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The efficacy of the combination of azithromycin with ceftriaxone for the treatment of community-acquired pneumonia in elderly patients

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality from infectious diseases, as well as a frequent reason for hospitalization in developed countries, especially in elderly patients. A number of studies have demonstrated the ability of macrolide antibiotics when combined with generation II-III cephalosporins to improve treatment outcomes in elderly patients (over 65 years) with CAP.

Scientists from the Institute of Infectious and Immunological Diseases and the Institute of Pneumology in Barcelona (Spain) conducted an open prospective comparative study on the efficacy of two macrolides (azithromycin and clarithromycin), prescribed together with ceftriaxone for treatment of community-acquired pneumonia in elderly patients.

The study included 603 patients with community-acquired pneumonia, who were divided into two groups. All patients received ceftriaxone iv (starting dose 2 g, then 1 g / day), followed by switching to amoxicillin / clavulanate at a dose of 875/125 mg 3 r / day, during 10 to 14 days. Patients in the first group (220) also received clarithromycin at a dose of 500 mg 2 r / day for at least 10 days (iv, orally), patients in the second group (383) received azithromycin at a dose of 500 mg 1 r / day for 3 days. Patients were not randomly divided into groups, as determined by the admitting physician, however, the two groups had similar characteristics in etiology, severity of illness, frequency of bacteremia, and patients in the azithromycin group were older (mean age 71.5 ± 17 and 65.8 ± 19, respectively, p is less than 0.01).

All patients underwent microbiological blood examination, sputum, serological blood tests and determination of the Legionella pneumophila 1 antigen serogroup in the urine.

As the results of the study showed, the average length of hospital stay was shorter in the azithromycin group (7.32 ± 5 days compared to 9.4 ± 7 days in the clarithromycin group, p less than 0, 01). Mortality was also lower in patients receiving azithromycin (3.7% versus 7.3% in the clarithromycin group, p less than 0.05).

Commenting on the results of the study, the scientists noted that the beneficial effect of macrolides on the results of the treatment of community-acquired pneumonia may be linked both to their activity against atypical pathogens and to the presence of anti-inflammatory properties. (effects on neutrophil migration, production of cytokines, etc.). However, the severity of the anti-inflammatory effect of azithromycin and clarithromycin was not studied during the study.

The advantages of azithromycin include its unique pharmacokinetic characteristics, thanks to which it penetrates well and accumulates in the mucosa of the lower respiratory tract, which allows the drug to be used once during a short 3-day course and ensures high compliance with this regimen. At the same time, the administration regimen of clarithromycin is less practical (a 10-day course with a double intake) and its administration is more difficult to control, since patients are generally released on the 5-7th day of treatment and continue their treatment alone on an outpatient basis.

The study revealed interesting data on the comparative efficacy of various macrolides (azithromycin, clarithromycin) in elderly patients with community-acquired pneumonia when treated with β-lactam antibiotics (ceftriaxone). However, they must be confirmed in randomized trials and should be supplemented by a study of the effect of various macrolides on the production of cytokines and other markers of inflammation.