Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients - A prospective, randomized, multicenter trial

Citation
En. Vergis et al., Azithromycin vs cefuroxime plus erythromycin for empirical treatment of community-acquired pneumonia in hospitalized patients - A prospective, randomized, multicenter trial, ARCH IN MED, 160(9), 2000, pp. 1294-1300
Citations number
32
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
ARCHIVES OF INTERNAL MEDICINE
ISSN journal
00039926 → ACNP
Volume
160
Issue
9
Year of publication
2000
Pages
1294 - 1300
Database
ISI
SICI code
0003-9926(20000508)160:9<1294:AVCPEF>2.0.ZU;2-C
Abstract
Objective: To compare the efficacy and safety of azithromycin dihydrate mon otherapy with those of a combination of cefuroxime axetil plus erythromycin as empirical therapy for community-acquired pneumonia in hospitalized pati ents. Methods: Patients were enrolled in a prospective, randomized, multicenter s tudy. The standard therapy of cefuroxime plus erythromycin was consistent w ith the American Thoracic Society, Canadian Community-Acquired Pneumonia Co nsensus Group, and Infectious Disease Society of America consensus guidelin es. The doses were intravenous azithromycin (500 mg once daily) followed by oral azithromycin (500 mg once daily), intravenous cefuroxime (750 mg ever y 8 hours), followed by oral cefuroxime axetil (500 mg twice daily), and er ythromycin (500-1000 mg) intravenously or orally every 6 hours. Randomizati on was stratified by severity of illness and age. Patients who were immunos uppressed or residing in nursing homes were excluded. Results: Data from 145 patients (67 received azithromycin and 78 received c efuroxime plus erythromycin) were evaluable. Streptococcus pneumoniae and H aemophilus influenzae were isolated in 19% (28/145) and 13% (19/145), respe ctively. The atypical pathogens accounted for 33% (48/145) of the etiologic diagnoses; Legionella pneumophila, Chlamydia pneumoniae, and Mycoplasma pn eumoniae were identified in 14% (20/ 145), 10%;, (15/145), and 9% (13/145), respectively. Clinical cure was achieved in 91% (61/67) of the patients in the azithromycin group and 91% (71/78) in the cefuroxime plus erythromycin group. Adverse events (intravenous catheter site reactions, gastrointestin al tract disturbances) were significantly more common in patients who recei ved cefuroxime plus erythromycin (49% [30/78]) than in patients who receive d azithromycin (12% [8/67]) (P<.001). Conclusions: Treatment with azithromycin was as effective as cefuroxime plu s erythromycin in the empirical management of community-acquired pneumonia in immunocompetent patients who were hospitalized. Azithromycin was well to lerated.