Macrolides in community-acquired pneumonia

The most recent American Thoracic Society and Infectious Diseases Society of America guidelines for community-acquired pneumonia recommend combination antibiotic therapy with a macrolide for all inpatients with severe disease because of the overwhelming data accumulated in the past 20 years that this combination is associated with better outcomes than monotherapy. 1 Metlay JP Waterer GW Long AC et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019; 200: e45-e67 Crossref PubMed Scopus (1719) Google Scholar Despite some estimates suggesting that addition of a macrolide to a β-lactam reduced mortality in severe disease by as much as 80% compared with non-macrolide based therapy, 2 Gattarello S Borgatta B Sole-Violan J et al. Decrease in mortality in severe community-acquired pneumococcal pneumonia: impact of improving antibiotic strategies (2000-2013). Chest. 2014; 146: 22-31 Summary Full Text Full Text PDF PubMed Scopus (76) Google Scholar the obligatory use of a macrolide has remained contested by some experts because of the absence of high quality, prospective trials. Clarithromycin for early anti-inflammatory responses in community-acquired pneumonia in Greece (ACCESS): a randomised, double-blind, placebo-controlled trialAddition of clarithromycin to standard of care enhances early clinical response and attenuates the inflammatory burden of community-acquired pneumonia. The mechanism of benefit is associated with changes in the immune response. These findings suggest the importance of adding clarithromycin to β-lactams for treatment of patients in hospital with community-acquired pneumonia to achieve early clinical response and early decrease of the inflammatory burden. Full-Text PDF