Latest news with #azithromycin
Medscape
4 days ago
- Health
- Medscape
Azithromycin Tops Doxycycline in Reducing Pneumonia Deaths
Among hospitalized patients with community-acquired pneumonia, those treated with azithromycin plus beta-lactams had lower in-hospital mortality and mortality rates at 30 and 90 days post-admission than those receiving doxycycline plus beta-lactams. METHODOLOGY: Researchers conducted a retrospective matched cohort study to compare mortality outcomes between patients hospitalized with community-acquired pneumonia treated with azithromycin and those treated with doxycycline, each in combination with beta-lactams. They enrolled 8492 patients (median age, 73 years; 54.3% men) who received azithromycin or doxycycline for at least 48 hours. Patients treated with doxycycline (n = 2671) were matched 1:1 with patients treated with azithromycin based on specific comorbidities, recent immunosuppressant use, and the pneumonia severity index. The primary outcome was mortality, assessed at hospital discharge and at 30 and 90 days post-admission; the secondary outcome was the number of hospital-free days within 28 days of admission. TAKEAWAY: The in-hospital mortality rates were significantly lower in the azithromycin group than in the doxycycline group (odds ratio, 0.71; P = .005). = .005). Treatment with azithromycin was associated with reduced 30-day mortality (hazard ratio [HR], 0.85; P = .041) and 90-day mortality (HR, 0.83; P = .005) compared with treatment with doxycycline. = .041) and 90-day mortality (HR, 0.83; = .005) compared with treatment with doxycycline. Patients receiving azithromycin had significantly more hospital-free days than those receiving doxycycline (adjusted estimate, 1.37; P < .001). < .001). Among patients who did not require ICU admission within 24 hours of hospitalization, azithromycin improved 90-day survival compared with doxycycline (adjusted HR, 0.85; P = .007). IN PRACTICE: 'Given that we found a difference in clinical outcomes between azithromycin vs doxycycline with beta-lactam therapy, our observational study suggests a potential benefit with using azithromycin for CAP [community-acquired pneumonia] treatment in contrast to the limited evidence available,' the authors wrote. SOURCE: This study was led by Yewande Odeyemi, MBBS, MS, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota. It was published online on May 16, 2025, in Clinical Infectious Diseases . LIMITATIONS: This study did not investigate the possible effects of specific beta-lactam antibiotics. It also did not assess the specific causes of community-acquired pneumonia, preventing the evaluation of the appropriateness of antibiotic treatments or the impact of atypical organisms. Additionally, other therapies or interventions were not considered, and outcomes were restricted to all-cause mortality. DISCLOSURES: This study did not receive any funding. One author reported receiving grant support from the National Institutes of Health. Another author reported receiving consulting fees from Wolters Kluwer and support for a speaking engagement from the American Society of Nephrology. The other authors reported having no conflicts of interest.
Medscape
23-05-2025
- Health
- Medscape
EMA Changes Azithromycin Use to Combat Antibiotic Resistance
The EMA's Committee for Medicinal Products for Human Use (CHMP) has recommended several changes to the way the antibiotic azithromycin is used in the EU, including the removal of certain indications. The recommendations aim to optimize the use of the antibiotic and minimize the development of antimicrobial resistance, CHMP said. CHMP's review and re-evaluation of the benefits and risks of azithromycin medicines given by mouth or IV infusion came at the request of the German Federal Institute for Drugs and Medical Devices. It has led to new changes that include uses of the drug to be refined and harmonized, uses to be discontinued, and a new product warning. The full list of revised uses, found in the published product information, mainly concern upper and lower respiratory tract infections, sexually transmitted diseases, female reproductive system infections, dental infections, and treatment and prevention of types of Mycobacterium avium complex infections in people living with HIV-1. CHMP said that the antibiotic could no longer be used in moderate acne vulgaris, eradication of Helicobacter pylori, and prevention of exacerbations of eosinophilic and noneosinophilic asthma. This is because its effectiveness in these conditions has not been clearly demonstrated, including that its benefits do not outweigh its risks. These indications will be removed from the product information. The committee pointed out that some azithromycin medicines are also approved in the EU for topical use, but that these medicines are out of the scope of the review procedure. Higher Risk for Resistance Azithromycin is included in the World Health Organization (WHO) list of essential medicines but is also classified by the WHO as an antibiotic that carries a higher risk for antimicrobial resistance. It is included in WHO's Watch category (AWaRe classification), so the drug should be prioritized as a key target for prudent use and monitoring. CHMP said that there had been an increased use of azithromycin in recent years. A study commissioned by the EMA and performed by DARWIN EU, which analyzed the prescription of the 141 antibiotics in WHO's Watch category between 2012 and 2021 in France, Germany, Spain, the Netherlands, and United Kingdom, found that azithromycin was among the top five most prescribed antibiotics in the majority of databases assessed, and within the top 10 in all the databases included. Data from the ATLAS and SENTRY databases showed an increasing global prevalence of azithromycin resistance among bacterial strains linked to the approved indications of azithromycin in the EU/European Economic Area. Research has also shown that azithromycin resistance has increased in recent years. A study published last month (April 2025) in Frontiers in Microbiology found that the prevalence of azithromycin resistance in pathogenic bacteria from clinical samples was 22%, and indicated an increase in prevalence after the COVID-19 pandemic, which the study's researchers described as 'a major concern.' CHMP explained that a new warning will also be included in the summary of product characteristics about the importance of clinicians assessing the benefits and the risks, considering the local prevalence of resistance, and deciding when preferred treatment regimens are not indicated. This is based on the fact that azithromycin could favor the development of resistance due to its long-lasting, decreasing levels in plasma and tissues after the end of treatment.
