Empiric Azithromycin Adds Outcome Benefit but Not Faster Recovery in Nonsevere CAP: Study

Researchers used a highly complex propensity-weighted cohort study design in order to conduct an experiment similar to a randomized controlled trial on the database collected within the Michigan HMS consortium. In particular, the analysis included patients admitted into the hospital during September 2015 – July 2024 years, diagnosed with non-severe CAP using ICD-10 codes along with having two or more symptoms characteristic of pneumonia, confirmed by x-ray or CT-scan. In order to have a clear sample group, patients with severe CAP, risk of developing MDR organisms, allergies to macrolides and those who received other antibiotic treatment such as doxycycline or fluoroquinolone were excluded from the experiment.

Key findings:

• A total number of 66,657 patients were included in the screening process in the research, out of whom 19,010 (28.5%) patients fulfilled the inclusion criteria.
• Out of those patients, a whopping number, i.e., 17,822 (93.8%), patients received empirical azithromycin for their treatment.
• After applying ITPW, the results were quite contrasting because there was no significant difference in the primary result: the median time taken to achieve clinical stability was found to be 3 days (IQR 3-4) in both the groups (aHR 1.00; p=0.91).
• The patients that were on empirical azithromycin had significantly lower composite mortality and re-admission rate of 10.8%, whereas the patients who did not have azithromycin in their regime had a rate of 15.1% (aHR 0.73; 95% CI 0.62-0.87; p=0.0004).
• Also, no significant differences were observed with respect to ICU transfer (0.9% vs. 1.4%; aHR 0.85; p=0.57).
• Moreover, no significant differences existed with respect to the duration of antibiotic therapy (median 6 days (IQR 5-8) vs. 7 days (IQR 5-9); p=0.23).

The findings of the large-scale assessment of Michigan hospitals reveal that although azithromycin does not accelerate early stabilization of patients, it is essential for their full recovery. In this regard, the results have clearly demonstrated that adding azithromycin to beta-lactam treatment decreases mortality within 30 days after admission as well as the probability of re-hospitalization. In other words, the above discussion supports the idea of using combination antibiotics in cases of CAP when no intensive treatment is required, as its wide spectrum leads to more positive outcomes.

Reference:

Ashwin B Gupta, Emily Walzl, David Ratz, Jennifer K Horowitz, Elizabeth McLaughlin, Tara Pearlman, Tawny Czilok, Tejal Gandhi, Lindsay A Petty, Anurag N Malani, David Paje, Preeti Misra, Scott Kaatz, Steven Bernstein, Mariam Younas, Scott A Flanders, Valerie M Vaughn, Outcomes associated with empiric azithromycin use among patients hospitalized with non-severe community-acquired pneumonia: emulation of a target trial, Clinical Infectious Diseases, 2026;, ciag222, https://doi.org/10.1093/cid/ciag222