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. 2021 Oct;49(10):3000605211049943.
doi: 10.1177/03000605211049943.

Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: a systematic review

Jumana Al-Salloum  1   2 , Syed Wasif Gillani  1 , Rana Kamran Mahmood  1   3 , Shabaz Mohiuddin Gulam  1   2
Affiliations

Comparative efficacy of azithromycin versus clarithromycin in combination with beta-lactams to treat community-acquired pneumonia in hospitalized patients: a systematic review

Jumana Al-Salloum et al. J Int Med Res. 2021 Oct.

Abstract

Objective: The objective was to compare the efficacy of azithromycin and clarithromycin in combination with beta-lactams to treat community-acquired pneumonia among hospitalized adults.

Methods: Five databases (PubMed, Google Scholar, Trip, Medline, and Clinical Key) were searched to identify randomized clinical trials with patients exposed to azithromycin or clarithromycin in combination with a beta-lactam. All articles were critically reviewed for inclusion in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Seven clinical trials were included. The treatment success rate for azithromycin-beta-lactam after 10 to 14 days was 87.55% and that for clarithromycin-beta-lactam after 5 to 7 days of therapy was 75.42%. Streptococcus pneumoniae was commonly found in macrolide groups, with 130 and 80 isolates in the clarithromycin-based and azithromycin-based groups, respectively. The length of hospital stay was an average of 8.45 days for patients receiving a beta-lactam-azithromycin combination and 7.25 days with a beta-lactam-clarithromycin combination.

Conclusion: Macrolide inter-class differences were noted, with a higher clinical success rate for azithromycin-based combinations. However, a shorter length of hospital stay was achieved with a clarithromycin-beta-lactam regimen. Thus, a macrolide combined with a beta-lactam should be chosen using susceptibility data from the treating facility.

Keywords: Community-acquired pneumonia; Streptococcus pneumoniae; azithromycin; beta-lactam; clarithromycin; macrolide; meta-analysis; respiratory tract infection; susceptibility data.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart for the identified articles.
Figure 2.
Figure 2.
Commonly used beta-lactams in combination with macrolides.
Figure 3.
Figure 3.
Percentage of clinical success rate among both macrolide–beta-lactam-based regimens.
Figure 4.
Figure 4.
Common Pneumonia Severity Index (PSI) score reported.
Figure 5.
Figure 5.
Number of bacteria isolated from each treatment arm.
Figure 6.
Figure 6.
Length of hospital stay (mean number of days).
See this image and copyright information in PMC

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