Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study database. Patients receiving a combination of beta-lactams plus macrolides for empiric therapy were included. Patients given beta-lactams and macrolides within 1 hour or more than 24 hours apart were excluded. TCS and LOS were analyzed with the Kaplan-Meier method, and log-rank tests applied to evaluate differences between both groups. To define the adjusted association between macrolide vs. beta-lactam timing on the risk of in-hospital mortality, a log-binomial regression model was used.
Results: A total of 555 patients were included, 63 with a macrolide first and 492 with a beta-lactam first. Median (IQR) time to clinical stability was 4 days (2.5)for patients receiving a macrolide first and 5 days (5) for patients receiving a beta-lactam first (P=<0.001). Median (IQR) time to clinical stability was 5 days (5) for patients receiving a macrolide first and 8 days (7) for patients receiving a beta-lactam first (P=<0.001). The adjusted percent in-hospital mortality was 1% for patients receiving a macrolide first and 8% for patients receiving a beta-lactam first (P=0.158).
Conclusion: These data suggest that, although not statistically significant, there is a clinically relevant decrease in in-hospital mortality if a macrolide is given before a beta-lactam. Since macrolides may decrease mortality only when given prior to beta-lactam antibiotics, their activity is likely due to anti-inflammatory effects and prevention of bacterial lysis as opposed to coverage of atypical pathogens.
F. Arnold, None
T. Wiemken, None
R. Kelley, None
M. Metersky, None
J. Ramirez, None
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