Macrolides Superior to Beta-Lactams in Pediatric Community-Acquired Pneumonia

Pills in blister pack
Pills in blister pack
Macrolides, despite inferior anti-pneumococcal activity, are the most commonly prescribed antibiotic class for CAP in Children.
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SAN DIEGO — Macrolides are associated with lower treatment failure rates compared with beta-lactams in children diagnosed with community-acquired pneumonia (CAP), according to findings from a retrospective cohort study presented at IDWeek 2017.

“Guidelines recommend amoxicillin as first-line therapy for mild, CAP in healthy, immunized children because of its effectiveness against S pneumoniae,” according to the study’s lead investigator Lori Handy, MD, MSCE, of the division of infectious diseases at The Children’s Hospital of Philadelphia in Pennsylvania, and colleagues. Despite the effectiveness of this medication, macrolides represent the most common class of antibiotics prescribed for outpatient CAP.

A team of investigators performed a retrospective study that evaluated the use of antibiotics in 10,470 pediatric patients with CAP. The International Classification of Diseases, Ninth Revision, Clinical Modification codes, based on the World Health Organization’s classification system, was used to identify patients with CAP. Of the identified patients, 4459 (42.6%) received macrolides, 4252 (40.6%) were prescribed amoxicillin, and 1759 (16.8%) received broad-spectrum beta-lactams.

Treatment failure, defined as pediatrician-ordered antibiotic change, visit to the emergency department (ED), or hospitalization at 2 weeks after diagnosis, occurred in a total of 633 patients (6.1%). Of these, 418 required a pediatrician-ordered antibiotic change, 169 required a visit to the ED, and 47 patients required hospitalization.

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Following adjustment, investigators found that macrolides correlated with lower odds of treatment failure in patients younger than 5 (adjusted odds ratio [aOR]: 0.52; 95% CI, 0.34-0.78) and in children 5 or older (aOR: 0.32; 95% CI, 0.25-0.41) compared with beta-lactam antibiotics and amoxicillin monotherapy. This relationship continued to be observed in patients receiving the lowest macrolide doses (OR: 0.46; 95% CI, 0.23-0.92).

According to Dr. Handy and colleagues, the findings of macrolides representing a higher success rate than beta-lactams is likely attributed “to residual confounding by indication or changing epidemiology of outpatient pneumonia.”


Theoklis Zaoutis, MD, has received consulting fees from Astellas and nabriva, and research grant from Merck.

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Handy L, Gerber JS, Bryan M, Zaoutis T, Feemster K. Comparative effectiveness of beta-lactams versus azithromycin for treatment of outpatient pediatric community-acquired pneumonia. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Oral Abstract 84.