title: Comparison of Clarithromycin and Amoxicillin/Clavulanic Acid for Community-Acquired Pneumonia in an Era of Drug-Resistant Streptococcus pneumoniae.
abstract: OBJECTIVE
  To compare the safety and efficacy of clarithromycin and amoxicillin/clavulanic acid in patients with community-acquired pneumonia due to penicillin-resistant and/or macrolide-resistant Streptococcus pneumoniae, by selecting clinical investigators who practice in study populations from geographic areas in which a high incidence of resistant strains is reported by surveillance.
  
  
  METHODS
  Prospective, randomised, investigator-blinded, multicentre study conducted in 45 sites in primary-care and referral centre settings.
  
  
  METHODS
  327 ambulatory patients diagnosed with radio-graphically confirmed community-acquired pneumonia administered clarithromycin 500mg immediate-release or amoxicillin/clavulanic acid 875mg/125mg twice daily for 7 days.
  
  
  RESULTS
  Similarly high clinical cure rates were observed among evaluable patients in both treatment groups at the test-of-cure visit (28-35 days post-treatment): 92% (114/124) for clarithromycin and 91% (117/129) for amoxicillin/clavulanic acid. Of 85 S. pneumoniae strains isolated pretreatment, four (5%) were classified as resistant to macrolides (one mefA, two ermB, and one ermB + mefA) and eight (9%) had reduced susceptibility to penicillin. The overall eradication rate for pathogens isolated from bacteriologically and clinically evaluable patients was 91% for clarithromycin and 93% for amoxicillin/clavulanic acid, and 89% and 92%, respectively, for S. pneumoniae strains. The rates of resolution and/or improvement in clinical signs and symptoms and radiological improvement were similar with clarithromycin to those with amoxicillin/clavulanic acid, as was overall incidence of adverse events.
  
  
  CONCLUSIONS
  A 7-day course of clarithromycin immediate-release was similar to amoxicillin/clavulanic acid based on high rates (>90%) of clinical cure, radiological improvement and pathogen eradication among ambulatory-care patients with community-acquired pneumonia. As the resistance rate at baseline was low, no conclusion could be made about clarithromycin's efficacy for infections caused by macrolide-resistant S. pneumoniae. Both treatments were well tolerated.
authors.affiliation: CEMIC, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Bonvehi
authors.forename: Katherine
authors.initials: K
authors.lastname: Weber
authors.forename: Todd
authors.initials: T
authors.lastname: Busman
authors.forename: Dee
authors.initials: D
authors.lastname: Shortridge
authors.forename: Gerard
authors.initials: G
authors.lastname: Notario