This article is more than 5 years old. Information may no longer be current.

Adding clarithromycin, naproxen to regimen shortens hospitalization for influenza

Cindy Cooper

ORLANDO, Fla. – Among patients hospitalized for influenza who had infiltrates, the addition of clarithromycin and naproxen to amoxicillin, esomeprazole and oseltamivir reduced 30-day and 90-day hospitalization and viral titer, and resulted in one fewer day of acute hospitalization, according to a presentation here at Hospital Medicine 18.

“The H3N2 strain was the dominant influenza strain this year and it has a higher mortality compare to H1N1, especially in children and the elderly,” said Cindy Cooper, MD, a hospitalist at Massachusetts General Hospital and assistant professor at Harvard Medical School. “In addition, the vaccines for this strain have been less effective.”

Researchers at a single center in Hong Kong studied whether the addition of NSAIDs and macrolides — medications with known antiviral properties — might benefit this patient population, she said.

The study randomly assigned 217 patients for treatment of laboratory-confirmed H3N2 influenza with infiltrates confirmed on either a CT scan or a chest X-ray.

All patients received amoxicillin, esomeprazole and oseltamivir, with the study group also receiving clarithromycin 500 mg and naproxen 200 mg on days 1 and 2.

The addition of clarithromycin and naproxen significantly lowered 30-day and 90-day mortality. Average pneumonia severity index scores were reduced, and the amount of viral titer recovered and the degree of resistance to neuraminidase inhibitors were reduced. If patients received this combination on the first day of treatment, the averaged one fewer day of hospitalization, she said.

“My expectation is, just like this past year, next year will be a bad year for influenza, but in the population of patients that is hospitalized with infiltrates, it seems as if we can make a significant impact on outcomes if we treat them with macrolides and naproxen in the first days of their treatment,” Cooper said.

Reference:

Cooper C, et al. Updates in Hospital Medicine. Presented at: Hospital Medicine 2018; April 9-11; Orlando, Fla.

Disclosure: The researchers report no relevant financial disclosures.