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Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study.
Clin Microbiol Infect. 2007 Feb; 13(2):162-171.CM

Abstract

This study compared patients with moderate-to-severe community-acquired pneumonia (CAP) requiring hospitalisation, who received initial therapy with either intravenous ceftriaxone plus intravenous azithromycin, followed by step-down to oral azithromycin (n = 135), with patients who received intravenous ceftriaxone combined with either intravenous clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin (n = 143). Clinical and bacteriological outcomes were evaluated at the end of therapy (EOT; day 12-16) or at the end of study (EOS; day 28-35). At baseline, mean APACHE II scores were 13.3 and 12.6, respectively, with >50% of patients classified as Fine Pneumonia Severity Index (PSI) category IV or V. Clinical success rates (cure or improvement) in the modified intent-to-treat (MITT) population at EOT were 84.3% in the ceftriaxone/azithromycin group and 82.7% in the ceftriaxone/clarithromycin or erythromycin group. At EOS, MITT success rates (cure only) were 81.7% and 75.0%, respectively. Equivalent success rates in the clinically evaluable population were 83% and 87%, respectively, at EOT, and 79% and 78%, respectively, at EOS. MITT bacteriological eradication rates were 73.2% and 67.4%, respectively, at EOT, and 68.3% vs. 60.9%, respectively, at EOS. Mean length of hospital stay (LOS) was 10.7 and 12.6 days, and the mean duration of therapy was 9.5 and 10.5 days, respectively. The incidence of infusion-related adverse events was 16.3% and 25.2% (p 0.04), respectively. An intravenous-to-oral regimen of ceftriaxone/azithromycin was at least equivalent in efficacy and safety to the comparator regimen and appeared to be a suitable treatment option for hospitalised patients with CAP.

Authors+Show Affiliations

Division of Pneumology, University Hospital Basel, Basel, Switzerland. Electronic address: MTamm@uhbs.ch.Pulmonary Division and Respiratory ICU, Silvestrini Hospital, Perugia, Italy.Division of Pulmonology, Department of Medicine, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa.Infectious Diseases Division, University Hospital, Geneva, Switzerland.University of Milan, IRCCS, Policlinico, Milan, Italy.Pfizer, New York, NY, USA.Pfizer, New York, NY, USA.Department of Internal Medicine and Infectious Diseases, University Medical Centre, Utrecht, The Netherlands.

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17328728

Citation

Tamm, M, et al. "Clinical and Bacteriological Outcomes in Hospitalised Patients With Community-acquired Pneumonia Treated With Azithromycin Plus Ceftriaxone, or Ceftriaxone Plus Clarithromycin or Erythromycin: a Prospective, Randomised, Multicentre Study." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 13, no. 2, 2007, pp. 162-171.
Tamm M, Todisco T, Feldman C, et al. Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study. Clin Microbiol Infect. 2007;13(2):162-171.
Tamm, M., Todisco, T., Feldman, C., Garbino, J., Blasi, F., Hogan, P., de Caprariis, P. J., & Hoepelman, I. M. (2007). Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 13(2), 162-171. https://doi.org/10.1111/j.1469-0691.2006.01633.x
Tamm M, et al. Clinical and Bacteriological Outcomes in Hospitalised Patients With Community-acquired Pneumonia Treated With Azithromycin Plus Ceftriaxone, or Ceftriaxone Plus Clarithromycin or Erythromycin: a Prospective, Randomised, Multicentre Study. Clin Microbiol Infect. 2007;13(2):162-171. PubMed PMID: 17328728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and bacteriological outcomes in hospitalised patients with community-acquired pneumonia treated with azithromycin plus ceftriaxone, or ceftriaxone plus clarithromycin or erythromycin: a prospective, randomised, multicentre study. AU - Tamm,M, AU - Todisco,T, AU - Feldman,C, AU - Garbino,J, AU - Blasi,F, AU - Hogan,P, AU - de Caprariis,P J, AU - Hoepelman,I M, PY - 2007/3/3/pubmed PY - 2007/3/23/medline PY - 2007/3/3/entrez SP - 162 EP - 171 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin Microbiol Infect VL - 13 IS - 2 N2 - This study compared patients with moderate-to-severe community-acquired pneumonia (CAP) requiring hospitalisation, who received initial therapy with either intravenous ceftriaxone plus intravenous azithromycin, followed by step-down to oral azithromycin (n = 135), with patients who received intravenous ceftriaxone combined with either intravenous clarithromycin or erythromycin, followed by step-down to either oral clarithromycin or erythromycin (n = 143). Clinical and bacteriological outcomes were evaluated at the end of therapy (EOT; day 12-16) or at the end of study (EOS; day 28-35). At baseline, mean APACHE II scores were 13.3 and 12.6, respectively, with >50% of patients classified as Fine Pneumonia Severity Index (PSI) category IV or V. Clinical success rates (cure or improvement) in the modified intent-to-treat (MITT) population at EOT were 84.3% in the ceftriaxone/azithromycin group and 82.7% in the ceftriaxone/clarithromycin or erythromycin group. At EOS, MITT success rates (cure only) were 81.7% and 75.0%, respectively. Equivalent success rates in the clinically evaluable population were 83% and 87%, respectively, at EOT, and 79% and 78%, respectively, at EOS. MITT bacteriological eradication rates were 73.2% and 67.4%, respectively, at EOT, and 68.3% vs. 60.9%, respectively, at EOS. Mean length of hospital stay (LOS) was 10.7 and 12.6 days, and the mean duration of therapy was 9.5 and 10.5 days, respectively. The incidence of infusion-related adverse events was 16.3% and 25.2% (p 0.04), respectively. An intravenous-to-oral regimen of ceftriaxone/azithromycin was at least equivalent in efficacy and safety to the comparator regimen and appeared to be a suitable treatment option for hospitalised patients with CAP. SN - 1198-743X UR - https://www.unboundmedicine.com/medline/citation/17328728/Clinical_and_bacteriological_outcomes_in_hospitalised_patients_with_community_acquired_pneumonia_treated_with_azithromycin_plus_ceftriaxone_or_ceftriaxone_plus_clarithromycin_or_erythromycin:_a_prospective_randomised_multicentre_study_ DB - PRIME DP - Unbound Medicine ER -