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Lower mortality among patients with community-acquired pneumonia treated with a macrolide plus a beta-lactam agent versus a beta-lactam agent alone

  • E. García Vázquez
  • J. Mensa
  • J. A. Martínez
  • M. A. Marcos
  • J. Puig
  • M. Ortega
  • A. Torres
Article

Abstract

A cohort of 1,391 patients with community-acquired pneumonia of unknown etiology, atypical pneumonia, Legionella pneumophila pneumonia, viral pneumonia, or pneumococcal pneumonia was studied according to a standard protocol to analyse whether the addition of a macrolide to β-lactam empirical treatment decreases mortality rates. Patients admitted to the intensive care unit were excluded. Severity was assessed using the PORT score. An etiological diagnosis was achieved in 498 (35.8%) patients (292 infections due to Streptococcus pneumoniae). Treatment was chosen by the attending physician according to his/her own criteria: β-lactam agent in 270 and β-lactam agent plus a macrolide in 918 cases. The mortality rate was 13.3% in the group treated with a β-lactam agent alone and 6.9% in the group treated with a β-lactam agent plus a macrolide (p=0.001). The percentage of PORT-group V patients was 32.6% in the group treated with a beta-lactam agent alone compared to 25.7% in the group who received a β-lactam agent plus a macrolide (p=0.02). After controlling for PORT score, the odds of fatal outcome was two times higher in patients treated with a beta-lactam agent alone than in those treated with a β-lactam agent plus a macrolide (adjusted OR = 2, 95%CI 1.24–3.23). The results suggest that the addition of a macrolide to an initial β-lactam-based antibiotic regimen is associated with lower mortality in patients with community-acquired pneumonia, independent of severity of infection, thus supporting the recommendation of a β-lactam-agent plus a macrolide as empirical therapy.

Keywords

Macrolide Pneumococcal Pneumonia Microbiological Diagnosis Urinary Antigen Test Protected Specimen Brush 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgement

This study was supported by RED GIRA and RED RESPIRA, Instituto Carlos III.

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • E. García Vázquez
    • 1
    • 4
  • J. Mensa
    • 1
  • J. A. Martínez
    • 1
  • M. A. Marcos
    • 2
  • J. Puig
    • 2
  • M. Ortega
    • 1
  • A. Torres
    • 3
  1. 1.Infectious Diseases DepartmentHospital Clinic UniversitariBarcelonaSpain
  2. 2.Microbiology DepartmentHospital Clinic UniversitariBarcelonaSpain
  3. 3.Institute of Pneumology and Thoracic Surgery, IDIBASHospital Clinic UniversitariBarcelonaSpain
  4. 4.Servicio de Medicina Interna-InfeccionesHospital Universitario Virgen de la ArrixacaEl Palmar (Murcia)Spain

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