Περίληψη:
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.
Συγγραφείς:
Giamarellos-Bourboulis, Evangelos J.
Mylona, Vassiliki and
Antonopoulou, Anastasia
Tsangaris, Iraklis
Koutelidakis, Ioannis
and Marioli, Androniki
Raftogiannis, Maria
Kopterides, Petros
and Lymberopoulou, Korina
Mouktaroudi, Maria
Papageorgiou,
Christos
Papaziogas, Basileios
Georgopoulou, Antonia-Panagiota
and Tsaganos, Thomas
Papadomichelakis, Evangelos
Gogos,
Charalambos
Ladas, Malvina
Savva, Athina
Pelekanou, Aimilia
and Baziaka, Fotini
Koutoukas, Pantelis
Kanni, Theodora and
Spyridaki, Aikaterini
Maniatis, Nikolaos
Pelekanos, Nikolaos and
Kotsaki, Antigone
Vaki, Ilia
Douzinas, Emmanuel E. and
Koratzanis, Georgios
Armaganidis, Apostolos
