Azithromycin Monotherapy for Patients Hospitalized With Community-Acquired Pneumonia

Feldman, Randy B.; Rhew, David C.; Wong, J; Charles, Robert Antoine; Goetz, Matthew Bidwell

doi:10.1001/archinte.163.14.1718

Cited by 25 publications

(19 citation statements)

References 38 publications

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“…43 Numerous comparative studies have examined the mortality rate among patients hospitalized with CAP. [17][18][19][20][21][22]27,36,39,[44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Most were retrospective studies that compared different CAP management strategies. These studies demonstrated that the in-hospital mortality rate ranges from approximately 0% to 18% and the 30-day mortality rate ranges from 1% to 23%.…”

Section: Mortalitymentioning

confidence: 99%

“…Reported 30-day readmission rates for CAP are Ͻ 1% to 20%. 21,22,27,45,46,50,51,65 In a study conducted in Edmonton, Alberta, from November 2000 to March 2006, 72% of patients with CAP were rehospitalized at least once. 26 Jencks et al 65 recently observed that among Medicare patients, the rehospitalization rate for those discharged with pneumonia (20%) was only slightly less than that for patients discharged with heart failure (27%) or COPD (23%).…”

Section: Mortalitymentioning

confidence: 99%

“…Most studies examining the etiology of CAP (Table 3) 17,18,45,51,63,66 have been conducted in hospitalized patients and mainly relied on blood and sputum cultures and Legionella urinary antigen assays to identify organisms. 17,18,44,45,54 In general, an organism was identifi ed in less than half of hospitalized patients, and more commonly in ICU patients than in ward patients.…”

Section: Microbiological Etiology and Resistance Patternsmentioning

confidence: 99%

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Burden of Community-Acquired Pneumonia in North American Adults

File¹,

Marrie²

2010

Postgraduate Medicine

412

283

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To determine the burden of community-acquired pneumonia (CAP) affecting adults in North America, a comprehensive literature review was conducted to examine the incidence, morbidity and mortality, etiology, antibiotic resistance, and economic impact of CAP in this population. In the United States, there were approximately 4.2 million ambulatory care visits for pneumonia in 2006. Pneumonia and influenza continue to be a common cause of death in the United States (ranked eighth) and Canada (ranked seventh). In 2005, there were>60,000 deaths due to pneumonia in persons aged>or=15 years in the United States alone. The hospitalization rate for all infectious diseases increased from 1525 hospitalizations per 100 000 persons in 1998 to 1667 per 100 000 persons in 2005. Admission to an intensive care unit was required in 10% to 20% of patients hospitalized with pneumonia. The mean length of stay for pneumonia was >or=5 days and the 30-day rehospitalization rate was as high as 20%. Mortality was highest for CAP patients who were hospitalized; the 30-day mortality rate was as high as 23%. All-cause mortality for CAP patients was as high as 28% within 1 year. Streptococcus pneumoniae continues to be the most frequently identified pathogen associated with CAP, and pneumococcal resistance to antimicrobials may make treatment more difficult. The economic burden associated with CAP remains substantial at >$17 billion annually in the United States. Despite the availability and widespread adherence to recommended treatment guidelines, CAP continues to present a significant burden in adults. Furthermore, given the aging population in North America, clinicians can expect to encounter an increasing number of adult patients with CAP. Given the significance of the disease burden, the potential benefit of pneumococcal vaccination in adults is substantial.

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Section: Mortalitymentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Microbiological Etiology and Resistance Patternsmentioning

confidence: 99%

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Burden of Community-Acquired Pneumonia in North American Adults

File¹,

Marrie²

2010

Postgraduate Medicine

412

283

View full text Add to dashboard Cite

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“…While the impact of empirical CAP antibiotic selection on outcomes has been evaluated in various patient care settings, limited information exists for Veterans Affairs (VA) patients (14,28), and we are unaware of any published CAP study that specifically examines the impact of combination therapy versus monotherapy for VA patients with severe CAP. It is difficult to generalize the findings of other studies to VA patients because of the vast differences in study populations: VA patients are typically older, with multiple comorbidities.…”

mentioning

confidence: 99%

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

Lodise

Kwa

Cosler

et al. 2007

Antimicrob Agents Chemother

103

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“…Pseudomonas aeruginosa is a ubiquitous gram-negative opportunistic pathogen and a prevalent organism implicated in nosocomial infections (12). This bacterium has also been shown to be highly problematic in immunocompromised individuals (1,8,26).…”

mentioning

confidence: 99%

Molecular Basis of Azithromycin-Resistant Pseudomonas aeruginosa Biofilms

Gillis

White

Choi

et al. 2005

Antimicrob Agents Chemother

172

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Pseudomonas aeruginosa biofilms are extremely recalcitrant to antibiotic treatment. Treatment of cystic fibrosis patients with azithromycin (AZM) has shown promise. We used DNA microarrays to identify differentially expressed transcripts in developing P. aeruginosa biofilms exposed to 2 g/ml AZM. We report that transcripts for multiple restriction-nodulation-cell division (RND) efflux pumps, known to be involved in planktonic antibiotic resistance, and transcripts involved in type III secretion were upregulated in the resistant biofilms that developed in the presence of AZM. Interestingly, the MexAB-OprM and MexCD-OprJ efflux pumps, but not type III secretion, appear to be integral to biofilm formation in the presence of AZM, as evidenced by the fact that a mutant deleted in both mexAB-oprM and mexCD-oprJ was unable to form a biofilm in the presence of AZM. A mutant deleted in type III secretion was still able to form biofilms in the presence of drug. Furthermore, single mexAB-oprM-and mexCD-oprJ-null mutants were able to form a biofilm in the presence of drug, indicating that either of the pumps can confer resistance to AZM during biofilm development. In contrast to planktonically grown cells, where no mexC expression was detectable regardless of the presence of AZM, biofilms exhibited induction of mexC expression from the outset of their formation, but only in the presence of AZM. mexA, which is constitutively expressed in planktonic cells, was uniformly expressed in biofilms regardless of the presence of AZM. These data indicate that the MexCD-OprJ pump acts as a biofilm-specific mechanism for AZM resistance.

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Azithromycin Monotherapy for Patients Hospitalized With Community-Acquired Pneumonia

Abstract: Azithromycin monotherapy is equally as efficacious as other ATS-recommended regimens for treating hospitalized patients with mild-to-moderate community-acquired pneumonia.

Cited by 25 publications

References 38 publications

Burden of Community-Acquired Pneumonia in North American Adults

Burden of Community-Acquired Pneumonia in North American Adults

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

Molecular Basis of Azithromycin-Resistant Pseudomonas aeruginosa Biofilms

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