@article{3161277,
    title = "Effect of clarithromycin in patients with suspected Gram-negative
sepsis: results of a randomized controlled trial",
    author = "Giamarellos-Bourboulis, Evangelos J. and Mylona, Vassiliki and and Antonopoulou, Anastasia and Tsangaris, Iraklis and Koutelidakis, Ioannis and and Marioli, Androniki and Raftogiannis, Maria and Kopterides, Petros and and Lymberopoulou, Korina and Mouktaroudi, Maria and Papageorgiou, and Christos and Papaziogas, Basileios and Georgopoulou, Antonia-Panagiota and and Tsaganos, Thomas and Papadomichelakis, Evangelos and Gogos, and Charalambos and Ladas, Malvina and Savva, Athina and Pelekanou, Aimilia and and Baziaka, Fotini and Koutoukas, Pantelis and Kanni, Theodora and and Spyridaki, Aikaterini and Maniatis, Nikolaos and Pelekanos, Nikolaos and and Kotsaki, Antigone and Vaki, Ilia and Douzinas, Emmanuel E. and and Koratzanis, Georgios and Armaganidis, Apostolos",
    journal = "The Journal of antimicrobial chemotherapy",
    year = "2014",
    volume = "69",
    number = "4",
    pages = "1111-1118",
    publisher = "Oxford University Press",
    doi = "10.1093/jac/dkt475",
    keywords = "bacteraemia; pyelonephritis; intra-abdominal infection; respiratory
distress syndrome; hospitalization costs",
    abstract = "A previous randomized study showed that clarithromycin decreases the
risk of death due to ventilator-associated pneumonia and shortens the
time until infection resolution. The efficacy of clarithromycin was
tested in a larger population with sepsis.
Six hundred patients with systemic inflammatory response syndrome due to
acute pyelonephritis, acute intra-abdominal infections or primary
Gram-negative bacteraemia were enrolled in a double-blind, randomized,
multicentre trial. Clarithromycin (1 g) was administered intravenously
once daily for 4 days consecutively in 302 patients; another 298
patients were treated with placebo. Mortality was the primary outcome;
resolution of infection and hospitalization costs were the secondary
outcomes.
The groups were well matched for demographics, disease severity,
microbiology and appropriateness of the administered antimicrobials.
Overall 28 day mortality was 17.1 (51 deaths) in the placebo arm and
18.5 (56 deaths) in the clarithromycin arm (P0.671). Nineteen out of 26
placebo-treated patients with septic shock and multiple organ
dysfunctions died (73.1) compared with 15 out of 28
clarithromycin-treated patients (53.6, P0.020). The median time until
resolution of infection was 5 days in both arms. In the subgroup with
severe sepsis/shock, this was 10 days in the placebo arm and 6 days in
the clarithromycin arm (P0.037). The cost of hospitalization was lower
after treatment with clarithromycin (P0.044). Serious adverse events
were observed in 1.3 and 0.7 of placebo- and clarithromycin-treated
patients, respectively (P0.502).
Intravenous clarithromycin did not affect overall mortality; however,
administration shortened the time to resolution of infection and
decreased the hospitalization costs."
}