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Macrolides reduce mortality in hospitalized bacteremic pneumococcal pneumonia patients
Israel: Researchers from Israel found that empirical therapy with Macrolides like Azithromycin and Roxithromycin has lessened the mortality by 45% in hospitalized bacteremic pneumococcal pneumonia (BPP) without even the necessity for a full course of therapy. The study results were published in the journal Clinical Infectious Diseases.
Community-acquired pneumonia frequently causes hospitalization and death. Empirical therapy guidelines recommend the use of either combination therapy with a β-lactam and an advanced macrolide (azithromycin or clarithromycin) or mono-therapy with respiratory quinolones in hospitalized community-acquired pneumonia patients. As previous literature suggested lower mortality with advanced macrolides, Michal Chowers and the team from Israel conducted a study to characterize antibiotic treatment patterns and assess the role of quinolones or macrolides in empirical therapy.
As a part of an ongoing, nationwide, prospective, population-based, active surveillance of pneumococcal bacteremia adult cases data was collected from all 26 hospitals and 1 major outpatient health maintenance organization from 1 July 2009 to 30 June 2017 in Israel. Cases without information on antibiotic treatment were excluded. A BPP case was defined by the isolation of Streptococcus pneumoniae from blood, with infiltrates on imaging. The independent predictors of in-hospital mortality were assessed by logistic regression analysis.
Key findings:
- A total of 2016 patients with BPP having a median age was 67.2 years were identified. Among them 55.1% were men.
- Lobar pneumonia was present in 1440 (71.4%), and multi-lobar in 576 (28.6%).
- The Median length of hospital stay was 6 days (IQR 4-11).
- empiric antibiotics with anti-pneumococcal coverage like ceftriaxone were given in 1267 (62.8%) out of a total of 1921 cases (95.3%).
- The coverage to atypical bacteria was given in 1159 (57.5%), of which 64% were with macrolides.
- A total of 372 (18.5%) required mechanical ventilation, and 397 (19.7%) died.
- Age, being at high-risk for pneumococcal disease, and multi-lobar pneumonia were the independent predictors of mortality.
- The predictors of survival were the female sex and macrolide therapy.
- Either azithromycin or roxithromycin treatment for as short as two days was a predictor of survival. Quinolone therapy had no effect.
Thus, a short-duration macrolide therapy was protective against in-hospital mortality in this large cohort of patients with BPP.
Further reading: Chowers M, Gerassy-Vainberg S, Cohen-Poradosu R, et al. The Effect of Macrolides on Mortality in Bacteremic Pneumococcal Pneumonia: A Retrospective, Nationwide Cohort Study, Israel, 2009-2017. Clin Infect Dis. 2022;75(12):2219-2224. doi: 10.1093/cid/ciac317
BDS, MDS
Dr.Niharika Harsha B (BDS,MDS) completed her BDS from Govt Dental College, Hyderabad and MDS from Dr.NTR University of health sciences(Now Kaloji Rao University). She has 4 years of private dental practice and worked for 2 years as Consultant Oral Radiologist at a Dental Imaging Centre in Hyderabad. She worked as Research Assistant and scientific writer in the development of Oral Anti cancer screening device with her seniors. She has a deep intriguing wish in writing highly engaging, captivating and informative medical content for a wider audience. She can be contacted at editorial@medicaldialogues.in.
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