Clarithromycin vs Combined Cefuroxime and Erythromycin in the Treatment of Hospitalised Community-Acquired Pneumonia Patients — Intravenous Followed by Oral Therapy
Tóm tắt
This study compared intravenous followed by oral clarithromycin (500mg twice daily; manufactured by Abbott Laboratories) with intravenous followed by oral erythromycin and cefuroxime (1g erythromycin three times daily, 1.5g cefuroxime three times daily intravenously, 500mg erythromycin, 500mg cefuroxime axetil orally) in the treatment of patients admitted to hospital with community-acquired pneumonia in 21 centres in Europe and Canada. 235 patients were enrolled for the study, of whom 169 (88 clarithromycin and 81 erythromycin/cefuroxime) were clinically evaluable and 47 (24 clarithromycin and 23 erythromycin/cefuroxime) were bacteriologically evaluable. All clinically evaluable patients received intravenous therapy for between 2 and 5 days. No significant differences between the treatment groups were seen regarding age, underlying disease, extent of chest x-ray shadowing and other indices of severity of pneumonia. A satisfactory clinical response was observed in 91 and 88% of clinically evaluable patients and 71 and 66% of all patients (intent-to-treat analysis) in the clarithromycin and erythromycin/cefuroxime groups, respectively, and similar bacterial cure rates were obtained (67 and 70%, respectively). There were no significant differences in the clinical and bacterial response rates between the two treatment groups. There was a significantly greater number of patients experiencing drug-related adverse events in the erythromycin/cefuroxime group (65%) than in the clarithromycin group (49%; p = 0.018), with significantly less nausea, vomiting, diarrhoea and abdominal pain occurring in the clarithromycin group. We concluded that clarithromycin is a suitable monotherapy for patients with community-acquired pneumonia who require intravenous treatment, and is associated with significantly fewer adverse effects than the combination of erythromycin and cefuroxime.
Tài liệu tham khảo
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