Statistics from Altmetric.com
Beta-lactams or macrolides for pneumonia?
Macrolide antibiotics such as azithromycin are frequently prescribed as a first-line antibiotic in presumed community-acquired pneumonia (CAP): the usual rationale is that nArrower-spectrum beta-lactam antibiotics would not cover atypical organisms such as Mycoplasma pneumoniae. Indeed, first-line macrolides are officially recommended by some US authorities. The outcome of a large prospective trial challenges this (EPIC study. Williams D et al. JAMA Peds 2017. doi:10.1001/jamapediatrics. 2017.3225). Researchers from Tennessee and Utah identified 1420 previously healthy children, all of whom had been hospitalised for radiologically-proven CAP. Of these, 1020 received beta-lactam monotherapy (mostly cephalosporins, ampicillin, amoxicillin/clavulanate), and 400 received a combination of a beta-lactam and a macrolide (azithro- or clarithromycin). This was not a randomised controlled trial, but using propensity scoring they were able to make a valid comparison of these groups. They found no differences in length-of-stay, rates of intensive care admission, readmissions, or recovery time.
They all had detailed microbiological studies. Using sensitive PCR tests they were able to identify 125 who actually harboured atypical organisms: even within this subgroup there were no outcome differences according to treatment.
These children all required admission: extrapolating the results to less unwell children treated in emergency departments …
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.