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

Abstract

Objective The objective was to compare the efficacy of azithromycin and clarithromycin in combination with beta-lactams to treat community-acquired pneumonia among hospitalized adults. Methods Five databases (PubMed, Google Scholar, Trip, Medline, and Clinical Key) were searched to identify randomized clinical trials with patients exposed to azithromycin or clarithromycin in combination with a beta-lactam. All articles were critically reviewed for inclusion in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Seven clinical trials were included. The treatment success rate for azithromycin–beta-lactam after 10 to 14 days was 87.55% and that for clarithromycin–beta-lactam after 5 to 7 days of therapy was 75.42%. Streptococcus pneumoniae was commonly found in macrolide groups, with 130 and 80 isolates in the clarithromycin-based and azithromycin-based groups, respectively. The length of hospital stay was an average of 8.45 days for patients receiving a beta-lactam–azithromycin combination and 7.25 days with a beta-lactam–clarithromycin combination. Conclusion Macrolide inter-class differences were noted, with a higher clinical success rate for azithromycin-based combinations. However, a shorter length of hospital stay was achieved with a clarithromycin–beta-lactam regimen. Thus, a macrolide combined with a beta-lactam should be chosen using susceptibility data from the treating facility.

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

“…39 It has been found that patients who receive a macrolide-β-lactam combination have shorter hospital stays. 40 The pharmacokinetic profiles of azithromycin are less complex, which may influence the therapeutic decision when combining a macrolide with a β-lactam antibiotic and other drugs. [41][42][43][44][45] Furthermore, the longer half-life of azithromycin allowed for a single-dose daily regimen aids in improving adherence and higher rates of clinical cure at the end of treatment.…”

“…[41][42][43][44][45] Furthermore, the longer half-life of azithromycin allowed for a single-dose daily regimen aids in improving adherence and higher rates of clinical cure at the end of treatment. 40 The study found reservations regarding fluoroquinolones (FQs) and doxycycline. A Clinical perspective would suggest that this was a reasonable strategy.…”

“…41–45 Furthermore, the longer half-life of azithromycin allowed for a single-dose daily regimen aids in improving adherence and higher rates of clinical cure at the end of treatment. 40…”

Impact of Administering Intravenous Azithromycin within 7 Days of Hospitalization for Influenza Virus Pneumonia: A Propensity Score Analysis Using a Nationwide Administrative Database

“…In a prospective cohort study of patients with severe CAP, the combination of beta-lactam and azithromycin was also associated with a significantly lower 30-day mortality (OR = 0.12, 95% confidence interval (CI): 0.007–0.57) compared with beta-lactam alone [ 26 ]. A meta-analysis of beta-lactam and macrolide combination therapy for CAP discovered that azithromycin-based combinations had higher clinical success rates than clarithromycin-based combinations (87.55% vs. 75.42%) [ 27 ]. A multicenter, multinational observational study of patients with severe CAP suggested that the combination of aspirin with CAM or azithromycin was associated with the 30-day survival rate (HR, 0.71, 95% CI: 0.58–0.88, p = 0.002) [ 28 ].…”

The Global Burden of Community-Acquired Pneumonia in Adults, Encompassing Invasive Pneumococcal Disease and the Prevalence of Its Associated Cardiovascular Events, with a Focus on Pneumolysin and Macrolide Antibiotics in Pathogenesis and Therapy

“…While one systematic review and meta-analysis found no comparator studies between erythromycin and azithromycin, studies comparing erythromycin with clarithromycin showed erythromycin to be less effective [ 104 ]. Furthermore, a systematic review of azithromycin versus clarithromycin in combination with a BL, showed a higher success rate for azithromycin-based combinations, but a shorter hospital length of stay with clarithromycin-based combinations [ 105 ].…”