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The Clinical Efficacy of the Initial Combination of the Third generation Cephalosporin and intravenous/oral new Macrolide Antibiotics for the Treatment of Severe Community-acquired Pneumonia FREE TO VIEW

Chaicharn Pothirat, MD*; Nattapoon Kosachunhanun, MD
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Chiang Mai University, Chiang Mai, Thailand


Chest. 2004;126(4_MeetingAbstracts):723S. doi:10.1378/chest.126.4_MeetingAbstracts.723S
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PURPOSE:  To compare the mortality rate (as a primary outcome) and the rates of clinical response, complication and length of hospital stay (as secondary outcomes) between the group receiving third generation non-pseudomonal cephalosporin alone with the group receiving additional combined a new IV/oral macrolide for the treatment of severe community-acquired pneumonia.

METHODS:  An open-blinded, randomized controlled study was conducted prospectively among the admitted patients diagnosed as severe community-acquired pneumonia by using ATS and BTS criteria during 1 August 2001-31 July 2002 period (n=110). The third generation non-pseudomonal cephalosporin (ceftriazone of cefotaxime) was used conventionally to treat these groups of patients who the etiologic agents were initially unknown. The additional IV/Oral macrolide(clarithromycin) was administered randomly by the investigating nurse. The Chi-square test and student t-test was a statistical mean using for comparisons the differences of the clinical outcomes between the two groups.

RESULTS:  Although, the overall mortality rate of the group receiving the new macrolide combined in the regimen and the group receiving third generation cephalosporin alone was not statistically difference (23.33% vs. 37.84%, p=0.203), but the CAP-related mortality of the former group was significantly lower than the latter one (6.67 % vs. 29.73 %, p=0.018). All the secondary outcomes of the former were significantly better than the latter (the rates of initial response and CAP-related complication were 96.67 % vs. 70.27 %, p=0.005; 22.22% vs 80%, p=0.023, respectively) except the mean length of hospital stay tended to be shorter for 4 day in the former but this didn’t reach statistical difference [12.27(5-30) days vs. 16.74(5-43) days, p=0.091].

CONCLUSION:  The severe community-acquired pneumonic patients receiving the initial combination of the third generation non-pseudomonal cephalosporin and a new macrolide antibiotic had much better clinical outcomes including: lower CAP-related mortality and complications; higher initial response and cure; lower initial deterioration and tended to have a shorter length of hospital stay.

CLINICAL IMPLICATIONS:  Initial combination of third generation cephalosporin and new macrolide can improve severe community-acquired pneumonia related-outcomes.

DISCLOSURE:  C. Pothirat, None.

Monday, October 25, 2004

2:30 PM- 4:00 PM




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