Treatment of community-acquired pneumonia in outpatients: randomized study of clarithromycin alone versus clarithromycin and cefuroxime.
OBJECTIVE
To evaluate the efficacy of clarithromycin alone in comparison with the combination of clarithromycin and cefuroxime in the treatment of nonhospitalized patients with community-acquired pneumonia (CAP) in a Mediterranean population.


METHODS
CAP was defined as the acute onset of fever (>38 degrees C) with pulmonary opacity on chest roentgenogram. The American Thoracic Society (ATS) criteria (1993) were used to decide on patient hospitalization. Ninety subjects, of whom 53 (59%) were men, with a mean age (+/-SD) of 38+/-15 years, were randomized: 45 received clarithromycin 500 mg b.i.d. orally for 14 days (CL group), and 45 received clarithromycin plus cefuroxime 500 mg b.i.d. orally for 7 days (CLCE group). Patients were monitored with clinical, radiological, and laboratory controls at 3 and 21 days. There were no significant differences between the two groups with regard to demographic, clinical, physical and laboratory data.


RESULTS
The mean time to defervescence was 2.4+/-1.4 and 2.4+/-1.5 days, respectively. Chest roentgenogram clearance was complete in all cases, without statistically significant differences in the time to resolution between both arms. Side effects were mild (no significant differences between groups): 5 patients in the CL group and 3 in the CLCE group showed gastrointestinal symptoms. Two patients (2.2%), both in the CLCE group, needed hospital admission during follow-up, but all 90 patients showed an excellent outcome. A causative agent was determined in 25 cases (28%). Legionella pneumophila, Streptococcus pneumoniae, and Mycoplasma pneumoniae were the most frequent pathogens.


CONCLUSIONS
Empirical treatment of outpatient CAP with clarithromycin can be considered adequate in the Mediterranean area, independently of the microbiological etiology. ATS criteria for admitting patients with CAP are appropriate in this population.
Rovira
E
E
Department of Internal Medicine, Hospital Sagunt, Valencia, Spain.
Martínez-Moragón
E
E
Belda
A
A
Gonzalvo
F
F
Ripollés
F
F
Pascual
J M
JM
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002444:Cefuroxime / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000188:drug therapy; D004359:Drug Therapy, Combination / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy*
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D017291:Clarithromycin; D002444:Cefuroxime