Implications for Macrolide Treatment in Community-Acquired Pneumonia

¹ From the Washington University School of Medicine, St. Louis
² From the University of Maryland School of Medicine, Baltimore
³ From the Johns Hopkins School of Medicine, Baltimore
⁴ From the Johns Hopkins School of Medicine, Baltimore; and the National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md.

Study objectives: To identify associated clinical parameters, concurrent respiratory tract infections, and the association between macrolide-based therapy and mortality in patients with community-acquired pneumonia ascribed to atypical.

Design: Secondary analysis of prospective, cross-sectional study.

Setting: Tertiary care hospital.

Patients: Three hundred eighty-five consecutive patients who were admitted to the Johns Hopkins Hospital from November 11, 1990, through November 10, 1991, and treated for community-acquired pneumonia.

Results: An atypical pathogen was identified in 29 of 385 adults (7.5%). A second pathogen was detected in 16 of 29 patients (55.2%) in whom an atypical pathogen was detected, compared with 13 of 137 patients (9.5%) in whom conventional bacterial pathogens were detected (odds ratio, 10.22; 95% confidence interval, 3.7 to 28.8; p<0.0001), During hospitalization, only four patients (13.8%) with detection of an atypical pathogen received at least 7 days of either a macrolide or tetracycline. No patient identified to have an atypical pathogen died. For patients who either provided paired sera or who died, 24 of 197 (12.2%) had atypical pathogens detected.

Conclusions: Despite vigorous study methods, atypical pathogens were uncommon in our hospitalized population. A second concurrent respiratory pathogen was identified for most patients with atypical pneumonia. Although macrolide use was rare in this patient population, mortality was zero for patients in whom an atypical pathogen was detected, affirming that macrolide-based therapy need not be routine in the therapeutic management of community-acquired pneumonia.

Key Words: atypical pathogen • Chlamydia species • community-acquired • legionella • macrolide • Mycoplasma pneumoniae • pneumonia

Submitted on August 7, 1997
Accepted on October 31, 1997

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