Clinical efficacy of oral clarithromycin monotherapy in patients with mild or moderate community-acquired pneumonia

摘要

Clarithromycin (CAM) is a new macrolide antibiotic which is active against a wide range of organisms responsible for community-acquired pneumonia (CAP) and has superior pharmacokinetics and tolerance compared to erythromycin. In this study, we evaluated the clinical efficacy and antimicrobial activity of CAM in the empirical treatment of patients with CAP. CAM (200 mg given twice daily for 2 weeks) was orally administered to 26 patients with mild or moderate suspected atypical pneumonia, including 15 patients in whom treatment with beta-lactam antibiotics was largely ineffective. Causative pathogens were identified on the basis of quantitative sputum cultures, blood cultures, and routine serological testings; M. pneumoniae was most commonly observed in patients with CAP (38.5%; 10/26), followed by H. influenzae (11.5%; 3/26), C. pneumoniae (3.8%; 1/26), and S. constellatus (3.8%; 1/26). Penicillin-resistant, or penicillin-susceptible Streptococcus pneumoniae were isolated from 1 patient (3.8%) and 2 patients (7.7%), respectively out of 26 patients with CAP. There were no detectable pathogens in 8 of 26 patients. The treatment of CAM resulted in complete resolution of all signs and symptoms of pneumonia in all the patients and was not accompanied with any adverse events. The overall incidence of laboratory abnormalities was not detectable in the patients evaluated. Although it is important to make differential diagnosis of atypical from bacterial pneumonia in designing therapeutic strategy, it is often difficult to make an appropriate diagnosis in patients with CAP. Because of diagnostic difficulties, CAM with a broad antimicrobial spectrum is recommended as the first-line drug for the treatment of lower respiratory infections, particularly in patients with suspected atypical pneumonia.