Related Experiment Videos
Clarithromycin in the management of community-acquired pneumonia
1Hill Top Research, Inc., Pharmaceutical Clinical Trials Division, Fresno, California 93710, USA.
Objective:
To review the epidemiology and diagnosis of community-acquired pneumonia (CAP) and examine factors that influence the choice of empiric antimicrobial therapy.
Background:
CAP remains a common disease with substantial associated morbidity and mortality. Outpatient management of patients with CAP has become increasingly complex because of the availability of newer antimicrobial agents, evolving patterns of resistance, and the increasing recognition of atypical pathogens. Although Streptococcus pneumoniae remains a commonly encountered pathogen, the development and increasing prevalence of antibiotic resistance has become an area of concern, especially in outpatients. The newer macrolide antimicrobial drugs-clarithromycin and azithromycin-are effective against commonly encountered pathogens, are well tolerated, and have an established tolerability profile, although the low serum levels achieved by azithromycin hinder its use in patients with suspected bacteremia.
Methods:
A MEDLINE search was performed of English-language articles published from 1990 to 2000 on the treatment of CAP. This article reviews the treatment of CAP, with emphasis on the use of clarithromycin.
Conclusion:
Although laboratory surveillance studies have reported macrolide-resistant S. pneumoniae, recent evidence defining the mechanism of this resistance, coupled with the pharmacokinetic properties of the macrolide agents, suggests that the actual rate of clinical macrolide resistance is low.
Insights
Community-acquired pneumonia (CAP) management is complex. Newer macrolides like clarithromycin are effective, and clinical macrolide resistance rates for Streptococcus pneumoniae are low despite lab data.
Area of Science:
- Infectious Diseases
- Pharmacology
- Epidemiology
Background:
- Community-acquired pneumonia (CAP) presents significant morbidity and mortality.
- Outpatient CAP management is complicated by new antimicrobials, resistance, and atypical pathogens.
- Streptococcus pneumoniae is common, but antibiotic resistance is a growing concern.
Purpose of the Study:
- Review the epidemiology and diagnosis of CAP.
- Examine factors influencing empiric antimicrobial therapy selection.
- Focus on the role of clarithromycin in CAP treatment.
Main Methods:
- Conducted a MEDLINE search of English-language articles (1990-2000).
- Focused on the treatment of community-acquired pneumonia.
- Emphasized the use of clarithromycin in the review.
Main Results:
- Macrolide antimicrobial drugs (clarithromycin, azithromycin) are effective and well-tolerated.
- Azithromycin's low serum levels may limit its use in suspected bacteremia.
- Laboratory data show macrolide-resistant S. pneumoniae, but clinical resistance rates appear low.
Conclusions:
- Despite laboratory findings of macrolide resistance in S. pneumoniae, clinical resistance rates are low.
- Pharmacokinetic properties of macrolides support their clinical utility.
- Clarithromycin is a viable option for treating community-acquired pneumonia.