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Empirical therapy of community-acquired pneumonia: macrolides are not ideal choices
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA.
Abstract:
Macrolides are a rational option for patients with community-acquired pneumonia managed as outpatients. For hospitalized patients, they may be used to supplement other drugs, usually betalactams, because of their excellent activity versus Legionella, Chlamydia pneumoniae, and Mycoplasma pneumoniae. The reason for lack of confidence for macrolides as single agents in hospitalized patients, especially for seriously ill patients, is the lack of studies confirming good results for seriously ill patients, and relatively poor in vitro activity against some important pathogens. Resistance is noted to erythromycin, clarithromycin, and azithromycin by 10% to 15% of Streptococcus pneumoniae, about 40% of penicillin resistant S pneumoniae, most Fusobacteria, some Streptococcus aureus, and all gram-negative bacilli.
Insights
Macrolides are effective for outpatient community-acquired pneumonia. For hospitalized patients, they supplement beta-lactams, but resistance and limited data for severe cases affect their use as monotherapy.
Area of Science:
- Infectious Diseases
- Pharmacology
- Pulmonology
Background:
- Macrolides are recommended for outpatient community-acquired pneumonia.
- They offer excellent activity against atypical pathogens like Legionella, Chlamydia pneumoniae, and Mycoplasma pneumoniae.
Purpose of the Study:
- To evaluate the role of macrolides in managing community-acquired pneumonia.
- To assess their efficacy as monotherapy versus combination therapy in hospitalized patients.
Main Methods:
- Review of existing literature and in vitro susceptibility data.
- Analysis of macrolide effectiveness in different patient populations (outpatient vs. inpatient, severe vs. non-severe).
Main Results:
- Macrolides are a rational choice for outpatients.
- In hospitalized patients, they are best used adjunctively with beta-lactams.
- Concerns exist regarding macrolide monotherapy in severe cases due to limited supporting studies and in vitro resistance.
Conclusions:
- Macrolides remain valuable for community-acquired pneumonia, particularly in outpatients.
- Their use in hospitalized patients should be guided by pathogen susceptibility and disease severity.
- Resistance patterns necessitate careful consideration of macrolide monotherapy.