Ceftriaxone versus ceftriaxone plus a macrolide for community-acquired pneumonia in hospitalized patients with HIV/AIDS: a randomized controlled trial

January 31, 2018 at 11:25 pm

Clinical Microbiology and Infection February 2018 V.24 N.2 p146–151 

Figueiredo-Mello, P. Naucler, M.D. Negra, A.S. Levin

Objectives

To evaluate if treatment with ceftriaxone and a macrolide, improved patient outcome when compared with monotherapy with ceftriaxone, in hospitalized patients with human immunodeficiency virus/acquired immunodeficient syndrome (HIV/AIDS) with community-acquired pneumonia (CAP).

Methods

Adult patients with HIV hospitalized due to suspected CAP were randomized to receive one of two regimens, ceftriaxone plus macrolide or ceftriaxone plus placebo, at a 1:1 proportion (Brazilian Clinical Trials Registry: RBR-8wtq2b). The primary outcome was in-hospital mortality and the secondary outcomes were mortality within 14 days, need for vasoactive drugs, need for mechanical ventilation, time to clinical stability and length of hospitalization.

Results

A total of 227 patients were randomized, two were excluded after randomization; 225 patients were analysed (112 receiving ceftriaxone plus placebo and 113 receiving ceftriaxone plus macrolide). The frequency of the primary outcome, in-hospital mortality, was not statistically different between the regimens: 12/112 (11%) patients who received ceftriaxone plus placebo and 17/113 (15%) who received ceftriaxone plus macrolide died during hospitalization (hazard ratio 1.22, 95% CI 0.57–2.59). We did not find differences between the regimens for any of the secondary outcomes, including mortality within 14 days, which occurred in 5/112 (4%) patients with ceftriaxone plus placebo and in 12/113 (11%) patients with ceftriaxone plus macrolide (relative risk 2.38, 95% CI 0.87–6.53).

Conclusions

Among hospitalized patients with HIV/AIDS with CAP, treatment with ceftriaxone and a macrolide did not improve patient outcomes, when compared with ceftriaxone monotherapy.

abstract

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30332-4/fulltext

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30332-4/pdf

 

Entry filed under: Antimicrobianos, Bacterias, Bacteriemias, HIV/SIDA, HIV/SIDA Infecciones Oportunistas, HIV/SIDA Trastornos respiratorias, Infecciones respiratorias, Metodos diagnosticos, REPORTS, Resistencia bacteriana, Sepsis, Update.

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