Addition of a Macrolide to a β‐Lactam–Based Empirical Antibiotic Regimen Is Associated with Lower In‐Hospital Mortality for Patients with Bacteremic Pneumococcal Pneumonia

Abstract

To assess the association between inclusion of a macrolide in a beta-lactam-based empirical antibiotic regimen and mortality among patients with bacteremic pneumococcal pneumonia, 10 years of data from a database were analyzed. The total available set of putative prognostic factors was subjected to stepwise logistic regression, with in-hospital death as the dependent variable. Of the 409 patients analyzed, 238 (58%) received a beta-lactam plus a macrolide and 171 (42%) received a beta-lactam without a macrolide. Multivariate analysis revealed 4 variables to be independently associated with death: shock (P<.0001), age of >or=65 years (P=.02), infections with pathogens that have resistance to both penicillin and erythromycin (P=.04), and no inclusion of a macrolide in the initial antibiotic regimen (P=.03). For patients with bacteremic pneumococcal pneumonia, not adding a macrolide to a beta-lactam-based initial antibiotic regimen is an independent predictor of in-hospital mortality. However, only a randomized study can definitively determine whether this association is due to a real effect of macrolides.

Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

“…12,14,15 This finding was not supported by the results of the present study, which included only HIV-infected patients.…”

“…However, the percentage of patients with HIV infection among the studied subjects was not reported neither was this group of patients analyzed separately. 14 The multicentric (international) and prospective study carried out in 2004, with the objective of assessing the effect on mortality of the combination of antibiotics in patients with bacteremia due to S. pneumoniae, specified the number of patients with HIV infection in each group. In the group who received combined therapy, 11.4% of the patients had HIV infection and in the monotherapy group, 37.0%; this difference was significant (p < 0.01).…”

“…Some studies have a group of patients with immunodeficiencies, but none of them particularly assessed HIVinfected patients. [12][13][14] There is evidence of decreased mortality in patients treated with hospital-based regimens that included the combination of beta-lactams and macrolides, when compared to other regimens. 14 Other studies have demonstrated benefits with regimens that contain macrolides, when compared to regimens without this class of antibiotic agent.…”

“…[12][13][14] There is evidence of decreased mortality in patients treated with hospital-based regimens that included the combination of beta-lactams and macrolides, when compared to other regimens. 14 Other studies have demonstrated benefits with regimens that contain macrolides, when compared to regimens without this class of antibiotic agent. 12,15 Additionally, the benefit of combined therapy over monotherapy have been demonstrated.…”

Impact of antibiotic therapy on systemic cytokine expression in pneumococcal pneumonia

“…Taking into account the relationship between IL-6 and poor prognosis for PP, the modulation of the expression of this cytokine may be a key point for improving patient outcomes. Whether combination therapy can improve outcomes in patients with CAP is a controversial issue [21][22][23][24][25][26]. Moreover, most studies have used the combination of -lactam plus macrolide, not -lactam plus fluoroquinolone.…”