Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

Mello, Claudia Figueiredo; Negra, Marinella Della

doi:10.1016/S1413-8670(11)70186-6

The Brazilian Journal of Infectious Diseases

ISSN: 1413-8670

The Brazilian Journal of Infectious Diseases is the official publication of the Brazilian Society of Infectious Diseases (SBI). It aims to publish relevant articles in the broadest sense on all aspects of microbiology, infectious diseases and immune response to infectious agents.
The BJID is a bimonthly publication and one of the most influential journals in its field in Brazil and Latin America with a high impact factor. Since its inception it has garnered a growing share of the publishing market.

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Bacterial pneumonia is one of the main causes of morbidity and mortality in patients infected by the human immunodeficiency virus (HIV). The main objective of this study was to evaluate the effect of macrolide therapy in combination with a beta-lactam based empiric regimen for inpatients with community-acquired pneumonia and HIV.

Methods

This is a retrospective cohort study of hospitalized patients. Adult patients who had received treatment with ceftriaxone or ceftriaxone plus clarithromycin were included.

Results

76 patients met the inclusion criteria. Among baseline characteristics analyzed, only respiratory rate showed significant difference: patients who had received clarithromycin were more likely to have a respiratory rate > 30/min than patients who received only ceftriaxone (64% versus 36%, p = 0.03). ICU admission was the only outcome that showed a significant difference, more frequent in the ceftriaxone plus clarithromycin group (45% versus 20%, p = 0.03).

Conclusions

This study does not support the addition of a macrolide to a beta-lactam based regimen in HIV-infected patients. This is probably related to the patients’ immunodeficiency status, which impairs the immunomodulatory properties of the macrolides.

Keywords:

HIV

pneumonia

macrolides

mortality

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References

[1.]

M.W. Hull, P. Phillips, J.S. Montaner.

Changing global epidemiology of pulmonary manifestations of HIV/AIDS.

Chest, 134 (2008), pp. 98-1287

[2.]

G. Madeddu, M.L. Fiori, M.S. Mura.

Bacterial communityacquired pneumonia in HIV-infected patients.

Curr Opin Pulm Med, 16 (2010), pp. 7-201

[3.]

R. Kohli, Y. Lo, P. Homel, et al.

Bacterial pneumonia HIV therapy, and disease progression among HIV-infected women in the HIV epidemiologic research (HER) study.

Clin Infect Dis, 43 (2006), pp. 8-90

http://dx.doi.org/10.1086/504802 | Medline

[4.]

M. Saindou, C. Chidiac, P. Miailhes, et al.

Pneumococcal pneumonia in HIV-infected patients by antiretroviral therapy periods.

HIV Med, 9 (2008), pp. 7-203

[5.]

R.T. Heffernan, N.L. Barrett, K.M. Gallagher, et al.

Declining incidence of invasive Streptococcus pneumoniae infections among persons with AIDS in an era of highly active antiretroviral therapy, 1995-2000.

J Infect Dis, 191 (2005), pp. 45-2038

[6.]

D.R. Park, V.L. Sherbin, M.S. Goodman, et al.

The etiology of community-acquired pneumonia at an urban public hospital: influence of human Immunodeficiency virus infection and initial severity of illness.

J Infect Dis, 184 (2001), pp. 77-268

[7.]

C. Feldman, K.P. Klugman, V.L. Yu, et al.

Bacteraemic pneumococcal pneumonia: impact of HIV on clinical presentation and outcome.

J Infect, 55 (2007), pp. 35-125

[8.]

M.C. Rodriguez-Barradas, J. Goulet, S. Brown, et al.

Impact of pneumococcal vaccination on the Incidence of pneumonia by HIV infection status among patients enrolled in the Veterans Aging Cohort 5-Site Study.

Clin Infect Dis, 46 (2008), pp. 100-1093

[9.]

N. French, J. Nakiyingi, L.M. Carpenter, et al.

23-valent pneumococcal polysaccharide vaccine in HIV-1-infected Uganda adults: doble-blind, randomised and placebo controlled trial.

Lancet, 355 (2000), pp. 11-2106

[10.]

A. Curran, V. Falcó, M. Crespo, et al.

Bacterial pneumonia in HIVinfected patients: use of the pneumonia severity index and impact of current management on incidence, aetiology and outcome.

HIV Med, 9 (2008), pp. 15-609

[11.]

R.A. Corrêa, F.L.C. Lundgren, J.L. Pereira-Silva, et al.

Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes – 2009.

J Bras Pneumol, 35 (2009), pp. 574-601

Medline

[12.]

M.L. Metersky, A. Ma, P.M. Houck, D.W. Bratzler.

Antibiotics for bacteremic pneumonia: Improved outcomes with macrolides but not fluoroquinolones.

Chest, 131 (2007), pp. 73-466

[13.]

L.M. Baddour, V.L. Yu, K.P. Klugman, et al.

Combination antibiotic therapy lowers mortality among severely ill patients with pneumococcal bacteremia.

Am J Respir Crit Care Med, 170 (2004), pp. 4-440

http://dx.doi.org/10.1164/rccm.2404005 | Medline

[14.]

J.A. Martínez, J.P. Horcajada, M. Almela, et al.

Addition of a macrolide to a beta-lactam-based empirical antibiotic regimen is associated with lower in-hospital mortality for patients with bacteremic pneumococcal pneumonia.

Clin Infect Dis, 36 (2003), pp. 95-389

[15.]

M.I. Restrepo, E.M. Mortensen, G.W. Waterer, R.G. Wunderink, J.J. Coalson, A. Anzueto.

Impact of macrolide therapy on mortality for patients with severe sepsis due to pneumonia.

Eur Respir J, 33 (2009), pp. 9-153

Medline

[16.]

G.W. Amsden.

Anti-inflammatory effects of macrolides--an underappreciated benefit in the treatment of communityacquired respiratory tract infections and chronic inflammatory pulmonary conditions?.

J Antimicrob Chemother, 55 (2005), pp. 10-21

http://dx.doi.org/10.1093/jac/dkh519 | Medline

[17.]

O. Culić, V. Eraković, I. Cepelak, et al.

Azithromycin modulates neutrophil function and circulating inflammatory mediators in healthy human subjects.

Eur J Pharmacol, 450 (2002), pp. 89-277

[18.]

R. Anderson, H.C. Steel, R. Cockeran, et al.

Comparison of the effects of macrolides, amoxicillin, ceftriaxone, doxycycline, tobramycin and fluoroquinolones, on the production of pneumolysin by Streptococcus pneumoniae in vitro.

J Antimicrob Chemother, 60 (2007), pp. 8-1155

[19.]

M. Ellis, S. Gupta, S. Galant, et al.

Impaired neutrophil function in patients with AIDS or AIDS-related complex: a comprehensive evaluation.

J Infect Dis, 158 (1988), pp. 76-1268

[20.]

D.R. Kuritzkes.

Neutropenia Neutrophil Dysfunction, and Bacterial Infection in Patients with Human Immunodeficiency Virus Disease: The Role of Granulocyte Colony- Stimulating Factor.

Clin Infect Dis, 30 (2000), pp. 60-256

[21.]

D.L. Pitrak.

Apoptosis and its Role in Neutrophil Dysfunction in AIDS.

Oncologist, 2 (1997), pp. 4-121

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