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Macrolide treatment showed benefit in pneumonia with atypical pathogens

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LONDON — Patients with community-acquired pneumonia due to atypical pathogens showed a differential clinical benefit at day 4 when they received 1 day of treatment with clarithromycin, according to Thomas File, MD.

File, an Infectious Disease News Editorial Board member, and colleagues conducted a subset analysis of the FOCUS 1 and FOCUS 2 studies. In these studies, patients with community-acquired pneumonia were randomly assigned to IV ceftaroline fosamil 600 mg once every 12 hours or IV ceftriaxone 1 g once-daily, for 5 to 7 days. In the FOCUS 1 study, patients also received two doses of oral clarithromycin 500 mg on day 1, to provide coverage for atypical pathogens.

This subset analysis included those patients who community-acquired pneumonia was due to atypical pathogens. At baseline, 28.1% of patients in the FOCUS 1 trial and 24.2% of patients in the FOCUS 2 trial had an atypical pathogen. The pathogens identified included Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila and mixed atypicals.

They found that those patients with atypical pathogens who received clarithromycin demonstrated a differential clinical benefit at day 4, specifically in patients with M. pneumoniae or C. pneumoniae. However, at the standard test-of-cure timepoint, no difference in clinical benefit. In patients with L. pneumophila, there was no difference at day 4, but there was a difference favoring the clarithromycin group at the test-of cure timepoint.

On multivariate analysis, three risk factors had a statistically significant association with response on day 4: PORT score, meeting the American Thoracic Society criteria and presence of hypoxemia. The odds ratio of 2.5 (95% CI, 1.14-5.32) suggested a benefit of clarithromycin for patients with atypical pathogens.

“Although not a prospective, randomized comparison, our observations suggest that outcome assessment at an early time point may better identify differential effects of two treatments than a later evaluation and that empiric atypical coverage may impact early clinical response,” File said. “Additional study is warranted.”

References:

• File T. #P721. Presented at: 22nd European Congress of Clinical Microbiology and Infectious Diseases; March 31-April 3, 2012; London.

Disclosures:

• Dr. File reports no relevant financial disclosures.