5-DAY AZITHROMYCIN IN THE TREATMENT OF PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

A pooled analysis of 10 studies was undertaken to compare the efficacy of azithromycin with that of other oral antimicrobial agents in the treatment of patients with community-acquired pneumonia. Data from a total of 430 patients with radiographically confirmed pneumonia were analyzed; 222 received azithromycin (500 mg on day 1, then 250 mg once daily for 4 days), and 208 received other antimicrobial agents (cefaclor, erythromycin, amoxicillin, amoxicillin/clavulanic acid, or josamycin) at approved dosages. Clinical success (cure or improvement) was recorded in 88.2% of patients treated with azithromycin and 87.7% of assessable comparator patients. In patients >60 years of age, clinical success rates were lower than rates in patients less than or equal to 60 years for both treatment groups. Radiologic data also showed similar efficacy in the two treatment groups, with clearing or improvement of radiologic appearance recorded in 90.0% (171 of 190 patients) and 91.9% (158 of 172 patients) of azithromycin- and comparator-treated patients, respectively. Both treatment groups had similar bacteriologic efficacy, with eradication rates of 88.1% in the azithromycin-treated patients and 86.6% in the comparator-treated patients. Relatively low mortality rates were recorded in both groups; mortality was 0.5% (1 of 212 patients) in the azithromycin patients, and 1.5% (3 of 195 patients) in the comparator patients. All comparator patients who died were >60 years of age and taking cefaclor; no patient died as a result of pneumonia. Pneumococcal bacteremia occurred in 5 patients receiving azithromycin and 4 patients receiving comparators; clinical cure was achieved in 4 of 5 azithromycin patients and in 4 of 4 patients receiving comparators. In conclusion, azithromycin is effective in the treatment of community-acquired pneumonia in patients who are candidates for treatment with oral antibiotics. A 5-day course of azithromycin offers equivalent efficacy to 7- to 10-day, multiple daily dose treatment with other oral antimicrobial agents.