Oral versus intravenous clarithromycin in moderate to severe community-acquired pneumonia: an observational study

Nikolas Rae, Aran Singanayagam, Stuart Schembri, James D. Chalmers

Research output: Contribution to journalArticle

131 Downloads (Pure)

Abstract

Objectives: British Thoracic Society guidelines recommend clarithromycin in addition to beta-lactam antibiotics for patients with community-acquired pneumonia and CURB-65 score 2-5. Intravenous therapy is commonly used but there are few data on whether oral therapy is equally effective.

Methods: This observational study used propensity matching to compare two groups of patients with moderate to severe community-acquired pneumonia (CURB-65 score 2-5) treated with oral (n = 226) or intravenous (n = 226) clarithromycin on admission. Outcomes were 30-day mortality, intensive care unit admission, time to clinical stability, and length of hospital stay.

Results: There was no significant difference in 30-day mortality (16.8% for intravenous [IV] group vs. 14.6% for oral group, hazard ratio for IV group 1.11 95% CI 0.70-1.78), ICU admission (10.6% in both groups) or complications (10.6% for IV group and 9.3% for oral group) between the groups. The time to clinical stability in both cohorts was a median of 5 days (interquartile range 3-7 days, p = 0.3). The median length of hospital stay was 8 days in the IV group (interquartile range 4-14 days) and 7 days in the oral group (interquartile range 4-13 days), p = 0.5. No other differences were observed between oral and IV groups.

Conclusion: Where the oral route is not compromised, oral macrolides appear to be equivalent to IV in treating moderate to severe CAP.

Original languageEnglish
Article number2
Pages (from-to)1-5
Number of pages5
JournalPneumonia
Volume9
DOIs
Publication statusPublished - 5 Feb 2017

Fingerprint

Clarithromycin
Observational Studies
Length of Stay
Pneumonia
Mortality
Macrolides
beta-Lactams
Intensive Care Units
Guidelines
Anti-Bacterial Agents
Therapeutics

Keywords

  • Macrolide
  • Pneumonia
  • Severity
  • Combination therapy
  • Antibiotic

Cite this

@article{c58025f361cf4d58ab8d16122b1bf726,
title = "Oral versus intravenous clarithromycin in moderate to severe community-acquired pneumonia: an observational study",
abstract = "Objectives: British Thoracic Society guidelines recommend clarithromycin in addition to beta-lactam antibiotics for patients with community-acquired pneumonia and CURB-65 score 2-5. Intravenous therapy is commonly used but there are few data on whether oral therapy is equally effective.Methods: This observational study used propensity matching to compare two groups of patients with moderate to severe community-acquired pneumonia (CURB-65 score 2-5) treated with oral (n = 226) or intravenous (n = 226) clarithromycin on admission. Outcomes were 30-day mortality, intensive care unit admission, time to clinical stability, and length of hospital stay.Results: There was no significant difference in 30-day mortality (16.8{\%} for intravenous [IV] group vs. 14.6{\%} for oral group, hazard ratio for IV group 1.11 95{\%} CI 0.70-1.78), ICU admission (10.6{\%} in both groups) or complications (10.6{\%} for IV group and 9.3{\%} for oral group) between the groups. The time to clinical stability in both cohorts was a median of 5 days (interquartile range 3-7 days, p = 0.3). The median length of hospital stay was 8 days in the IV group (interquartile range 4-14 days) and 7 days in the oral group (interquartile range 4-13 days), p = 0.5. No other differences were observed between oral and IV groups.Conclusion: Where the oral route is not compromised, oral macrolides appear to be equivalent to IV in treating moderate to severe CAP.",
keywords = "Macrolide, Pneumonia, Severity, Combination therapy, Antibiotic",
author = "Nikolas Rae and Aran Singanayagam and Stuart Schembri and Chalmers, {James D.}",
note = "No specific funding was required for this study. Dr Schembri is supported by a National Research Scotland fellowship.",
year = "2017",
month = "2",
day = "5",
doi = "10.1186/s41479-017-0025-2",
language = "English",
volume = "9",
pages = "1--5",
journal = "Pneumonia",
issn = "2200-6133",
publisher = "Springer Verlag",

}

Oral versus intravenous clarithromycin in moderate to severe community-acquired pneumonia : an observational study. / Rae, Nikolas; Singanayagam, Aran ; Schembri, Stuart; Chalmers, James D.

In: Pneumonia , Vol. 9, 2, 05.02.2017, p. 1-5.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Oral versus intravenous clarithromycin in moderate to severe community-acquired pneumonia

T2 - an observational study

AU - Rae, Nikolas

AU - Singanayagam, Aran

AU - Schembri, Stuart

AU - Chalmers, James D.

N1 - No specific funding was required for this study. Dr Schembri is supported by a National Research Scotland fellowship.

PY - 2017/2/5

Y1 - 2017/2/5

N2 - Objectives: British Thoracic Society guidelines recommend clarithromycin in addition to beta-lactam antibiotics for patients with community-acquired pneumonia and CURB-65 score 2-5. Intravenous therapy is commonly used but there are few data on whether oral therapy is equally effective.Methods: This observational study used propensity matching to compare two groups of patients with moderate to severe community-acquired pneumonia (CURB-65 score 2-5) treated with oral (n = 226) or intravenous (n = 226) clarithromycin on admission. Outcomes were 30-day mortality, intensive care unit admission, time to clinical stability, and length of hospital stay.Results: There was no significant difference in 30-day mortality (16.8% for intravenous [IV] group vs. 14.6% for oral group, hazard ratio for IV group 1.11 95% CI 0.70-1.78), ICU admission (10.6% in both groups) or complications (10.6% for IV group and 9.3% for oral group) between the groups. The time to clinical stability in both cohorts was a median of 5 days (interquartile range 3-7 days, p = 0.3). The median length of hospital stay was 8 days in the IV group (interquartile range 4-14 days) and 7 days in the oral group (interquartile range 4-13 days), p = 0.5. No other differences were observed between oral and IV groups.Conclusion: Where the oral route is not compromised, oral macrolides appear to be equivalent to IV in treating moderate to severe CAP.

AB - Objectives: British Thoracic Society guidelines recommend clarithromycin in addition to beta-lactam antibiotics for patients with community-acquired pneumonia and CURB-65 score 2-5. Intravenous therapy is commonly used but there are few data on whether oral therapy is equally effective.Methods: This observational study used propensity matching to compare two groups of patients with moderate to severe community-acquired pneumonia (CURB-65 score 2-5) treated with oral (n = 226) or intravenous (n = 226) clarithromycin on admission. Outcomes were 30-day mortality, intensive care unit admission, time to clinical stability, and length of hospital stay.Results: There was no significant difference in 30-day mortality (16.8% for intravenous [IV] group vs. 14.6% for oral group, hazard ratio for IV group 1.11 95% CI 0.70-1.78), ICU admission (10.6% in both groups) or complications (10.6% for IV group and 9.3% for oral group) between the groups. The time to clinical stability in both cohorts was a median of 5 days (interquartile range 3-7 days, p = 0.3). The median length of hospital stay was 8 days in the IV group (interquartile range 4-14 days) and 7 days in the oral group (interquartile range 4-13 days), p = 0.5. No other differences were observed between oral and IV groups.Conclusion: Where the oral route is not compromised, oral macrolides appear to be equivalent to IV in treating moderate to severe CAP.

KW - Macrolide

KW - Pneumonia

KW - Severity

KW - Combination therapy

KW - Antibiotic

U2 - 10.1186/s41479-017-0025-2

DO - 10.1186/s41479-017-0025-2

M3 - Article

C2 - 28702304

VL - 9

SP - 1

EP - 5

JO - Pneumonia

JF - Pneumonia

SN - 2200-6133

M1 - 2

ER -