EFFICACY OF A 3 DAY COURSE OF AZITHROMYCIN IN MODERATELY SEVERE COMMUNITY-ACQUIRED PNEUMONIA

This study was designed to evaluate the efficacy of a 3 day course of azithromycin in low to moderately severe community-acquired pneumonia. Forty patients with low to moderately severe community-acquired pneum onia (29 males, 11 females, mean age 46+/-17 yrs; 20 pretreated with b etalactams for 2-10 days with no results before admission to hospital; Is with evidence of co-morbidity) were enrolled in an open, randomize d study with azithromycin, 500 mg q.d. oral therapy for 3 days, versus clarithromycin, 250 mg b.i.d. oral therapy for 10+/-2 days. The aetio logy of pneumonia was identified in 18 patients by serology (nine Myco plasma pneumoniae, four Chlamydia pneumoniae, five Legionella pneumoph ila; one patient with chlamydial infection also had Klebsiella pneumon iae bacteraemia). A presumptive aetiological diagnosis was obtained wi th sputum culture in three other patients (one Haemophilus influenzae, two Haemophilus parainfluenzae), all strains were sole isolates with 10(8) Colony forming units (CFU), and with Gram stain in one patient w ith Streptococcus pneumoniae. All patients in the azithromycin group ( one after a second 3 day course), and all but two (of those available for evaluation) of the clarithromycin group were cured, Defervescence occurred after 2.6+/-1.6 days, and chest roentgenogram cleared after 8 .9+/-3.3 days, with no difference between the two groups. Tolerance wa s good, and there were no withdrawals from therapy. Azithromycin, as w ell as clarithromycin, may be a good first choice approach for the tre atment of low to moderately severe community-acquired pneumonia, but a 3 day course of azithromycin may increase patient compliance.