EFFICACY AND SAFETY OF AZITHROMYCIN VERSUS BENZYLPENICILLIN OR ERYTHROMYCIN IN COMMUNITY-ACQUIRED PNEUMONIA

Azithromycin, a recently introduced antibiotic, offers the potential a dvantages of short-course administration and lower toxicity compared t o other macrolides. Approved for the treatment of mild pneumonia, this drug was investigated in a study of patients hospitalized for communi ty-acquired pneumonia. In an open-labelled randomized study, oral azit hromycin was compared with intravenous benzylpenicillin in patients su spected to have pneumococcal pneumonia. Azithromycin was also compared with erythromycin, both administered orally, in all other patients. T hree hundred thirty-four patients with community-acquired pneumonia we re hospitalized, 108 of whom were randomized; 104 could be evaluated. A need for intravenous therapy was the most common reason for exclusio n. In the pneumococcal group, 35 patients received azithromycin and 29 benzylpenicillin. The clinical and radiological success rate achieved with azithromycin (83 %) was considerably higher than that achieved w ith benzylpenicillin (66 %), though the difference was not significant . In the non-pneumococcal group, 19 patients received azithromycin and 21 erythromycin; no differences in the success rate were found (79 % and 76 %, respectively). Eight patients on azithromycin had a blood cu lture positive for Streptococcus pneumoniae; in three of these patient s therapy was changed. None of the five patients with pneumococcal bac teraemia who received benzylpenicillin required a change in therapy. I t is concluded that oral azithromycin, administered as short-course th erapy, is an appropriate antibiotic for treating patients with communi ty-acquired pneumonia. However, it is not yet certain that azithromyci n is a good choice for patients with pneumococcal bacteraemia.