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, 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
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
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.”
- File T. #P721. Presented at: 22nd European Congress of Clinical Microbiology and Infectious Diseases; March 31-April 3, 2012; London.
- Dr. File reports no relevant