Macrolides reduce mortality risk in patients with bacteremic pneumococcal pneumonia
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
