IV Cefuroxime Plus Oral Clarithromycin or IV Erythromycin for the Treatment of Community-Acquired Pneumonia in Hospitalised PatientsA Pilot Study

The tolerability and efficacy of oral clarithromycin and parenteral erythromycin used in combination with parenteral cefuroxime were examined in a randomised, open-label pilot study. 20 patients hospitalised with mild to moderate community-acquired pneumonia were randomised to receive cefuroxime 750mg intravenously every 8 hours plus either clarithromycin 500mg orally twice daily (n = 10; group A) or erythromycin 500mg intravenously 4 times daily (n = 10; group B). Patients were evaluated daily and treatment groups were compared at discharge and 2 weeks later. Bacteriological, clinical and radiographic responses were evaluated. The total cost of antibiotic therapy was calculated based upon the total number of doses of clarithromycin, erythromycin and cefuroxime received during the entire course of treatment. In addition, an average charge for the pneumonia per length of stay yielded an estimate of the total cost of hospitalisation for each patient. The mean costs of inpatient macrolide treatment, hospitalisation and total therapy (total cost of antibiotic therapy + hospitalisation) were then compared between each group. After controlling for risk factors associated with a complicated hospital course, both groups demonstrated comparable responses to therapy, although complete resolution of signs and symptoms occurred earlier in group A (p = 0.015). The mean length of stay was 4 days in group A and 3.8 days in group B (p = 0.872). The mean cost of inpatient macrolide treatment was $US19.28 in group A and $US76.04 in group B (p = 0.002). The mean costs of antibiotic therapy and total therapy were not significantly different between groups. One patient in group A experienced mild dysgeusia, nausea, dizziness and hot flashes. Two patients in group B developed phlebitis necessitating a change in therapy. Patients receiving oral clarithromycin plus parenteral cefuroxime had comparable clinical response rates to those receiving parenteral erythromycin and cefuroxime.