Clarithromycin for improved clinical outcomes in community-acquired pneumonia: A subgroup analysis of the ACCESS trial
Year: 2024
Type: article
Abstract: BACKGROUND: In the ACCESS trial, the addition of clarithromycin to standard-of-care antibiotics (SoC) enhanced early clinical response and attenuated the inflammatory burden in adults with community-acquired pneumonia (CAP) requiring hospitalisation. A post-hoc analysis was performed to investigate the benefit in specific subgroups. METHODS: The primary endpoint comprised two conditions to be met during the first 72 h: ≥50% decrease in respiratory symptom severity score; and any of ≥30% decrease in sequential organ failure assessment score and favourable change in the kinetics of procalcitonin (PCT, defined as ≥80% PCT decrease or PCT <0.25 ng/mL). In this exploratory post-hoc analysis, achievement of the study composite primary endpoint was compared between the two treatment groups within subsets differentiated by demographic characteristics, comorbidities, CAP severity, baseline laboratory findings and corticosteroid co-administration. The impact of clarithromycin treatment on the need for mechanical ventilation (MV) in all subgroups was also analysed. RESULTS: The addition of clarithromycin significantly increased the proportion of patients achieving the primary endpoint across all subgroups and decreased the need for MV in 19 out of the 37 subgroups studied. For instance, the primary endpoint was attained in 32.7% of placebo-treated patients and in 67% of clarithromycin-treated patients with CURB-65 score ≥2 (P<0.0001), whereas MV was required in 18.8% and 7.4% of patients, respectively (P=0.022). The addition of corticosteroids alone was not as clinically advantageous as the use of clarithromycin alone, when added to SoC. CONCLUSION: Adding clarithromycin to SoC in the ACCESS trial achieved early clinical anti-inflammatory responses and decreased the need for MV in subgroups of hospitalised patients with CAP.
Authors: Karolina Akinosoglou, Konstantinos Leventogiannis, Elisavet Tasouli, Nikolaos Kakavoulis, Georgios Niotis, Sarantia Doulou, Lamprini Skorda, Konstantina Iliopoulou, Anna Papailiou, Paraskevi Katsaounou, Vassiliki Rapti, George Chrysos, Theodoros Seferlis, Styliani Gerakari, Konstantina Dakou, Ilias C. Papanikolaou, Haralampos Milionis, Samantha Kewitz, Sara Georgiadou, Theano Kontopoulou, Vasiliki Tzavara, Antonio Torres, Michael S. Niederman, Evangelos J. Giamarellos-Bourboulis
Institutions: University of Patras, National and Kapodistrian University of Athens, Evangelismos Hospital, General Hospital of Athens G. Genimatas, Tzaneion General Hospital, Agia Olga Hospital, Hellenic Institute for the Study of Sepsis, Corfu General Clinic, University of Ioannina, University Hospital of Larissa, General Hospital of Larisa, Greece, Universitat de Barcelona, Weill Cornell Medicine, Weill Cornell Medical Center
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,280
OpenAlex ID: W4405098258