New CDC Recommendations for Management of Community-Acquired Pneumonia Include Macrolide Antibiotics as First-Line Therapy
Pneumococcal Drug-Resistance Prompts Evaluation of Treatment Regimens
ABBOTT PARK, Ill., May 24 /PRNewswire/ -- A report published in the May 22 issue of the Archives of Internal Medicine
outlined recommendations from a working group convened by the U.S. Centers for Disease Control and Prevention (CDC) for the management of community-acquired pneumonia (CAP) and the surveillance of drug-resistant Streptococcus pneumoniae.
According to the report, macrolide antibiotics, including clarithromycin (Biaxin©), and doxycycline, are favored for outpatient management of adults with community-acquired pneumonia. Additionally, the outpatient recommendations regarding macrolides are in line with those in guidelines issued by the Infectious Disease Society of America (IDSA) and the American Thoracic Society (ATS); both organizations include the use of macrolides as a first-line treatment option for uncomplicated CAP in adults with no underlying risk factors.
CDC recommendations favor macrolides for outpatient CAP therapy because of their broadened coverage against atypical
pathogens, particularly M. pneumoniae. Pneumonia treated on an outpatient basis is not generally life-threatening and high penicillin-resistant S. pneumoniae isolates are uncommon among these patients, therefore, activity against these type of pneumococci is not necessary for an initial regimen. Macrolide resistance of S. pneumoniae is common among penicillin-resistant strains and is often high when present. Although evidence of the clinical impact of macrolide resistance is limited, macrolides do not provide optimal coverage for pneumococci that are highly resistant to penicillin.
``Macrolide antibiotics are a potent and effective first-line treatment option for CAP in the otherwise healthy adult,'' said John Bartlett, M.D., chief, Division of Infectious Disease, Johns Hopkins University School of Medicine and participant in the CDC working group. ``Macrolides provide coverage against a broad spectrum of respiratory pathogens -- including atypical pathogens responsible for CAP, such as M. pneumoniae and C. pneumoniae.''
Prompted by reports of rising antimicrobial resistance, the CDC convened a panel of health and infectious disease experts -- the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group -- to formally identify suitable empiric antibiotic regimens for both outpatients and inpatients with community-acquired pneumonia and also recommendations for the surveillance of drug-resistant S. pneumoniae. Suitable regimens for first-line therapy of outpatient treatment of CAP include a macrolide (e.g., erythromycin, clarithromycin, or azithromycin), doxycycline (or tetracycline), or an oral beta-lactam with good
anti-pneumococcal activity (cefuroxime axetil, amoxicillin, or amoxicillin/clavulanate). An alternative regimen for selected patients is a fluoroquinolone with anti-pneumococcal activity (e.g., grepafloxacin, levofloxacin, or sparfloxacin).
In an effort to address concerns regarding the emergence of fluoroquinolone resistance, the CDC report also recommends that newer fluoroquinolone antibiotics should be reserved for selected adult patients who have failed treatment with a first-line agent, are allergic to alternative agents, or have documented infection with highly drug-resistant pneumococci.
``Concern over antimicrobial resistance, particularly penicillin-resistant pneumococci, has necessitated the development of the CDC report,'' said Bartlett. ``By outlining therapeutic protocols for CAP, the recommendations will help practitioners make appropriate treatment choices that may prolong the life span of anti-infective agents.''
CAP affects approximately two to three million Americans, results in 10 million physician visits and claims 45,000 lives each year, making it one of the leading causes of death from disease. While S. pneumoniae is responsible for approximately two-thirds of the cases of CAP, other causative pathogens include the atypical pathogens, C. pneumoniae and M. pneumoniae.
For people with mild to moderate community-acquired pneumonia, Biaxin© (clarithromycin) tablets offer proven efficacy. Biaxin has been proven effective in clinical trials of adult outpatients with community-acquired neumonia due to S. pneumoniae, M. pneumoniae or C. pneumoniae (TWAR).
Biaxin has a well-established safety profile; in adult respiratory clinical trials the most common adverse events were nausea, abnormal taste or diarrhea (3 percent), dyspepsia, abdominal pain or headache (2 percent). Biaxin is contraindicated in patients with a known hypersensitivity to clarithromycin, or any macrolide antibiotic. Concomitant administration with cisapride, pimozide, or terfenadine is contraindicated due to the potential for cardiac arrhythmias. Biaxin should not be used in pregnant women except in circumstances for which no alternative therapy is appropriate. Biaxin may elevate digoxin serum concentration. Serum digoxin levels should be carefully monitored while digoxin and clarithromycin are taken concomitantly.
Abbott Laboratories (NYSE: ABT - news) has a long history of leadership in anti-infectives dating back to the 1930s. Abbott was one of the five pioneers in the United States to start commercial production of penicillin. Years later, in conjunction with the research efforts of two other pharmaceutical companies, Abbott developed an early macrolide antibiotic. Abbott currently manufactures and markets Biaxin, which was introduced in 1991 and grew to become a market leader for the treatment of respiratory infections. In addition, Abbott markets a cephalosporin antibiotic and recently signed a global licensing agreement
with Wakunaga Pharmaceutical Co., Ltd., of Osaka, Japan, to develop and market two investigational anti-infective
compounds. Abbott's commitment continues today with extensive research to discover and develop new compounds in this area.
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