Macrolides reduce mortality risk in patients with bacteremic pneumococcal pneumonia

Written By : Medha Baranwal |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2022-05-10T08:30:50+05:30 | Updated On 10 May 2022 11:21 AM IST

Israel: A recent study published in the journal Clinical Infectious Diseases showed that empirical therapy with macrolides among patients with bacteremic pneumococcal pneumonia (BPP) reduced mortality risk by 45%. The effect was apparent with azithromycin and with roxithromycin and did not require a full course of therapy.

Previous cohort studies of pneumonia patients have demonstrated lower mortality with advanced macrolides. Michal Chowers, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel, and colleagues, therefore, aimed to characterize antibiotic treatment patterns and assess the role of quinolones or macrolides in empirical therapy.

For this purpose, the researchers included all culture-confirmed bacteremic pneumococcal pneumonia (BPP) among adults in Israel in a historical cohort, 1/7/2009–30/6/2017 through active surveillance. Cases without information on antibiotic treatment were excluded. Independent predictors of in-hospital mortality were assessed using Logistic regression analysis.

A total of 2016 patients with BPP (median age 67.2 years; 55.1% were men) were identified.

The study revealed the following findings:

Lobar pneumonia was present in 1440 (71.4%), multi-lobar in 576 (28.6%). The median length of stay was 6 days (IQR 4-11).
A total of 1921 cases (95.3%) received empiric antibiotics with anti-pneumococcal coverage: ceftriaxone, in 1267 (62.8%).
Coverage for atypical bacteria was given to 1159 (57.5%), 64% of these, with macrolides.
A total of 372 (18.5%) required mechanical ventilation and 397 (19.7%) died.
Independent predictors of mortality were age (OR 1.050), being at high risk for pneumococcal disease (OR 2.090), and multi-lobar pneumonia (OR 2.240).
Female sex and macrolide therapy were protective: (OR 0.708; and OR 0.549 respectively).
Either Azithromycin or roxithromycin treatment for as short as two days was protective. Quinolone therapy had no effect.

To conclude, "empirical therapy using macrolides reduced mortality odds by 45%. This effect was evident with azithromycin and with roxithromycin. The effect did not require a full course of therapy."

Reference:

Michal Chowers, Shiran Gerassy-Vainberg, Ronit Cohen-Poradosu, Yonit Wiener-Well, Jihad Bishara, Yasmin Maor, Oren Zimhony, Bibiana Chazan, Bat-sheva Gottesman, Ron Dagan, Gili Regev-Yochay, IAIPD research group, The Effect of Macrolides on Mortality in Bacteremic Pneumococcal Pneumonia: A Retrospective, Nationwide Cohort Study, Israel, 2009-2017, Clinical Infectious Diseases, 2022;, ciac317, https://doi.org/10.1093/cid/ciac317

Clinical Infectious Diseasesbacteremic pneumococcal pneumoniapneumoniamacrolides

Source : Clinical Infectious Diseases

Medha Baranwal

MSc. Biotechnology

Medha Baranwal joined Medical Dialogues as an Editor in 2018 for Speciality Medical Dialogues. She covers several medical specialties including Cardiac Sciences, Dentistry, Diabetes and Endo, Diagnostics, ENT, Gastroenterology, Neurosciences, and Radiology. She has completed her Bachelors in Biomedical Sciences from DU and then pursued Masters in Biotechnology from Amity University. She has a working experience of 5 years in the field of medical research writing, scientific writing, content writing, and content management. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751