed in former studies, and were not captured because the propensity for prescribing monotherapy versus combination therapy was not investigated.…”

“…Few studies showed no effect [25][26][27][28]. Some features of these studies are described in table 4; most studies were retrospective.…”

Treatment with anti‐inflammatory drugs in community‐acquired pneumonia

“…In several retrospective or nonrandomized prospective clinical studies, a survival benefit has been shown in patients with pneumococcal CAP treated with a combination of b-lactam antibiotics and macrolides compared with those treated with b-lactam monotherapy [61][62][63][64][65]. However, two large prospective cohort studies showed no difference between these two regimens [66,67]. In a retrospective study in patients with severe sepsis owing to pneumonia caused by any microorganism, macrolide use was associated with decreased mortality, even in patients with macrolideresistant pathogens [68].…”