Addition of macrolide in treating adult hospitalized community-acquired pneumonia.
OBJECTIVE
Current clinical practice guidelines, including those in south Asia, recommend the addition of a macrolide to a broad-spectrum antibiotic for the treatment of severe hospitalized community-acquired pneumonia (CAP). The aim of this study was to observe the influence of macrolide addition on clinical outcomes of hospitalized adult patients with CAP.


METHODS
Over a 16-month period between 2002 and 2004, 141 eligible patients were prospectively recruited from an urban-based teaching hospital in Malaysia.


RESULTS
Of the 141 patients, 63 (44.7%) patients (age (standard deviation (SD)) 56 (20.0) years; 50.8% male) received a macrolide-containing antibiotic regimen, while 78 (55.3%; age (SD) 57 (20.2) years; 52.6% male) were on a single broad-spectrum antibiotic only. In total, 39 (27.7%) and 102 (72.3%) patients had severe and 'non-severe' pneumonia, respectively. Irrespective of whether they had severe or non-severe pneumonia, there were no significant differences in mortality (non-severe pneumonia, 6.5% vs. 5.4%, P = 0.804; severe pneumonia, 17.6% vs. 18.2%, P = 0.966), need of ventilation (non-severe pneumonia, 8.7% vs. 3.6%, P = 0.274; severe pneumonia, 23.5% vs. 13.6%, P = 0.425) or median length of hospital stay (non-severe pneumonia, 5.5 vs. 5 days, P = 0.954; severe pneumonia, 7 vs. 6 days, P = 0.401) between the two treatment regimens.


CONCLUSIONS
This observational, non-randomized study suggests that addition of a macrolide may not convey any extra clinical benefits in adult hospitalized patients with CAP.
Loh
Li-Cher
LC
IMU Lung Research, International Medical University, Kuala Lumpur, Malalysia. loh@imu.edu.my
Quah
Soong-Yuen
SY
Khoo
Sert-Kim
SK
Vijayasingham
Pillai
P
Thayaparan
Tarmizi
T
D000328:Adult; D000368:Aged; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D018942:Macrolides / Q000627:therapeutic use*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019370:Observation; D018410:Pneumonia, Bacterial / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014505:Urban Population
D018942:Macrolides