Effect of clarithromycin in patients with suspected Gram-negative sepsis: results of a randomized controlled trial
| Autor: | Androniki Marioli, Theodora Kanni, Apostolos Armaganidis, Vassiliki Mylona, Nikolaos A. Maniatis, Basileios Papaziogas, Athina Savva, Ioannis Koutelidakis, Emmanuel E. Douzinas, Iraklis Tsangaris, Maria Raftogiannis, Petros Kopterides, Aikaterini Spyridaki, Antonia-Panagiota Georgopoulou, Antigone Kotsaki, Thomas Tsaganos, Ilia Vaki, Evangelos J. Giamarellos-Bourboulis, Fotini Baziaka, Evangelos Papadomichelakis, Aimilia Pelekanou, Nikolaos Pelekanos, Christos Papageorgiou, Maria Mouktaroudi, Malvina Ladas, Charalambos Gogos, Korina Lymberopoulou, Georgios Koratzanis, Anastasia Antonopoulou, Pantelis Koutoukas |
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| Rok vydání: | 2013 |
| Předmět: |
Microbiology (medical)
Adult Male medicine.medical_specialty Adolescent Population Placebo Sepsis Placebos Young Adult Double-Blind Method Internal medicine Clarithromycin medicine Humans Pharmacology (medical) Prospective Studies education Adverse effect Aged Pharmacology Aged 80 and over education.field_of_study Septic shock business.industry Ventilator-associated pneumonia Health Care Costs Middle Aged medicine.disease Survival Analysis Surgery Anti-Bacterial Agents Systemic inflammatory response syndrome Infectious Diseases Treatment Outcome Administration Intravenous Female business Gram-Negative Bacterial Infections medicine.drug |
| Zdroj: | The Journal of antimicrobial chemotherapy. 69(4) |
| ISSN: | 1460-2091 |
| Popis: | Background 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. Methods 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. Results 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 (P = 0.671). 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%, P = 0.020). 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 (P = 0.037). The cost of hospitalization was lower after treatment with clarithromycin (P = 0.044). Serious adverse events were observed in 1.3% and 0.7% of placebo- and clarithromycin-treated patients, respectively (P = 0.502). Conclusions Intravenous clarithromycin did not affect overall mortality; however, administration shortened the time to resolution of infection and decreased the hospitalization costs. |
| Databáze: | OpenAIRE |
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